| Working with an attribution model |
“There's an attribution problem from the MCOs to us, and there's an attribution problem from us to the primary care physicians. If we're paying them cap [capitation], we've got to know who's in the pot. […] It's a huge issue for us, but it's not unique to us.” “The challenges then become defining who your patients are versus who your competitors’ patients are. And that's where the rules of patient attribution become very important, but then they're also very difficult to administer. Because what the insurance companies like are the unattributed patients, because that's where their profits are.” “An example would be—we've had patients that are attributed to us that have literally gone to two different primary care providers on the same day. All right? Who's attributable—whose patient is that now? I mean, there's a conundrum. They obviously didn't like what the first doctor told them, so they went to a second one. And you don't know if you were the first or the second one.”
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More interdisciplinary collaboration across the care continuum |
“… working with the specialty doctors and the inpatient setting, so they're becoming a little bit more cognizant of needing to really just collaborate, and not just focus specifically on their one little area, but trying to address as many of the concerns for the patient as is reasonable and possible.” “And when you start talking with doctors about clinical things and the right thing to do with their patients, that's what makes sense to them. That's what really hooks them in and grabs them in because they went into medicine for that reason, right?” “Well it's based upon … a partnership amongst care providers in a geographic area—physicians, hospitals, a network, if you will, who come together to achieve the triple aim.” “… recognizing that we can't be silo‐ed. If we're going to do this, we cannot all be in our own little world and worried about our own little world. We really have to extend ourselves out to the other areas to make sure that we have that safety net for the patient.”
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| Reliance on retrospective review |
“We have to caveat with everybody. It's claims data. It's not perfect. It's not 100%.” “It can be frustrating when they see things, ‘Oh, this person went to the ER 4 months ago.’ They might have gone to another ER seven more times, you know?” “So if you don't have that data though, how are you going to figure out how to take the risk, and what the risk should be?” ”If they're going to refer themselves, there's not much we can do, because we never know until after the fact.”
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Availability of near real‐time quality and performance data |
“Once the user gets access, to whether it's physician, an office manager, or whatever, they can see all of their patients, they can see how they're doing on their quality measures, which of course can have implications for their set ups. They can see their patients that have gaps in care. They can risk‐identify the population, they can run registries of patients with certain conditions, or condition with gaps in care, and send letters to those folks that have gaps in care.” “We had one physician tell us that, as a result of our program, his patients in his practice are getting better care. You know, because of the way that we measure diabetes. People were getting underneath the, you know, underneath his radar screen of not coming in and getting their diabetes checked. Not getting their eye exams, not getting their foot exams. And because [the ACO] measures those patients in his practice now, even the ones that are not measured are getting better care.” “We have to continually reinforce with the medical assistants that, you know, you missed it on this patient, you missed it on that patient, and just keep giving it back to them with the hopes that ultimately, it will improve.”
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| Patients lack understanding about the ACO |
“We haven't been using the name ‘ACO.’” “They [the patients] won't know what the [ACO] is … that's not going to mean anything.” “It's not the [ACO] reaching out to these folks; it's their primary doctor reaching out.”
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Engaging and educating patients |
“I think we are very engaged as an organization in trying to really work with the patients, to bring them in, to be part of their care, and to really, to guide them through this.” “… providing the resources, education, and support.”
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