How small practices are succeeding with value-based payment models
The transition from fee-for-service to value-based reimbursement is having a financial impact on all providers, but smaller practices in particular face stiff challenges as they try to improve care while reducing costs.
Smaller practices can be constrained by limited staff, technological and financial resources, making it difficult to achieve economies of scale or to ferret out unnecessary costs and waste.
Fortunately, seismic change also can present opportunities for small practices. Healthcare Finance News Associate Editor Jeff Lagasse writes about the options available to smaller practices to help them embrace the new economic model.
Oklahoma-based Utica Park Clinic entered into a data-sharing agreement with medical groups and payers, Lagasse writes, giving the clinic access to patient registries that revealed care gaps and identified Medicare patients who weren’t coming in enough for preventive care.
Utica Park Clinic’s Jeffrey Galles tells Lagasse, “There's a substantial amount of revenue associated with Medicare wellness visits, and there are a lot of patients who haven't been educated about the value of these visits."
Indeed, improving patient engagement is another strategy that smaller providers can pursue to remain competitive and ensure a stable revenue stream. Technology enables providers to engage with patients in a number of ways, such as electronic outreach to high-risk patients, creation of wellness programs, monitoring devices, web portals, and more.
If there is one prerequisite for a successful transition to value-based care, it’s having an internal champion who creates a vision and triggers a culture change.
Karen Handmaker, vice president of population health strategies at Phytel, tells Lagasse, “There are examples of very charismatic and very passionate people who have done amazing things by the power of their personality, their management style, how they engage with patients, how they use the resources they do have at hand to engage and stay with them. It becomes almost personal in a different way than it would be if you were part of a very large practice."
One way for smaller practices to compensate for lack of resources is to join or collaborate with a network of practices. Sharing data not only lets small practices assess their performance measures against peers, it also enables better population health and management of at-risk patients – a critical, pre-emptive way to avoid more expensive acute care or hospitalization.
"I don't think anybody can operate 100 percent alone," Handmaker tells HFN, “The small practices can still stay independent, but will still need to figure out how to collaborate with their colleagues in their communities. A large part of the intent of value-based care is to push care out into the community and make care something that happens in a collaborative way."
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