Healthcare is rapidly moving away from a fee-for-service environment to one in which reimbursement is based on outcomes and lower costs. This value-based contracting relies on data and analyses to identify patients at risk, develop treatment options for specific patient groups, and track progress, costs, and outcomes.
This data resides in physicians’ electronic health records (EHRs). However, physicians will need help in identifying EHR tools and how they can be leveraged to support reimbursement-related data and metrics. Population health management (PHM) is a good place to start. Many private insurers and Medicare increasingly have contracts requiring practices to address the health of specific populations. Reimbursement is based on the health and outcomes that are achieved.
That said, physician practices can be challenged in developing insights on various PHM dimensions. Pharmaceutical representatives offer a ready-made solution. They can leverage their knowledge and experience with measuring and influencing outcomes of particular patient populations, using the practice’s or health system’s data.
Examples of How Pharmaceutical Representatives Might Partner with Physician Practices on PHM Include:
1. Help practices identify PHM tools in the EHR. Like most people, physicians are not fully aware of their system’s capabilities. Yet there are many tools in the EHR that can help with PHM and reporting. For example, patient lists can be used to track a population from diagnosis to receipt of a new medication and adherence to therapy. Pharmaceutical representatives can help physicians identify needed EHR tools, understand the desired data, and comprehend its interpretation and utilization for future patient care.
2. Work with health systems to support their development of population health measures on their own populations. One opportunity is assisting health systems in generating their own reports showing current gaps-in-care, process failures, and potentially untreated patients. These powerful tools can help improve care and set up performance measurement programs for medication effectiveness.
3. Provide educational resources. Physicians and the practice staff need training and tools to become successful population health managers. Some can be out-of-the-box, such as identification of ICD-10 codes that can help address gaps in care, as well as prevent health incidents or hospital readmissions. Third-party educational materials also can be provided via the EHR and a partnership with the practice to set it up. This will enhance the brand’s relationship with the physician and the patient, as well as provide needed, credible information in a user-friendly way. Third-party, prepackaged order sets for care processes and the diagnosis and treatment of a particular condition also can be loaded into the EHR.
The move to value-based care is gaining momentum. Helping physicians mine their EHR data can help demonstrate positive results in the early stages of ramping up PHM systems to support value-based contracting. This can create new relationships with physician clients, who will view this assistance as a definite value add and something they can rely on in the future.