Busy primary care provider (PCP) practices need much more than an EMR and payer reports to thrive in a value-based care (VBC) environment. Physician practices and payers have begun the journey of transforming from fee-for-service business processes to VBC processes. As this fundamental change process matures, organizations will need more than analytic tools and reports to realize the full potential that VBC approaches represent to improve health outcomes and patient satisfaction and ultimately lower costs.
Primary care practices, in particular, need integrated processes and management systems across their operations that include clinical, operational, consumer and financial data analytic capabilities in order to effectively manage the business of healthcare while continuing to focus on delivering patient-centered care.
Many mid-to-large sized provider organizations that are transitioning to advanced, higher risk VBC models are faced with a stark reality: most payers do not have the care delivery expertise, the clinical population health processes, or the technology to truly support provider collaborations. The result is a large gap in data and/or actionable insights provided by payers to their provider partners who are managing patient care.
The typical resources provided by payers are very fragmented and difficult to integrate into provider operations:
- VBC Scorecard—fairly basic without context and usually delivered late with an already significant lag in timing means the data is not actionable in meaningful ways.
- Lots of lists—Quality, Risk, and other member lists are often ran at different intervals, on disparate tools, with data variations and sometimes conflicting results. The list overload is a real issue with providers who struggle to integrate it into their core workflow.
- Raw data—data dumps of core data that are high latency, contain data quality issues and are near impossible to tie directly to scorecards.
In exclusive multi-product or multi-payer/multi-product VBC frameworks, this environment creates real challenges—even for the most sophisticated and highest performing providers. Trying to manage all the variations in VBC design and the gaps in completeness, timeliness, and accuracy of data and analytics puts real pressure on busy care delivery organizations.
Providers who are in VBC partnerships with multiple payers have the additional burden of working with different technology solutions and processes since no two payers are ever alike, which limits the ability to simplify and scale processes.
Lucerna Health believes there is a better way to integrate and empower busy providers to succeed in VBC models through an end-to-end VBC operating system:
Deep data integration—close to real-time data integration of eligibility, medical and pharmacy claims, care management, contact center, consumer and other data from payers with the provider’s EMR.
More than VBC scorecards—comprehensive VBC program analytics and reporting that supports up front contract design and execution, ongoing opportunity analysis, forecasting and final reconciliation.
True EMR integration of analytics—patient profiles generated daily including risk, clinical, utilization, and contact information leading to prioritized patient registries embedded within EMR operational flows such as scheduling, referral management, program assignment and point of care.
Patient engagement models that work—sophisticated and automated patient campaigns designed to drive patient actions which are aligned to cost efficiency and quality outcome parameters of VBC model.