5 TACTICS VBC ORGANIZATIONS CAN TAKE TO ENGAGE THEIR PRIMARY CARE NETWORKS
It’s no secret that value-based care organizations (VBCs) that activate and engage their primary care physicians (PCPs) and networks are finding success.
Accountable care organizations (ACOs) and direct contracting entities (DCEs) that put PCPs in the center of their value-based care management model recognize the downstream value. Why? Because PCPs hold the key to influencing patient health through engagement and experience. They manage chronic disease and refer specialized care needs. Properly leveraging PCPs is a key area where VBC organizations can thrive or suffer.
February 8, 2022
Based on data from the 2020 MSSP Performance Results, a recent report shows that PCP visits per 1k were a key ACO success metric. But PCP engagement is still a struggle for most ACOs. The Centers for Medicare & Medicaid Services (CMS) announced a slight uptick in ACOs participating in the 2022 Medicare Shared Savings Program (MSSP). To many, this news is disappointing and shows that more work is needed to support value-based care organizations. Meanwhile, CMS once again readies to announce more DCE participants. The stakes are high to engage PCPs, but what does that look like?
Integrated Care Solutions (ICS) pulled together many collective years of experience in clinical, operational, and regulatory management to offer five tactics ACOs and DCEs can use to engage their primary care networks.
No. 1—Provide Well-Defined ‘Why’ & Goals
Establishing goals begins by answering, “What’s in it for the primary care network?” And then defining “why value” in conversations with them.
Need-to-Know
90% of physicians want to know how VBC will impact quality care, daily life, and compensation.
Begin by framing the conversation around value: Don’t worry about every dollar-by-dollar in quality score. Focus on quality metrics that the physician has agreed upon—and that data supports—and those better outcomes will lead to new revenue.
Have a plan. It is vital to tell individuals what is required to succeed.
“If you do not have well-defined goals backed by data, you aren’t setting yourself up for success.”
—Brian Fuller, ICS CEO
Check off the following as you define goals:
- What are your overarching goals?
- How are PCPs measured against current goals?
- What are realistic targets to improve performance?
- Provide regular updates, including mitigation planning for below-target performers.
No. 2—Build Out Data Sets to Support Goals
Attaining good data requires a third-party partnership in analytics or an internal infrastructure to analyze claims data and clinical information.
“It starts with using technology to gather insights from a data stack. Data delivers insights into what’s happening among a population’s health, uncovers opportunities for improvement, and targets initiatives that impact patient care.”
—Kristen Croke, ICS’ Director of Project Management
Take meaningful action: Allow PCPs to leverage data to adjust to real-time patients’ needs.
No. 3—Provide Education and Tools
Make sure to answer the question, “Besides analytics, what education and tools can you provide to help PCPs achieve joint goals?”
Provide context:
“For example, show—don’t tell. If you walk up to a physician and ask them to improve their risk-adjustment coding, they won’t know what that means. Instead, educate and provide context—especially if you represent an ACO or DCE. Explain and share examples of how risk-adjustment work will impact the potential revenue on the fee-for-service side and benchmarks needed to get into shared savings models and revenue streams that come with it.”
—Fuller
Several automation tools can support PCPs. Start by addressing the following:
- Care gap closures
- Risk-adjustment opportunities
- General outpatient care management
No. 4—Improve Physician to Physician Communication
Build trust within the network by empowering physicians to be the champions of value. Rarely does it work when an administrator or executive takes on that role.
“Physicians want to hear from their peers.”
—Andrea Rizik, MS, BSN, RN, ICS Vice President of Clinical Integration and Clinical Operations
Identify at least one physician champion in the network who will carry the value message and confidently explain why it matters to their colleagues.
No. 5—Establish the Legal Framework
Answer the question, “What kind of contractual relationship do you have with the primary care network?
Can you check off the following?
- What does your relationship look like legally?
- Is the PCP network part of your ACO or DCE?
- Are they a downstream partner to your risk?
- How is your relationship governed?
- Does the contract include performance metrics and outline aligned goals?
Need-to-Know
The legal framework is critical. Having the right agreements in these relationships really matters.
Let ICS be the Guide
One of the capabilities ICS brings to partners is the ability to help organizations succeed in value. ICS meets value-based organizations on their journey.
“We are not in the practice of practice transformation. ICS meets ACOs, DCEs, and their primary care networks on their journey—whether new to value or seasoned. Then we guide them on the path to improving the patient experience and reducing total cost-of-care.”
—Ajay Singh, Vice President of Strategic Growth
If you are an ACO or DCE interested in engaging your primary care network or in need of a partner with expertise in value-based care and proven results working with risk-bearing organizations, contact ICS today for a free consultation.
Additional Resources
ICS helps organizations transform from fee-for-service to value-based care and delivers ongoing care coordination, consulting, and expertise in data-driven processes necessary to achieve quality care and financial success. info@integratedcaresolutions.com
860-622-7645
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