COVID-19 Update: Read our messages to employees and clients

COVID-19 UPDATE
February 07, 2017
3 Ways to Put a Positive Spin on CPC+

Shared savings from the Comprehensive Primary Care (CPC) initiative’s second round are up. To be exact, the Centers for Medicare and Medicaid Services (CMS) report a total of $57.7 million in gross savings were generated in 2015 by 481 primary care practices serving more than 376,000 Medicare beneficiaries. Although three of the CPC regions had net losses, the savings generated in the other four regions covered those losses. Further, more than half of participating CPC practices will receive a share of over $13 million in earned shared savings.

The next step in the value-based primary care evolution is CPC+, which builds on the initiatives already in place. Here’s what you need to know.

Two tracks to choose from

Practices may participate in one of two CPC+ tracks. In Track 1, CMS will pay practices a monthly fee in addition to regular Medicare fee-for-service payments. In Track 2, practices will receive the monthly fee, plus a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments. Practices in Track 2 will provide more comprehensive services for patients with complex medical and behavioral health needs, including systematic assessment and support of psychosocial needs. Practices in both tracks will also receive prospective performance-based incentive payments that they will either keep or pay back to CMS, depending on their quality and utilization metrics. In addition, practices that participate in CPC+ may qualify for the additional incentive payments available for the Advanced Alternative Payment Models beginning in 2019. Allocating resources to three key strategies can help practices maximize savings and, therefore, practice revenues.

1. Support for serious or chronic diseases

Disease management treats a specific issue in isolation, whereas care coordination treats patients’ medical issues in the context of one another, thereby involving regular, ongoing care and, as needed, other healthcare professionals. The average Medicare patient sees between 3 and 11 physicians in a given year, and 69% have two or more chronic medical conditions — CPC+ seeks to join up providers and conditions through coordination efforts specifically relying on primary care.

The primary care provider (PCP) is responsible for establishing — in concordance with the patient’s wishes — goals of care and care priorities. The plan for chronic disease management will be rooted in the decisions that meet the patient’s psychosocial and everyday needs. This plan should be periodically reviewed and revised, particularly when some aspect of the patient’s condition or life changes. For example, medication levels may be re-adjusted as the patient’s condition improves; or, for example, if the patient’s daily life changes due to having to provide care for a loved one. Strategies for the patient’s own self-care must be explored and developed.

2. Improved information exchange

Even the best patient documentation in the world is useless if access to information is difficult. Regular communication is necessary to flag up changes in the patient’s conditions. Communication must occur between the patient and PCP; and between PCP and other primary and specialist providers (e.g., dietitian, psychologist, cardiologist, diabetologist). Opening lines of communication is essential, and that means data-sharing.

Data management capabilities and information reliability make the coordination of information flow possible. Electronic health record (EHR) interoperability lies at the core of collaborative care; therefore, the creation of thorough patient documentation in the EHR can be strongly supported by using certified medical scribes. In addition to ensuring your EHR system works with those of other providers, sharing claims data with other providers can help them better understand what kinds of care are being provided. Thus they can respond in the context of multiple chronic illnesses, even those not in their specialty, and providers can use the shared information to collaborate to initiate preventive care efforts.

Sharing thorough and complete patient documentation can help providers further collaborate by developing clinical pathways — which involves setting standards and efficient paths of care. As a bonus, such efforts benefit the patient and reduce duplicative and unwarranted care resulting in reduced costs.

3. Integrate the patient and family in the care team

Patient care can be seen as a machine that requires many people to coordinate numerous moving parts — the motor of this machine is run by patients and their families. Thus, the PCP should provide them with links to community resources, tools for supporting and empowering self-management and family/carer involvement, and easy, 24-hour access to patient information.

The EHR is the melting pot of information on managing the patient’s care and serves as the foundation for empowering the patient to understand and manage their conditions. Primary care practices should create an online patient portal that gives patients access to all elements of their care plan and helps them manage their conditions. The portal should let patients to:

  • Request/book appointments
  • View test results and summaries of assessments
  • Correspond with clinicians in a secure manner
  • Send prescription-refill requests to clinician and/or pharmacy
  • Access educational materials relevant to their diagnosis and medical condition
  • Schedule e-visits and attend a clinical visit virtually
  • Allow portability of the EHR
  • View all staff who support and are involved in their care

The portal should be user-friendly, with an intuitive search function and perhaps even mobile-friendly.

“We see CPC+ as the future of primary care in the U.S. and are pleased to partner with payers across the country that are aligned in this mission to transform our health care system,” says Dr. Patrick Conway, CMS deputy administrator and chief medical officer. “This model allows primary care practices to focus on what they care about most — serving their patients’ needs when and how they choose.”

Nurse Care Team Assistants
While nurses comprise the largest healthcare workforce, many suffer in silence from burnout and decreased job satisfaction. Our Nurse CTAs combat burnout with strategic support. From documenting patient encounters to monitoring vital signs, CTAs ensure nurses work top-of-license. CTAs close critical gaps in the care continuum and provide nurses with the added bandwidth to focus on critical care.

LEARN MORE AT CARETHROUGH.COM
TeleScribe Services
Providers with limited space or in need of increased privacy on behalf of their patients have valuable documentation support through our real-time video TeleScribe program. Healthcare sites in rural settings also benefit from our unrivaled offsite resource for optimized efficiency and tackling administrative burdens.

LEARN MORE AT SCRIBEAMERICA.COM
Care Team Assistants
Our team of experts have developed innovative strategies from the industry insights gained from nearly two decades of healtchare leadership to improve care team performance. A tailored, next-generation CTA Program extends your ability to support patients throughout their care journey.

LEARN MORE AT SCRIBEAMERICA.COM
Care Navigators
As healthcare business models evolve, so should care teams. Patients who are paired with Care Navigators report feeling less anxiety, and an increased ability to self-manage their conditions between visits. And providers report increased job satisfaction from improved efficiency, and knowing their patients have access to care teams, and strategic support.

LEARN MORE AT CARETHROUGH.COM
Scribe Services
There’s a reason why we’re the nation’s most frequently used scribe company: we offer professionally trained in-person and virtual medical scribes to meet the specific needs of our clients. We offer a variety of scribe programs, as well as technology and personnel solutions that address revenue cycle management, the transition to value-based care, and more through our HealthChannels family of companies.

LEARN MORE AT SCRIBEAMERICA.COM
Artificial Intelligence
Our advanced AI solutions tackle complex documentation challenges to reduce the administrative burden preventing doctors from delivering precision care. We'll guide you through the best practices for incorporating AI into your workflow. Gain visibility into your data with enhanced analytics driven by AI and CTAs.

LEARN MORE AT SOUNDLINES.COM