|By Leventhal, Rajiv|
ESSENCE HEALTHCARE IS ACCOMPLISHING HEALTHCARE'S TRIPLE AIM 'PLUS ONE' BY
As reimbursement cuts and other payment changes put intensifying pressure on physicians and medical groups, accountable care offers new opportunities for collaboration between payers and providers. Over the last decade, health insurers across the country have been practicing aspects of accountable care through the collaborative payer model, a care delivery innovation jointly developed by a payer and provider in which operational support tools, information, and technology help manage patient populations.
Essence was an early adopter of the cloudbased accountable delivery system platform (ADSP) from
DATA ACROSS THE CARE CONTINUUM
Via the ADSP, Essence pinpoints opportunities for improvement in these areas and then engages primary care physicians in the network to address them via a host of webbased platform applications and tools. There are more than 150 quality metrics in the platform, including the 33 metrics that are part of the Medicare Shared Savings Program (MSSP) accountable care organization (ACO), Healthcare Effectiveness Data and Information Set (HEDIS),
According to Zimmerman, ADSP aggregates and analyzes data from across the continuum of care-including electronic medical record (EMR) encounters, claims, pharmacy, lab, and other available data. It rationalizes that data to establish a unified, accurate view of patient care and population health, she explains.
"As CMO of Essence, I use the ADSP every day to evaluate performance on quality, cost and utilization measures, and look for both clinical and financial improvement opportunities," Zimmerman says. "My care managers use the platform to manage high-risk patients and close gaps in care. My director of quality improvement uses the platform to monitor performance on quality metrics. Our networked physicians use the ADSP to manage the health of their patients to view care reminders to close gaps in care, as well as to stratify their patient populations by needed interventions, outreach score and disease state."
PHYSICIAN EMPOWERMENT PAYS OFF
The underlying key to success, says Zimmerman, is physician engagement and satisfaction, something that she strives for as Lumeris' CMO. "Through the right incentives, tools and information, we empower physicians to change their behavior and make better-informed, value-based decisions. The results that we've achieved with
In terms of cost, Essence has seen a 30-percent reduction in cost when compared to fee-for-service
While accountable care involves risk and reward sharing, and is a departure from the feefor-service, volume-based care that the industry is used to, Zimmerman believes it is truly the nation's best hope for achieving better health outcomes, lower costs, and improved patient plus physician satisfaction. "As the market evolves from fee-for-service to value-based care, [we are] helping providers assume more risk for managing their patients and populations," she says. "And [to do that], technology-enabled solutions [are needed] to solve some of the industry's biggest challenges."
THROUGH THE RIGHT INCENTIVES, TOOLS AND INFORMATION, WE EMPOWER PHYSICIANS TO CHANGE THEIR BEHAVIOR AND MAKE BETTER-INFORMED, VALUE-BASED DECISIONS. -
|Copyright:||(c) 2014 Vendome Group LLC|
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