Increase patient population and improve quality - the two key factors in value-based care: Huma Farman Khan

Discover the importance of attribution management and quality metrics in healthcare. #valuebasedcare #healthcare"

The Significance of Attribution Management

Attribution management is a critical component of value-based care. It involves ensuring that patients are correctly attributed to the appropriate healthcare providers. Failure to manage attribution can lead to inaccurate assessments of quality, risk, and cost. For example, if a patient is attributed to a primary care doctor they have not seen in years or to a specialist who did not perform a specific procedure, the quality and cost metrics associated with that patient will be skewed. It is essential to actively manage this process to ensure accurate attribution and to engage with patients who may have been overlooked or have not been seen in a while.

Strategies for Attribution Management

There are two primary strategies for managing attribution: taking back the patient or disputing the attribution. Taking back the patient involves actively engaging with them and providing the necessary care to improve their quality, risk, and overall outcomes. Disputing the attribution requires a formal process to challenge the incorrect attribution and ensure that the patient is correctly aligned with the appropriate provider. Ignoring incorrect attribution or failing to engage with unseen populations will negatively impact your metrics and relationships with payer partners. It is crucial to actively manage attribution to improve patient care and enhance the value of the services.

Understanding Attribution Methods

There are several attribution methods used in healthcare, each with its own advantages and considerations. Plurality of care is an attribution method where the provider who sees the patient most frequently is considered their primary care provider (PCP). Medicare utilizes a voluntary alignment process where patients choose their PCP, while commercial insurers and Medicaid require patients to select a PCP. Geo-attribution assigns patients to providers based on their location or region, while prospective attribution assigns a specific population to a provider. Retrospective attribution looks back at the patients a provider has seen. It is essential to understand the attribution method used in a certain practice and how it impacts the metrics and patient care.

The Role of EMR and Payer Attribution

Electronic medical records (EMRs) and payer attribution play a significant role in managing attribution and improving quality. While EMRs allow providers to track patient visits and bill for services, payer attribution may only consider specific bills or encounters. It is crucial to initiate the revenue cycle management process to ensure accurate attribution. Additionally, EMRs can serve as a guide to identify patients who should be engaged and brought back into the attribution process. Leveraging EMRs to improve overall cost of care, quality, and risk is not only beneficial for metrics but also for providing excellent patient care.

Defining Provider Rosters and Hierarchy

Defining provider rosters and hierarchy is essential for accurate attribution and understanding who is responsible for each patient. It is crucial to align the provider roster and hierarchy with payer attribution to avoid discrepancies. Utilizing EMRs and designating a usual provider in the system can help clarify responsibility and ensure accurate attribution. While the tin level is generally reliable, it is beneficial to use individual provider-level attribution in conjunction with EMRs to guide the process and engage providers. By defining the responsibility and ownership of patients, practice can improve care coordination and enhance the overall value of care.

Understanding Quality Metrics

Quality metrics are a fundamental aspect of value-based care. They are typically measured as a percentage, with a numerator representing the population that meets the metric's criteria and a denominator representing the eligible population minus exclusions. While most quality metrics are percentage-based, some metrics may fall into other categories. It is crucial to understand the specific game of each quality metric and how it relates to patient care. Primary care functions such as well visits are typically measured as quality metrics, while specialists have their own set of metrics related to their respective areas of expertise. Some metrics, such as colonoscopies, may fall into a gray area and require collaboration between providers to ensure accurate attribution and optimal outcomes.

Optimizing Process Improvement for Quality Metrics

Process improvement is a key component of optimizing quality metrics. Lean Six Sigma, a methodology that focuses on defining, measuring, analyzing, improving, and controlling processes, can be a valuable tool in this regard. By using Lean Six Sigma principles, providers can identify root causes, increase problem-solving efficiency, and achieve significant improvements in quality metrics. It is crucial to understand the specific component of each quality metric and apply appropriate process improvement strategies to enhance outcomes. As the healthcare landscape becomes increasingly competitive, mastering these methodologies will be essential for success.

Monitoring and Predicting Quality Metrics

Monitoring quality metrics is essential for tracking progress and identifying areas for improvement. It is not enough to focus solely on the current numbers; understanding the trends and patterns over time is crucial. Some metrics may have an inverse relationship with time, while others may have a linear or logarithmic relationship. By conducting regression analyses and predicting future outcomes, providers can proactively address gaps and work towards achieving their goals. Monitoring quality metrics allows for continuous improvement and ensures that quality remains everyone's responsibility.

Conclusion and Future Outlook

In conclusion, understanding the value of value-based care requires a comprehensive approach that encompasses quality and attribution management. By actively managing attribution, providers can ensure accurate alignment and engage with patients to improve outcomes. Leveraging EMRs and payer attribution can enhance the accuracy of metrics and provide better patient care. Defining provider rosters and hierarchy is crucial for accountability and coordination. Process improvement methodologies such as Lean Six Sigma can drive significant improvements in quality metrics. Monitoring and predicting quality metrics allows for continuous improvement and ensures that quality remains a top priority.

As we look to the future, the game of value-based care will become increasingly challenging. Practices and Organizations must stay informed, adapt to changing metrics, and continue to prioritize patient care. By embracing process improvement methodologies and leveraging technology, providers can navigate the evolving landscape and deliver high-value care to their patients. Remember, you cannot improve what you do not measure. Let us continue to work together to make patients better and drive positive change in healthcare.

Happy Learning!

Ref: Insights from Dr Dan Fabius webinar on Attribution and Quality https://lnkd.in/en4aVp6F