Good data, payer partnerships can aid shift to value-based care
Without physician engagement, there is no value-based care, says Ann Marie Edwards, CEO at Alliance Cancer Specialists, a 22-oncologist practice across four sites in suburban Philadelphia.
During an educational session at HIMSS18, Edwards will team with Cliff Frank, interim executive director at Shore Quality Partners, a network of providers associated with Shore Medical Center in Somers Point, N.J., to lay out steps to enhance engagement.
“This session is about using real-world application of data to look at your own clinical behavior,” Frank will tell colleagues and practice staff members. “Value-based care is a guide to evidence-based medicine and getting rewarded for doing it.”
The speakers will give insights on developing achievable goals for VBC as the journey starts and how to work with insurers, regardless of the size of a practice. It isn’t just providers who need a new mindset but insurers also, Frank contends. “We’ll lay out the premise that pre-certification and denials don’t work; they are not sustainable in the march for clinical improvement, so engage and reward physicians and that’s how things will change.”
Payers have financial data and providers have clinical data, so if they can work together the whole picture of care becomes clear, he adds. “Look at the data together to form a plan that turns you into partners.”
To start, however, insurers need to clean their data, which Edwards and Frank contend is terrible at this time. Providers must ensure that payers are providing good data that is correct and accurate to drive physician behavior.
“The story really begins with the data,” Frank says. “Without having data to direct resources, it is difficult to go down the path to VBC. Data identifies the highest risks and greatest needs. It improves care and informs the treatment being given.”
Session 168, “Building a population health strategy that physicians love,” is scheduled at 2:30 p.m. on March 7 in room Delfino 4002.