In just over a year as Chief Medical Officer for Caravan Health, Dr. Anna Loengard has brought a clear focus to how our partners use clinical data in accountable care.

Working closely with our ACO medical directors and clinical staff, she has guided our ACOs through clinical care transformation. She will bring us up to date on this work next month at our third annual Accountable Care Symposium in Phoenix, AZ. Today’s blog previews her presentation.

What Problems are We Trying to Solve?

One of the main issues facing purchasers of health care is continued growth in health care costs in excess of GDP in the coming decades, without a clear link to improved outcomes. Federal officials have implemented numerous policy changes, including a proposed faster path to two-sided risk for ACOs, to manage this cost increase. We have learned that accountable care, when done right, can both save money and improve quality. Providers must figure out how to continue providing quality care and improving physician experience within a shifting policy environment. 

 

Projected Federal Spending on Medicare and Medicaid (percent GDP)
 

 

It All Starts by Strengthening Primary Care

Robust primary care delivery is central to Caravan Health’s model of transforming care and building financial sustainability. All Caravan Health ACOs start out by focusing on the basics. For many practices, that means increasing the number of annual wellness visits, building care teams for chronic care management, and employing proper hierarchical condition category (HCC) coding. Proper coding can’t be overlooked. It helps practices get appropriate credit for treating sicker patients, which is essential for achieving bonuses in all value-based models of care. 

Dr. Loengard will show that the path to accountable care success is rooted in meaningful clinical data. This is the heart of the Caravan Health model – team-based care, strong data analytics and accurate coding of chronic conditions are the foundation for primary care transformation and ACO shared savings.
 
The Importance of Data in Strategic Planning 

The Caravan Health approach always includes locally-driven team-based care. Our theory is that practice transformation will only succeed if health systems can make change locally. We have to figure out what the specific care needs are in a community and whether there is physician leadership to tackle those problems. Caravan Health employs strong data analytics that show us where our partner practices have the resources to make change. The data point the way forward. 

Data analytics are useful in communities of all sizes – even in smaller rural areas with a limited population size. Our systems allow providers to see what is going on with their patients when they are not in the office for appointments – whether or not they are picking up prescriptions, visiting the emergency room, or seeing specialist providers. With this information, providers can give extra support for those patients that need it. We can also compare a smaller community to a larger cohort made up of similar populations to see how what we can learn about optimizing care delivery. 

How it All Comes Together

Our ACOs have always prioritized improving care quality and better physician satisfaction – these are the very reasons they started in accountable care. It turns out these are a great way to save money for the practice and Medicare along the way. When our partner practices put the building blocks into place, we see results. 


Hear more from Dr. Loengard by watching her webinar: Ace Quality & Population Health, by Doing Less Work, Smart

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