June 13, 2019


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Insights from Caravan Health Chief Medical Officer Dr. Anna Loengard

Anna-Loengard-(2).jpgPhysicians often come to us with questions about why they should join an ACO. Sometimes they worry they will be asked to do more than ever as they shift from fee-for-service to fee-for-value in Medicare. Recently our Chief Medical Officer, Dr. Anna Loengard, went over strategies to make this shift as seamlessly as possible with a focus on practical solutions to keep up with an ever-changing payment and service delivery environment. Check out the recording here.
Value-Based Care Should Not Be a Tax on the Practice
Value-based medicine can sometimes feel like a series of check-the-box activities. Physicians are worried this will be a nuisance or worse, an extra cost for the practice. Quality reporting and pursuing value are time-consuming, but with a well-thought out plan there are clear benefits. Population-based models can actually require less work and be more successful when implemented purposefully.

The Caravan Health model puts physicians in the driver’s seat as leaders of the primary care team. Working together, the team creates change faster, more effectively, and with new streams of revenue. Even when actively cutting costs, practices should engage in these preventive fee-for-service activities to save money on more expensive care later on. Medicare has even implemented new billing codes for wellness, prevention, and chronic care management to compensate the extensive time needed to provide high quality care for all and extra support for complex patients.

Benefits of Strong Population Health Management
Our physician leaders tell us about the benefits of strong population health management, especially when it comes to annual wellness visits. These wellness appointments are different from a regular physical exam. The purpose of an AWV is to get an overall picture of a patient’s health and develop a preventive care plan, rather than focus on acute conditions. When these AWVs are conducted by trained nurses, it can free up physician time to attend to activities that only they can do.

There is some compelling data about the value of the AWV. A recent study published in the American Journal of Managed Care compared Medicare spending for beneficiaries who had an AWV against spending for those that did not. The study showed that annual wellness visits are associated with a 5.7% reduction in spending over the following 11 months. The savings were even higher for those patients with more complex conditions. Patients with an AWV were also more likely to receive important preventive services.
Team-Based Care is Critical to Success
Practice transformation won’t succeed without a fully engaged and empowered team. In particular, nurses can provide annual wellness visits, chronic care management, and other services under the supervision of a billing provider. Patients and providers both benefit from skilled nurses assessing and triaging in order to highlight the most urgent needs. These nurse-led activities can also contribute significant revenue, as shown in this slide.


The value of HCC coding cannot be overlooked. Appropriate HCC coding is how a practice gets credit for treating sicker patients in value-based models. We have seen time and again that paying attention to HCC coding workflows can make the difference between an ACO collecting shared savings or missing the mark. By integrating coding directly into AWV workflows, you can get reimbursed appropriately for the care you deliver without creating a lot of extra work for clinicians.
Improving Physician Satisfaction
This team-based approach to care is part of the solution to the serious issue of physician burnout. Some estimate that 44% of physicians are burned out and 11% are experiencing clinical depression. No one doubts that burnout has a negative effect on care, quality of life for providers, and retention of a high-quality physician workforce. With physician burnout at record levels, we need to be using all available solutions to combat the problem. Having a well-functioning team that empowers nurses and relieves burden on physicians, like in an accountable care model, can make a big difference.

In this model, “working at the top of license” does not mean taking the easy patients and giving them to someone of lower licensure. It means continuing to have some easier patients in the schedule, but with a team to support the most complex patients, both in the office and between visits if needed.
In the next few years, providers will have to make the transition from fee-for-service to fee-for-value. Value-based payment is here to stay, but physicians do not need another program to manage or form to complete, they need a plan for success. In a team-based environment, health care practice transformation should never be a task of one. The Caravan Health methodology is proven to get results.

Watch the webinar recording

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