December 16, 2021

Best-in-Class Attributes of Provider Performance Management

Tanya Travers

Best-in-Class Attributes of Provider Performance Management

Providers’ commitment to quality, excellence, innovation and safety requires more focus with every new NCQA measure or Medicare reform. In the context of shared risk payment models increasingly adopted by payors and providers, incomplete or poor performance against measures can mean the sacrifice of millions of dollars.

Underfunded value-based care (VBC) contracts cost one of our clients approximately $10 million a year. Out of a population of 75,000 patients in the care of 500 physicians, 65,000 were under-coded. And the number of under-coded patients were growing by 30% year-over-year.

To address inadequate VBC arrangements, we have defined some best-in-class practices by which providers improve their bargaining position by optimizing performance.

Acknowledge gaps in data. Especially with wellness visits, cancer screenings and other preventive care postponed due to the pandemic, providers should assume their patient profiles are missing important health and social determinant of health information.

Align as an organization on data capture approaches. In pre-visit clinical preparation, care teams can develop a protocol to collect data through lab tests, direct questioning, surveys and observation. Key to their success is the availability of health plan data and a mechanism to incorporate it into the EHR to inform the drivers for gaps in care and low-quality scores — medication adherence, physician follow-up, etc.

Leverage data across silos. Because providers deal with multiple payors, even sophisticated data on a proprietary health plan portal may be neglected by providers because they need to replicate the download of quality reports, gap analysis and more from a number of portals.

Manage key performance indicators and identify opportunities for performance improvement. When a patient has missed routine care or shows signs of rising risk for a chronic condition, providers need to intervene in a timely manner, when action will support the best outcome.

Consult peer-to-peer and risk-adjusted benchmarks. In a panel matching peers within the same network or region, create benchmarks for care per risk-adjusted factor. Providers’ understanding of their patients’ risk scores in the context of benchmarks enables priority setting and resource allocation to drive performance improvement.

Act on insights. Whether data analytics are simple or complex, if providers fail to respond to the results, they miss out on the value of their data governance effort and performance improvement opportunity.

To develop comprehensive patient profiles with actionable insights for intervention, assessment and VBC, health systems can partner with an advanced analytics solution provider like Gray Matter Analytics with the capability to ingest, integrate and transform data from disparate sources — clinical, claims and patient experience data, etc. Advanced analytics can yield insights to support increased care quality, health equity, chronic condition prevention and Medicare or payor reimbursements.
To learn more about how advanced analytics can generate actionable insights for improved provider performance, watch our ACAP webinar on demand.