Chief Strategy Officer
Hallmarks of the post-Affordable Care Act era are a significant shift toward value-based and risk-sharing contracts. The leader of the reimbursement pack, the Centers for Medicare & Medicaid Services (CMS), has moved aggressively in the direction of value based reimbursement arrangements with providers. To provide some perspective, in 2011, no Medicare payments were delivered under risk arrangements. In less than five years, Medicare has achieved its target of making 30 percent of payments risk-based and it is on track to meet its goal of 50 percent by 2018.
Payers, too, have embraced risk-sharing contracts with hospitals, physicians and other providers. More than 825 accountable care organizations (ACOs) have been created, and currently are serving 28 million Americans. Nearly all payers surveyed for a Deloitte 2015 Study of Medicare Advantage Health Plans and Providers said they have some type of value-based arrangements in place. As a result, payers, hospitals and physicians are more closely aligned with shared goals of improving healthcare quality and cost. All have higher expectations about the ability of data and analytics to help providers guide behavior and decisions that result in shared savings and improved patient health and satisfaction. More than payers and hospitals, physicians – who are on the frontlines of delivering patient care and therefore are critical to the success of all value-based contracts – have mixed feelings about data and analytics. Undoubtedly, many physicians have had challenging experiences with electronic health records (EHRs), which have colored their view of technology in healthcare. In 2015, Geneia conducted a nationwide survey of400 physicians who practice medicine full time, and found:
- 84 percent of physicians said the amount of quality time they are able to spend with patients has decreased in the last 10 years,
- An overwhelming majority – 87 percent – said that the “business and regulation of healthcare” has changed the practice of medicine for the worse, and
- Overall, the nationwide Physician Misery Index was 3.7 out of 5, indicating that the scales have tipped from satisfaction to misery.
The survey also asked physicians their impression of the impact data and analytics tools have had on medicine. The results were more positive than expected. Nearly 60 percent, for example, felt data and analytics helped identify and triage the highestneed patients and created greater efficiencies in office workflow. Physician sentiment towards technology is surprisingly nuanced. Doctors indicated data and analytics tools have the potential to reduce recordkeeping time, one of their primary frustrations, while also contributing to it. The bottom line: physicians will actively engage in the success of value-based contracts only if they are confident the technology will help them effectively and efficiently support and care for the health of their population and – at a minimum – not interfere with meaningful patient relationships. The Theon® advanced analytics platform does just this. It integrates clinical information such as diagnoses, prescriptions and lab results with medical and pharmacy claims so physicians can readily identify and stratify their attributed members into cohorts such as:
- The Healthy, with the goal of keeping them that way
- The At-Risk, with the goal of preventing or delaying progression to chronic disease
- The Chronically Ill, with the goal of slowing or halting disease progression
The Theon® platform goes further by applying consumer-engagement modules like the Propensity to Engage to the stratified population. This allows physicians to readily determine not only their attributed patients who are highest risk and/or the highest utilizers, but also those who are most likely follow a disease-management plan. Rather than dedicating limited patient time to all diabetic patients, for example, physicians are able to use Geneia’s advanced analytics solution to identify those patients most likely to follow a care plan to improve their health and focus resources on this group.
Once physicians determine their highest-impact patients – those at risk who are also most likely to engage in making changes to improve their health – the Theon® platform offers additional consumer engagement modules to help determine the type of messages most likely to resonate. The Next Best Action for Outreach helps physicians and their care teams decide the most appropriate communication vehicle for individualized patient engagement. As studies have shown, some patients respond well to text reminders while others are more likely to change their behavior following an in-person visit with their physician.
Advanced analytics and insight tools like the Theon® platform offer physicians the very real possibility of creating more time for meaningful relationships with their highest impact patients, thereby addressing one of the primary causes of physician dissatisfaction. This can increase physician engagement in using advanced analytics tools and ultimately lead to better health outcomes and more successful value-based contract arrangements for payers and providers alike.