“Primary care doctors, what are people saying about you?”
Right now, insurance companies, self-insured corporations and collaborative organizations are trying to differentiate the high value primary care providers versus the low value providers. These entities are looking at data and information, making best guesses and starting to direct patients to those providers perceived as "high value".
This is a dangerous game. By the very nature of the process, the data anyone has access to at any one time is inaccurate - what a doctor does in his office is dynamic and always changing. Even if providers start being more proactive in their practices and have their entire staff acquire training, it could take as long as 18 months before these improvements manifest themselves in the data. Just like someone aiming to lose weight focusing on diet and exercise, it could take months for others to notice the weight loss. For primary care providers, this time delay could cost them business and access to patients.
Another setback providers face is the data itself, which can be greatly influenced by just one or two catastrophically ill patients. If they are providing high value care for 95 percent of patients, but 5 percent have very severe conditions, this can sway the overall data to appear as if they aren’t doing a very good job. Statistics, its all in how you slice it.
Data source and patient demographics are also factors. Data sets may come from a particular insurance program heavily skewed toward older patients or those with chronic conditions. If this is the data insurers are using for analysis the picture of the practice may be biased. Perhaps a certain provider has a reputation for being very successful at managing complex patients, so their associates in their group or community send them the most complicated patients. Now their performance doesn’t look as good, when in fact they may be one of the best doctors in the community! What if an insurance company has insured a large number of employees that work at a particular plant or facility, who are not prone to be proactive in their health care and adhere to an “if it ain’t broke, don’t fix it” mentality? This makes it a challenge to increase compliance and get engagement from the population.
So, what are the solutions?
• Make sure you have proactive population based programs in place
• Make sure your staff is empowered to proactively reach out for non-compliant patients, and that they have the training to engage and encourage these patients to come in
• Acquire the most recent data from multiple insurance companies, covering the broadest range of the patients you serve possible
Even by accomplishing all of this, the data is still going to be incomplete because the profile would still lag behind actual performance by 90-120 days (the time it takes claims to be processed). What additional steps can you take to ensure that you are being noticed for your high value services? First, pay attention to who is talking about you in the marketplace. Visit healthgrades.com or consumerhealthratings.com and see what people are saying about you and your staff. Secondly, ensure that whatever you’re doing in your practice is well publicized. You can do this by creating a personal website for your practice and updating your patients and community about what you’re up to.
Another way to create publicity and stay in the eyes of the community is to create a profile here on Open Health Market. Open Health Market is the website employers visit to help figure out the quality of providers in their community. If you already have a profile on OHM, make sure your information is correct and up to date. This service will keep the community aware of the high value care you provide and allow employers to make well-informed decisions based on quality.
More and more primary care physicians are using OHM to ensure that they are being recognized for the high quality services they provide. Just recently the Dallas Business Group on Health sent a letter to the physician groups and hospitals in North Texas requesting that they create a profile with Open Health Market, and that they respond to the Request for Quality Information that is being requested there. In addition, the North Texas Value Based Health Care Collaborative is working diligently to identify and work with providers who are committed to serving high value care.
By following these steps, providers ensure that the public sees their practice as being one of quality, and become known for being a high value primary care physician.
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