The most important element of participating in a value-based payment model is getting complete claims data on your patient, regardless of where the patient received care. Every community health system has unique strengths and weaknesses. Getting claims data on your patients will help you focus on the issues that are meaningful and impactful for improving quality and lowering costs, and help you avoid spending valuable time and resources on issues that are not relevant to you and your patients.
Generally, 25% or more of high-risk, high-cost patients are not receiving regular care from a primary care clinician. Getting the full claims data helps you identify these patients and provide them with the support they need to help them manage their disease.
In value-based payments, you become accountable for all of the care your patients receive, regardless of where they went for care or why. This makes you the quarterback – the coach of your patient’s health and well-being. This means that if they over-utilize the Emergency Department, whether it is local or outside the community, it is your job to find out why and help them get the care they need in the most appropriate setting. Claims data will help you identify those patients.
Being successful in value-based payments also requires that you are more selective about where your patients are referred. Claims data is a rich source of information about the quality and cost of your tertiary, specialty and post-acute care network. Our analysts will work with your clinicians to better understand the best partners for your patient’s care.
Your care coordinator will use Lightbeam to identify high-risk patients for additional support and to set up transition programs with your high-volume providers. Your practice will use the program to identify gaps in care and improve quality scores. Your practice staff will use the program to provide clinicians with data about where the patient has been, what drugs are being refilled and how often, improve HCC coding and identify gaps in care that can be addressed at the time of the visit.