Leveraging payer data to close care caps and simplify value-based care

Value-based care models come with high complexity and few guarantees. For healthcare organizations to do well and maximize returns, they must excel in everything from collaborating with other providers to integrating the systems required for reporting. Without a good roadmap for navigating this landscape, it’s easy for practices to wind up lost. Across the athenahealth network, healthcare organizations are using tools and technology to help them achieve their value-based care goals.

Here is one of them.

When physicians Lynn Joffe, M.D., and Lindy Gilchrist, M.D., opened DTC Family Health in south-metro Denver in 2002, their vision for how care should be delivered may have been slightly ahead of its time.

“Our approach from the start was that our job is to take care of the whole patient,” said Dr. Joffe, “but the American fee-for-service system is diametrically opposed to that.”

Fortunately, it wasn’t long before value-based care started gaining steam: “We realized that if we did it right, we suddenly had an opportunity to be reimbursed fairly for our work,” Dr. Joffe said.

Fast forward to today, and the seven-provider family practice has experience in several value-based programs. The biggest is an Aledade ACO, a group that includes about 40 other primary care practices across Colorado.

Over the years, Dr. Joffe and her colleagues have learned to lean on technology to simplify the clinical and administrative processes that are essential for participation in pay-for-performance models. And when it comes to their partnership with athenahealth, they’ve seen a clear benefit in the realm of provider-payer alignment.

“One of the biggest barriers is just knowing who your patients are and who you’re supposed to be taking care of,” Dr. Joffe explained, adding that it becomes easier when there’s communication and collaboration with payers. “My job is to identify how complex my patient is so that we can anticipate what they’re going to cost the healthcare system. Then we can work to decrease that, if possible, and when we do, that’s mutually beneficial for everyone — the patient, our practice, the payers, and society.”

The athenahealth EHR brings payer data and diagnosis information to the point of care to bridge potential gaps, Dr. Joffe said. That’s helped the practice excel in areas like chronic care management, for example, and most important, it’s paved the way for success in value-based care.

“I think we’re doing well,” said Dr. Joffe. 

“We’re doing well for our patients as well as for our practice.”