What are value-based care programs?

The move toward value-based care began in 2008 with the passage of the Medicare Improvements for Patients & Providers Act (MIPPA). Ten years later, in 2018, there are a number of value-based programs designed to reward healthcare providers for the quality of their care rather than the number of patient visits.

The Centers for Medicare & Medicaid Services (CMS) states that its value-based programs support their three-part aim of:

  • Better care for individuals
  • Better health for populations
  • Lower cost

The five original value-based programs had as their goal the linking of provider performance of quality measures to provider payment:

  • End-Stage Renal Disease Quality Incentive Program (ESRD QIP)
  • Hospital Value-Based Purchasing (HVBP) Program
  • Hospital Readmission Reduction (HRR) Program
  • Value Modifier (VM) Program (also called the Physician Value-Based Modifier or PVBM)
  • Hospital Acquired Conditions (HAC) Reduction Program

In further promoting the goal of providing quality care to patients, increasing the focus on value-based care over the frequency of patient visits, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) created a Quality Payment Program (QPP). The QPP:

  • Changes the way that Medicare rewards clinicians for value over volume
  • Streamlines multiple quality programs under the new Merit Based Incentive Payments System (MIPS)
  • Gives bonus payments for participation in eligible alternative payment models (APMs)

CMS states that their value-based programs are important because they encourage a move toward paying providers based on the quality, rather than the quantity of care they give patients. Fewer hospital readmissions, coordinated care between healthcare providers, and reduced costs for patients and providers are some of the anticipated results of the value-based care programs.

Electronic health records (EHRs) are also an essential element in value-based care programs. Providers who take advantage of the many features of an EHR system, including accessing patient information immediately, coordinating with a patient’s specialty providers, and communicating with patients securely are better equipped to provide the quality care that is the ultimate goal of value-based care.

Damien Neuman
September 10, 2018


Exploring chronic care management adoption for primary care physicians

As the population in the US ages, more patients will need care for chronic conditions. Those over the age of 65, a group that is increasing in numbers as Baby Boomers enter the age of retirement and Medicare eligibility, are more prone to conditions such as arthritis, hypertension, diabetes, and other chronic conditions that will require management by primary care physicians.

A recent survey conducted by Quest Diagnostics explored the adoption of chronic care management. The survey, involving 801 primary care physicians and patients over 65 with multiple chronic conditions, found that primary care physicians feel “overwhelmed and overworked.” These physicians want to spend more time with the patients who need them most but feel their lack of time impedes the quality of that care.

Specifically, the survey found that “almost nine in ten PCPs (86%) say they have felt unable to address the needs of their chronic care patients adequately, with almost three in ten (28%) saying this happens a lot. For most physicians—85 percent—lack of time is the key culprit.”

Although most (95%) of the physicians participating in the survey said they are in primary care because of a desire to care for the “whole patient,” two-thirds (66%) of them say they “don’t have time to address social and behavioral issues, such as loneliness or financial concerns, that could affect the health of their patients,” possibly contributing to or exacerbating chronic conditions among those patients. Only 9% of the physicians participating in the survey are “very satisfied that their patients are getting all the attention they need to care for all medical issues.

Patients with chronic conditions also typically require continued medication and, in fact, account for 83.1 percent of all prescriptions in the United States. The surveyed physicians indicated they felt the need to follow up with these patients to ensure they understand their instructions fully, with 88% saying they are “concerned their Medicare patients with multiple chronic conditions are not taking their medications as prescribed.”

An additional challenge for primary care physicians treating patients with chronic health conditions is the Medicare reimbursement schedule. Most of the physicians surveyed stated they need to see these patients multiple times throughout the year, to properly manage their conditions; however, under Medicare, patients are eligible for an introductory preventive visit within 12 months of qualifying for Medicare and an Annual Wellness Exam every year thereafter.

Greg Miller
August 8, 2018


How primary care can contribute to population health

The primary care physician often acts as a home base for patients who need additional or specialty care. Patients with chronic or complex conditions, especially, tend to see multiple providers for care that needs to be coordinated by the primary care physician. Contributing to population health is a main goal for coordinating this care.

A framework recently developed by the Public Health Leadership Forum (PHLF) and Healthcare Transformation Task Force (HCTTF) emphasizes the need for cross-coordination among independent physicians and other health providers, including social workers, whose focus is also on population health.

As HCTTF notes, “There is mounting recognition that to truly improve health outcomes in the U.S. and curb chronic diseases there must be an interdisciplinary, coordinated, and cross-sector approach to address acute conditions and the upstream social factors that contribute to poor health outcomes.”

HCTTF further explains that the framework “requires action from key stakeholders to realize the comprehensive community wellness vision:

  • Public health and health care leaders can use the framework to convene collaborative groups, commit the time and resources needed to effectively collaborate on a shared vision, and grow a generation of health professionals who view multi-sector collaboration as the norm.
  • Local, state, and federal policy makers can learn from the examples of effective cross-sector collaboration that informed development of the framework to advance policies and programs that create the catalysts and conditions in which collaborative wellness approaches thrive.
  • Health practitioners can identify opportunities to engage and support community-based organizations in structured partnerships to ensure health interventions can truly take hold.”

Primary care providers can take advantage of technology when caring for their patients, with an eye toward population health management. Elation’s Clinical First Electronic Health Record (EHR) enables primary care providers to effectively coordinate care while:

Tyler Comstock
July 30, 2018


Survey says patients want better care coordination, communication

Communication with a patient can make a significant difference in healthcare outcomes for both the patient and the independent physician. Likewise, with an aging population, effective collaboration with specialty providers and healthcare facilities can become a crucial factor in the treatment of patients with chronic or complex conditions. As the transition to value-cased care continues, communication and coordination of services will become increasingly important.

Those two areas are also of vital importance to the patients themselves, a recent survey discovered. Inaugural Health Ambitions Study, a research project conducted by Aetna, posed a variety of questions to 1,000 people as well as separate questions to 400 physicians, divided evenly between primary care and specialty providers. The survey found that the majority of patients want their physicians to communicate with them better and to coordinate their care more effectively.

The survey found that “77% of respondents said it’s very important for their doctors to talk in an easy-to-understand manner.” Taking the time to explain diagnoses, medications, and treatment plans can make a difference in whether patients understand their medical situation and take their medications properly. Follow-up self-care by the patient can also be impacted by whether the physician made the instructions clear and understandable during the visit.

Communication after the visit can also contribute to positive outcomes. Patients surveyed also believe that “privacy and data security are important parts of healthcare.” Communicating with patients electronically can ensure that all of their data is private and secure. Younger patients, in particular, prefer digital tools when accessing their medical records and communicating with their physician.

Of those patients participating in the Aetna survey, just over half want their independent physicians to coordinate care with other healthcare providers more effectively. A tool such as a Collaborative Health Record will provide independent physicians the ability to communicate and coordinate with other healthcare providers to ensure their value-based care results in quality outcomes.

Greg Miller
July 24, 2018


What do primary care physicians think about eConsult systems?

Primary care physicians (PCPs) quite often consult with specialty providers or refer patients to other healthcare providers, particularly when their patients have chronic or complex conditions. A relatively new technology enabling the use of electronic consultations may help reduce the costs to patients when they need the care of such specialty providers. Electronic consultations (eConsults) are “non–face-to-face (F2F) consultations between a PCP and a specialist that utilize secure messaging to exchange information.”

A recent study published in The American Journal of Managed Care (AJMC) examined the use of eConsults among primary care physicians, to determine their effect on healthcare costs. The study also revealed the physicians’ attitudes toward the new technology. The study involved a “total of 369 Medicaid patients (who) were referred for cardiology consultations by primary care providers who were randomly assigned to use either eConsults or their usual face-to-face referral process.” All sites studied used an integrated electronic health record (EHR) system.

The results of the study suggested that “eConsults are associated with total cost savings to payers due principally to reductions in the cost of cardiac outpatient procedures.” However, the study also found that some primary care physicians were adverse to the use of such technology, for varied reasons.

A total of 36 primary care physicians participated in the study. Although a number of the physicians saw improvements in efficiencies, particularly in the reduced time involved in a consultation, some of the participating primary care physicians viewed eConsults as actually adding to their own workload. Some also felt that the wait time for an eConsult was longer than for a traditional face-to-face consultation. The use of eConsults, in most cases, reduced the amount of administrative work involved in coordinating visits, which may have staffing implications for the practice.

The researchers noted that the appeal of eConsults may be outweighed by “patient visit volume, staff support shortages, perceptions about compensation, the excessive burden of administrative and clerical tasks, and institutional culture” and so needs further study.

Greg Miller
June 29, 2018


Primary care physician salaries rise as shortage looms

A study conducted by the Medical Group Management Association (MGMA) found that, overall, primary care physicians’ compensation has increased significantly over the past five years. However, the shortage of primary care physicians that has long been anticipated will probably become a reality in the next few years, according to the Association of American Medical Colleges (AAMC).

The MGMA study, the 2018 MGMA DataDive Provider Compensation, found that “primary care physicians’ compensation rose by more than 10 percent over the past five years.” That number varied by state. In fact, in two states, Alabama and New York, the median total compensation decreased.

The top five states for primary care physician compensation increases were Wyoming (41 percent), Maryland (29 percent), Louisiana (27 percent), Missouri (24 percent) and Mississippi (21 percent). The lowest paying state was reported to be the District of Columbia at $205,776 in median total compensation. Nevada was found to be the highest paying state with $309,431 in median total compensation.

Physician pay has been augmented by additional benefits offered to primary care physicians to attract and retain them, an indication that the physician shortage is looming. The study found that primary care physicians were offered higher signing bonuses, continuing medical education stipends, and relocation expense reimbursements.

The AAMC has estimated that there will be a shortfall of between 14,800 and 49,000 primary care physicians by 2030. Between the growth of the aging of the US population, more people will need medical attention, especially for age-related health conditions.

Dr. Halee Fischer-Wright, President and Chief Executive Officer at MGMA, stated that “MGMA’s latest survey has put strong data behind a concerning trend we’ve seen in the American healthcare system for some time—we are experiencing a real shortage of primary care physicians.”

Elation Health is focused on helping primary care physicians care for their patients more effectively and more efficiently. We are committed to strengthening the relationship between patients and physicians, enabling phenomenal care for everyone.

Nick Dealtry
June 26, 2018


ACA increased primary care utilization but risky behaviors also went up, study shows

One of the goals of the Affordable Care Act (ACA) that was enacted in March of 2010 was to provide access to quality healthcare to more people. The idea, generally, was to improve the health outcomes for patients at a lower cost to them. Patients with quality, low-cost healthcare should be more inclined to seek out preventative care. That, in fact, has proven to be the case, according to a recent study conducted by the National Bureau of Economic Research (NBER).

The NBER examined patient behavior three years after the law had taken effect. Their study used “data from the Behavioral Risk Factor Surveillance System and an identification strategy that leverages variation in pre-ACA uninsured rates and state Medicaid expansion decisions.” That research found that preventive care did indeed increase, but so did the risky behaviors of the people surveyed.

Primary care visits for preventive tests and immunizations increased in an “economically meaningful” way, according to the report. The study found that the “number of checkups rose by 3.8 percentage points, flu shots by 1.9, pap tests by 4.3, mammograms by 1.5 and HIV tests by 2.1.” These results “imply that between 17% and 50% of newly insured people increased preventive care.”

However, the study also found that the “likelihood that someone would become a risky drinker increased 1.6 percentage points. Smoking and exercise also showed signs of worsening, but not in a significant way.” The researchers posited that these types of risky behaviors may have increased because they are not directly related to the cost of healthcare. Patients do not tend to reduce their drinking or smoking habits, in particular, unless these activities begin to affect their health.

A further significant finding in the research conducted by NBER was that the use of primary care tended to increase among patients with private insurance and was not caused by the Medicaid expansion that occurred in many states as a result of the ACA. The researchers’ theory was that because Medicaid payments are much slower than private insurance, many patients may have actually had a difficult time finding a primary care physician.

Greg Miller
June 15, 2018


Experts urge for improvements in quality measures for primary care physicians

Because family physicians routinely see complex patients of varied backgrounds and medical needs, it’s time to create a better way to measure quality outcomes in primary care.

That’s the opinion of the National Quality Forum’s Measure Applications Partnership (MAP), which announced findings of a report aimed at identifying performance metrics the Department of Health and Human Services could potentially eliminate.

MAP is made up of some 150 healthcare leaders from 90 public and private organizations. It make recommendations several times a year for improving quality metrics. However, it does not consider the steps HHS and CMS would be required to take to make the changes.

While MAP typically recommends new measures or changes to those already in place, last month’s report suggested removing 51 of 240 measures that are included in seven federal programs and used to determine payments to physicians. The report also recommended finding ways to improve performance measures in nine other federal programs.

A report last fall by Johns Hopkins’ Armstrong Institute for Patient Safety and Quality mirrored MAP’s recommendations. That report identified specific steps policymakers should take, including:

  • Have one body that sets healthcare standards, similar to an organization like the Financial Accounting Standards Board, which sets standards for public companies. The body should be independent and work to determine who quality data is gathered.
  • Understand the science behind performance measures and encourage collaboration between government agencies that work in this field. That would decrease the $15.4 billion spent annual measuring and reporting quality metrics.
  • Disseminate data efficiently. With adequate funding, policymakers can determine how to communicate the correlation between quality and cost differences to patients.

Both reports said improving the way primary care physicians measure and report quality outcomes is vital to the longevity of independent practices. For many doctors, too much of a focus on these areas leads to burnout and a feeling of disconnect between clinician and patient.

At Elation, we strive to help independent physicians build relationships and focus on providing the highest quality care for patients. A well-designed EHR for primary care provider is vital to physicians’ ability to capture accurate quality data while treating patients.

We also know the move to CPC+ model will deliver incentives to physicians who meet quality metrics. To do so, solo practitioners will need help from a trusted partner like Elation.

Let us show you how we can help. Contact Elation today for a demonstration.

Tyler Comstock
May 22, 2018


CMS changes to marketplace plans may affect primary care

Healthcare costs are rising but wages are not. On the Affordable Care Act (ACA) marketplace, cost-sharing reduction payments are being eliminated. The Centers for Medicare & Medicaid Services (CMS) has announced changes in marketplace plans that affect the way patients choose to access their healthcare services. All of these add up to choices for patients that may impact their ability or desire to visit their primary care physician.

Financial considerations are significant in the choice of plans under the ACA for many patients. Low-income patients, in particular, must balance the monthly cost of their healthcare plan with their expected expenditures for preventive and catastrophic care. All patients must choose between the bronze, silver, and gold plans on the marketplace.

Although the bronze option is less expensive on a monthly basis, it does typically carry the highest deductible for the year. In fact, as explained in an article published by the Robert Wood Johnson Foundation (RWJF), “Marketplace plans as a rule have high deductibles; the medians for bronze, silver, and gold plans in 2018 are $6,400, $3,800, and $1,250, respectively.”

The RWJF article points out, though, that “Due to the quirks introduced by the elimination of cost-sharing reduction payments (CSRs), subsidy-eligible customers often found they could get better deals by choosing bronze or gold. The share of marketplace enrollees in bronze plans, in particular, increased from 23 percent to 29 percent. Among those new to the marketplace, the trend toward bronze was even greater—34 percent of new enrollees on healthcare.gov chose bronze plans.”

So while patients may choose the bronze option because it costs less each month to keep their healthcare coverage, they may be hesitant to visit their primary care physician because the visit itself will be costly for them as the plan does not offer primary care coverage. The RWJF article explains that, “62 percent of bronze plans require that the deductible be met before any cost-sharing for primary care, while this is the case for less than 25 percent of silver and about 18 percent of gold plans.” As patients look for ways to save on their healthcare expenses, these financial barriers may keep them from being able to access primary care services.


Tyler Comstock
May 14, 2018


Study shows the impact of EHRs on the primary care providers’ patient encounter

A recent study published in Family Medicine was conducted in an attempt to update and more clearly detail the amount of time primary care physicians spend with patients when using electronic health records (EHRs). As the researchers indicated in their report, “Although several studies of the impact of EHRs on physician work report an effect on time as a percentage of their work day, almost no previous studies measured the actual time spent.”

Observers participating in the study shadowed primary care physicians, including “attendings, residents, and their ambulatory patients in 982 visits in clinics affiliated with 10 residencies of the Residency Research Network of Texas.” They recorded time spent with patients as well as EHR screen time, using personal watches or cell phones.

Elation Health recognizes the challenges faced by many primary care physicians who desire patients’ medical records that can be easily accessed and that are always current and accurate. We also recognize that primary care physicians need more face time with patients and less screen time. The results of the study actually indicate that the physicians and residents that were observed spent a mean time of:

  • 35.8 minutes per visit
  • 2.9 minutes working in the EHR prior to entering the exam room
  • 16.5 minutes of face-to-face time
  • 2.0 minutes working the EHR in the room (73.4% of the visits)
  • 7.5 minutes of non-face time (mostly working in the EHR)
  • 6.9 minutes of EHR work outside of normal clinic operational hours (64.6% of the visits)

Elation’s Clinical First EHR solution helps physicians reduce their screen time, enabling them to spend more time engaging with patients. Most EHRs rely on a linear workflow which forces back-and-forth screen toggling and extra clicks. Elation’s Cockpit View surfaces everything primary care physicians need in a unique three-pane console, providing more flexibility.

With Elation’s EHR, primary care physicians can order and reorganize windows based on the specific practice workflow — helping physicians surface the information they need quicker and more efficiently. Physicians can document visit notes, order lab tests, e-prescribe, and write referrals in any order.

Clinical First is a commitment to building a provider-centric Clinical EHR that exists at the nexus of the clinical workflow, supports the physician-patient relationship, and drives outstanding patient outcomes.

Greg Miller
May 8, 2018