Prevention: Results

Value-based care has strong showing in prevention

Telehealth and wellness have enhanced patient well-being

Amid an ever-changing and evolving healthcare system, prevention remains the foundation of patient well-being.

As pandemic restrictions eased, patients migrated largely back to physicians’ offices in 2021. Challenges persisted for many, though, that led value-based care practices nationwide to further prioritize efforts to connect with patients still struggling with access and to bolster equitable care delivery.

Telehealth continued to offer a pathway for virtual visits. Some physician practices expanded provider-supplied transportation to shuttle patients to and from medical appointments and some even deployed mobile clinics to bring care closer to their patients. Many practices intensified patient outreach and follow-up through integrated care teams to help understand and overcome hurdles to well-being.

Those actions were evident and impactful, as Humana MA individual members affiliated with value-based physicians outperformed those in non-value-based settings in all Healthcare Effectiveness Data and Information Set (HEDIS®) preventive screenings and adherence measures in 2021. Screenings were generally between 6% and 19% higher for the value-based cohort compared to non-value-based, with the largest gap in controlling blood sugar.1

Those resulted in a 35% and a full-Star difference in the HEDIS average Stars rating for preventive screenings: 4.2 Stars for value-based vs. 3.1 Stars non-value-based. The patient safety average Stars rating was 3.1 for value-based vs. 3.0 for non-value-based.

Those combined for a 2021 average overall Stars score for value-based providers of 4.0 vs. 2.92 for non-value-based.

“One of the things value-based programs do is get you more into interdisciplinary medicine,” says Dr. Laura Scott, executive vice president of population health for Summit Health that serves the New York-New Jersey area. “You get more resources to support the provider in a way that, maybe in a small group or outside a value-based arrangement they can’t afford to do… they have better visibility of who’s not doing things we know keep them healthy and prevent expenses down the road.”

“That means,” Dr. Laura says, “pinpointing open care gaps, tracking upcoming appointments and ensuring patients receive Annual Wellness Visits (AWVs).” To the latter, which help physicians detail care regimens for the near- and long-term, 47% of value-based Humana MA members received an AWV in 2021, compared to just 33% of non-value-based members.

One of the things value-based programs do is get you more into interdisciplinary medicine
Dr. Laura Scott

Why it matters

Value-based practices attribute much of their care delivery success to creating holistic views of their patients and to the effectiveness of their teams to coordinate with each other and communicate with patients. That means going beyond simply understanding what physically ails patients to identifying not-so-obvious factors negatively impacting well-being and determining how to appropriately address them.

“Seniors have unique clinical needs when compared to the rest of the population,” says Dr. Vivek Garg, Chief Medical Officer for Humana’s primary care organization that operates CenterWell™ and Conviva clinics and cares for about 110,000 Humana MA members with a value-based approach.*

“Our senior-focused primary care model is a holistic approach to healthcare, giving our patients access to a physician, nurse, social worker, pharmacist and behavioral therapist. Together, our team monitors and addresses factors that may have a major impact on the patient's health. Preventative care reduces the risk of health issues and empowers patients to improve their health and quality of life.”

The way forward

Summit Health, for example, is scrutinizing its organizational structure and workflows to better facilitate care team collaboration. They’re examining schedules and requirements to build-in time during the day for primary care providers to huddle with their teams to review key dashboards.

“We’ve taken the approach for providers to know their numbers: their sick patients, are they getting admitted and what are we doing to address those things,” Scott says. “It’s a different approach on knowing your numbers related to your own team and the patients you take care of.”

Tackling new approaches to care delivery meant incorporating team-based care at UC Health Coordinated Care Colorado. The organization is piloting an RN-led AWV program with RN care managers performing annual wellness visits under the PCP’s supervision. Care managers are ideally suited for this work, as they can identify high-risk patients for outreach, perform their Annual Wellness Visits, help them move through the health system effectively and better manage their care experience.

“These new care teams use clinical registries to hone in on the most-complex patients, and by integrating claims data into the electronic health records system, they are also aware of any visits to the hospital or ED outside of their home system,” says Dr. Amy Scanlan, UC Health’s Medical Director. She goes on to explain that “Being able to provide meaningful insights to clinicians at the point of care makes a significant difference in shifting to value.”

Summit Health, for example, is scrutinizing its organizational structure and workflows to better facilitate care team collaboration. They’re examining schedules and requirements to build-in time during the day for primary care providers to huddle with their teams to review key dashboards.

“We’ve taken the approach for providers to know their numbers: their sick patients, are they getting admitted and what are we doing to address those things,” Scott says. “It’s a different approach on knowing your numbers related to your own team and the patients you take care of.”

Tackling new approaches to care delivery meant incorporating team-based care at UC Health Coordinated Care Colorado. The organization is piloting an RN-led AWV program with RN care managers performing annual wellness visits under the PCP’s supervision. Care managers are ideally suited for this work, as they can identify high-risk patients for outreach, perform their Annual Wellness Visits, help them move through the health system effectively and better manage their care experience.

“These new care teams use clinical registries to hone in on the most-complex patients, and by integrating claims data into the electronic health records system, they are also aware of any visits to the hospital or ED outside of their home system,” says Dr. Amy Scanlan, UC Health’s Medical Director. She goes on to explain that “Being able to provide meaningful insights to clinicians at the point of care makes a significant difference in shifting to value.”

*CenterWell™ and Conviva primary care clinics are payer-agnostic and treat patients with MA coverage from other payers as well as Original Medicare.

Source

  1. Humana internal data.

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