By Harshini Reddy Parvatha
Given the numerous changes practices are navigating to succeed in the world of value-based care, running a high performance primary care practice with low costs is critical. A key factor to achieve and sustain reduced costs is to appropriately manage your post-acute network.
Practices are increasingly empowering primary care physicians to share data and utilize technology to inform their decision to choose the right institutions with clinicians who can deliver high quality and efficient care, and share information back. Even though there may be an initial investment of operational costs to build an infrastructure, the long-term benefits are well worth it. A first step may be to establish fee schedule redistribution to support primary care by bringing physicians to the table.
When choosing a network for referrals, such as institutions like a skilled nursing facility or rehabilitation hospital, practices should consider if the institution brings consistent value to the practice and keeps the patient at the center of care (e.g., an institution that invests in diabetic educators to work with patients’ post-discharge). If you are an independent practice, analyze the data to see what value the specialists bring based on objective measures of value. The lack of access to this data is certainly a blind spot for practices.
In addition, in collaboration with payors, it is essential for practices to set the stage to negotiate contracts openly and amicably in order to set targets together, based on the practice metrics utilized internally to drive transformation. To demand a place at the table with payors, the practice should include their clinicians to establish reasonable quality commitments and financial efficiency.
Inclusion in narrow networks is based on information that the payors hold. Accessing data from payors is important in understanding your value. For example, it may not be reasonable to provide all care management services to all patients, but in utilizing data, there’s an opportunity to determine where patients need those services the most.
To conclude, to be successful in an advanced payment methodology, evaluate partnerships and associations outside the nuclear practice. Leverage thoughtful partners that hold the same values of patient care as your practice!