Dr. Joe Nicholson is the Chief Medical Officer at 

. There, Dr. Joe provides strategic direction, operational oversight, and thought leadership for CareAllies’ clinical programs and operations, including all value-based arrangements within IPA/CIN or ACO constructs. Additionally, he supports business development and provides clinical oversight for all companies and programs under CareAllies, including new models of care rolled out by CMS, like MSSP.

Joe Nicholson, DO

The end of a calendar year and the beginning of a new one can be a busy time for healthcare practices, and this year is shaping up to be no different. In much of the country, colder weather has arrived, which may mean more patients coming into your practice with colds and viruses.

At the same time, physicians are seeing some patients for their annual physical, or additional follow-up visit, before the year ends. This is especially important for individuals who have chronic conditions that require regular medication, screenings and specialist appointments. And in January, a practice may experience an additional influx of patients due to changes in health plans, including those on a new Medicare plan, resulting in practices needing to establish care with those patients as soon as possible.

As practices navigate this busy period, putting processes in place now for accurate documentation will help in the long run.

Physicians can have many back-to-back appointments in one day decreasing the opportunities for accurate documentation. This can lead to the likelihood of details being overlooked, especially if the patient you are seeing for the first time has several underlying conditions. Completing all necessary documentation to describe the individual’s current condition, treatment needs, interventions, and medications must be done with precision.

Accurate clinical documentation aligns providers and health plans with the patient’s care needs, giving all stakeholders a complete picture of the patient’s health risks and treatment plans. This enables more efficient, effective, and targeted care that follows best practices. Such documentation also helps you understand your patient population’s acuity. Accurate and complete re-documentation for all chronic conditions is particularly important in your Medicare population. This also drives best-in-class clinical activities, testing and follow-up associated with those chronic conditions.

How can a practice ensure documentation accuracy when patient volume is high?

An important first step involves taking the pressure off physicians to conduct every aspect of documentation and pre-work prior to the patient’s arrival, and during their office-visit. Pre-work prior to the patient’s arrival in the office, is the cornerstone for good patient care. Some doctors use a morning huddle to accomplish this, knowing that e.g. when Mrs. Smith arrives – she will need to receive her vaccines, and she is due for a referral for colonoscopy. Good use of experienced physician extenders, such as nurse practitioners, to conduct intake and wellness exams can also drive efficiencies. These providers can spend more time with patients learning about their current health status and determining their needs. During the appointment, they can review the patient’s known conditions and ask about any changes that have happened within the past year that could indicate any changes in their status. The nurse practitioner can complete the necessary documentation, order the appropriate screenings and tests, and refill prescriptions as needed. From the patient’s perspective, the appointment feels no different than a regular annual check-up.However, by using this approach, medical practices can ensure they have sufficient time to accurately record the appointment and close care gaps. This also allows physicians to focus on complex or acute issues that require their level of expertise during the visit.

Another way to enhance documentation is through the use of data intelligence tools. These tools can seamlessly integrate data from claims, CMS data, supplemental, and medical record information to the patient’s electronic health records (EHR) to understand the care the patient is receiving from their entire care team, even from outside the primary care physician's practice. Such tools can list members of the patient’s care team, help physicians determine gaps in the patient’s care, and show historical and suspected chronic conditions. Expanded documentation can also note events such as emergency department visits and hospitalizations, share reminders about upcoming appointments, and list medications. The technology will even prompt providers to consider potential red flags that may trigger a further appointment or a connection with the physician. When this information is aggregated into one chart, clinicians can better understand the patient’s current status and align services with the patient’s needs.

In addition to ensuring accurate documentation, the above strategies can improve the patient experience as well. Physician extenders allow the patient to have quality time with a provider to answer their questions. Data intelligence tools enable a more efficient appointment, which builds patient confidence when the practice is prepared and able to create a personalized care plan that meets the patient’s needs. From a provider perspective, the two-pronged approach also reduces the administrative work for physicians.

By implementing some proactive strategies that can support accurate documentation amid higher patient volume, practices can ensure they are capturing the right information at the right time to improve patient outcomes and support their providers in the best way possible.

Articles

Completing all necessary documentation to describe the individual’s current condition, treatment needs, interventions, and medications must be done with precision.

Ensuring comprehensive documentation during times of higher patient volume

COVID-19 vaccination has become a tricky subject for providers to navigate during patient visits. While we need to understand our patients’ vaccination status to care for them, we must also remain sensitive to potential vaccine hesitancy. Against this backdrop lies a golden opportunity for us to help our patients make sound, educated decisions about whether to get the COVID-19 vaccine.

Only about 55% of the U.S. population is fully vaccinated.

1 Despite a slight rise in vaccination rates due to the Delta variant, 

daily vaccination rates remain far below their peak.

2 Providers may assume that people who are not vaccinated do not 

 to be vaccinated; however, many other factors may be at play including misinformation and social determinants of health.

Recent data suggests that most Americans trust their doctors and other health care workers.3,4 Therefore, providers can play an integral role in increasing vaccination rates across the U.S., but only if we first understand each patient’s unique situation and concerns. We must get to the root of existing barriers.

Some of the most common potential barriers include 

 or health care access, lack of education/guidance, misinformation, and financial misunderstanding. Although providers may not be able to address all barriers, many can be overcome by connecting patients with existing community resources.

For example, free transportation services available through health plans, ride-sharing companies, and other community groups can make vaccination clinics accessible to those without transportation. Other patients may mistakenly believe they have to pay for a vaccination or are worried about vaccine side effects. Providers can alleviate such anxieties by offering accurate information.

The process of motivational interviewing can help identify and address health barriers. It is a collaborative, patient-centered way to guide conversations, and it is just as effective for informing COVID-19 vaccination decisions as it is for overcoming medication non-compliance and other challenges.

Motivational interviewing entails four steps represented by the acronym OARS:

 questions; those that require more than a “yes” or “no” response. For instance, rather than asking, “Are you planning to be vaccinated?” ask, “Why haven’t you received the COVID-19 vaccine yet?” That opens the door to begin discussing both perceived and actual barriers.

 that you want what is best for the patient. Take a moment to appreciate the patient’s apprehensions with a statement such as, “It is natural to be apprehensive…” Then, emphasize that you care about the patient, their family, and their loved ones. For instance: “This shot is especially important for you because of your [

insert appropriate job/underlying health condition/vulnerable family here

].” Or, “I care about you, and because your health puts you at risk of complications from COVID-19, I strongly recommend you receive a vaccine.”

 on what you hear from the patient about why they are hesitant to receive a COVID-19 vaccination, but then start to reinforce their commitment to change their behavior. Explain the importance of immunization, offer solutions to barriers, and share reliable evidence and resources.

 the conversation to remind patients you are engaged in their care and want to guide them to healthier behaviors.

Many patients look to their health care providers for up-to-date knowledge, which gives us an excellent opportunity to combat misinformation. For example, providers can explain that researchers were developing mRNA vaccines years before COVID-19 emerged, so they are not using new technology rushed to market. We can explain how the vaccines benefit individuals, their families, their friends, and their communities’ “normal” way of life. 

Provider Relief Fund recipient reporting obligations and government enforcement actions

As providers, we cannot discount our power to persuade. Patients who receive accurate intelligence from a trusted source like their doctor may better understand the benefits of COVID-19 vaccination and therefore increase vaccination rates nationwide. 

Through motivational interviewing, providers can identify and start to overcome barriers to care. We can help patients make educated choices about protecting themselves, their loved ones, and their communities.

Centers for Disease Control and Prevention. COVID Data Tracker. 

https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-total

https://covid.cdc.gov/covid-data-tracker/#vaccination-trends

Amid coronavirus threat, Americans generally have a high level of trust in medical doctors.

https://www.pewresearch.org/fact-tank/2020/03/13/amid-coronavirus-threat-americans-generally-have-a-high-level-of-trust-in-medical-doctors/

Americans are most likely to trust healthcare workers and doctors.

https://www.ipsos.com/en-us/americans-are-most-likely-trust-healthcare-workers-and-doctors

 is the Chief Medical Officer at CareAllies, providing strategic direction, business development expertise, and clinical oversight. Learn more at 

How to talk with patients about vaccine concerns.

COVID-19 Vaccines: Effective patient communication strategies

Joe Nicholson, DO; chief medical officer of CareAllies discusses how value-based care strategies can reduce administrative burdens, improve customer service and the patient experience.

Videos

How value-based care strategies can reduce administrative burdens, improve customer service and the patient experience.

Benefits of engaging with value-based care

Joe Nicholson, DO; chief medical officer of CareAllies discusses how the provider experience is altered in a value-based care strategy.

How the provider experience is altered in a value-based care strategy. 

Value-based care provider experience at the individual level

, chief medical officer of CareAllies discusses why a value-based care model should be adopted instead of a fee-for-service model.

Joe Nicholson, DO; chief medical officer of CareAllies discusses why a value-based care model should be adopted instead of a fee-for-service model. 

Why physicians should adopt a value-for-service model

Practices are questioning whether to accept 

 more than ever before. Even before COVID-19 hit, there was a clear slowdown in adoption of value-based care contracts. A recent 

 report to Congress stated that only 561 accountable care organizations (ACOs) participated in the Shared Savings Program in 2018—down 44 from its height. 

As the COVID-19 pandemic has deepened the financial and psychological challenges for practices, the idea of taking on the risk of a value-based care model may seem like an incredibly high hurdle in the current climate. Yet this is precisely the time to appreciate the substantial benefits that risk-based agreements offer both patients and practices.

When constructed properly, risk-based agreements reward practices that double-down on care management strategies that improve patient outcomes and stabilize practice reimbursement as they lower overall health costs. That’s because unlike traditional fee-for-service (FFS) models that reimburse based on service volume, risk agreements’ compensation structure pays practices for proactively managing key clinical factors and patient conditions, such as diabetes or smoking habits.

Managing a Practice: Advice from your peers

By focusing on outcomes, practices must also embrace and address the impact that 

 (SDoH) have on a patient's health. The impact of SDoH on overall patient outcomes has been dramatically illustrated and exacerbated during the pandemic. People with the means to work from home and self-isolate, for example, have fared better than those required to work on-site in places where social distancing difficulties increase the risk of coronavirus exposure.

Even before COVID-19, however, many studies showed connections between SDoH factors, such as food insecurity and 

, and a higher risk of costly conditions such as diabetes and cardiovascular disease. The incentives to address SDoH that are inherent or specifically built into risk-based contracts can help reduce the impact of these conditions and thus the incidence of physically and financially devastating medical events. That makes risk-based models powerful motivators for driving cost-effective care delivery—as long as practices have the insights they need to support the risks they assume.

The benefits of improving patient outcomes from risk-based models have been well documented over the years and there is a continued increase in quantifiable results from programs that successfully navigate the new payment systems; however, many organizations have yet to fully embrace these contracts.

There are many different risk-based models for practices to consider, and most fall along a risk continuum that looks something like this:

. Practices get paid for the volume of services they provide. When the number of services drops, so does reimbursement.

. Practices begin to get paid for managing the care of specific populations. Incentivized to identify and address contractually defined gaps in care.

. Shared savings with upside risk only. Practices accept multi-year risk-sharing across a group, looking at contract management, claims, and costs.

. Practices accept full upside and downside risk, typically through multi-year arrangements that require mature capabilities.

At their core, risk-based models should inspire the flexibility to deliver care in the manner most effective for patients’ overall health. The financial model should encourage practices to offer services that usually are not reimbursed—such as care management or telehealth services, for example—as well as address SDoH.

To decide on the best risk-based arrangement for an individual practice or practice group, providers should ask themselves the following questions: 

Which payers have progressive policies around chronic condition management, including active investment in services to address patients’ SDoH challenges?

Does the payer’s quality or population health reporting give you insights into non-traditional gaps such as SDoH gaps or behavioral health gaps?

Does the payer’s benefit coverage include holistic, person-centered care—including behavioral health?

Which payers have similar requirements for quality reporting that could simplify testing and scaling risk-based arrangements?

Does the payer’s approach to utilization management empower the 

 to make decisions about its service and treatment offerings?

Practices that successfully transition from FFS to risk-based arrangements often start small and slowly increase the percentage of their revenue tied to risk-based agreements over time. Since newer Medicare SSP models tend to reduce the window for upside risk and accelerate the engagement of downside risk, practices may want to focus first on existing targets for clinical improvement. For example, if you already have a process for ensuring patients have their annual HbA1c test or mammogram screenings, build on those programs to close any final gaps and then address more complex needs.

More often than not, practices will need to revamp some processes to make them consistent and repeatable across payer contracts, and to ensure alignment among the practice’s clinical and administrative efforts. In addition, practices and payers must strengthen their collaboration.

A commitment to data-sharing is a crucial part to executing these risk-based contracts, including understanding SDoH and improving population health. In fact, the ability to gather and access data all along the care continuum (payer, provider, patient, and potentially leveraging external data sources) is the only way to move the needle on patient outcomes. While the quality metrics measured will vary with each contract, payers should be willing to give practices supporting clinical and cost data about the patient populations impacted. This enables the practice to assess where improvements are needed, as well as provide the appropriate patient outreach.

Treating asthmatic patients during the COVID-19 pandemic

In an FFS environment, practices that identify SDoH among their patients sometimes try to address the issues through hand-offs to social services. Sometimes the processes work well; other times, patients fall through the cracks.

Risk-based models, on the other hand, encourage practices to use quantitative and qualitative data to identify SDoH to leverage internal care management workflows to address them. Thoughtful programs need to be employed to be effective in your impact for SDoH related issues. When managed effectively—and supported by ample collaboration and data exchange—risk-based models promote better business results for practices by achieving better outcomes for patients.

When managed effectively—and supported by ample collaboration and data exchange—risk-based models promote better business results for practices by achieving better outcomes for patients.