Primary care providers have been hit hard during the COVID-19 pandemic. Despite the ongoing need to provide healthcare for their communities, PCPs saw a precipitous drop in patient volume during the early months of the pandemic – up to 30% in some regions, according to the Commonwealth Fund.
For many practices, especially those entirely reliant on fee-for-service, the resulting shortfall in operating revenue put them in danger of having to close their doors. While service rates have rebounded in recent months, the virus continues to challenge the fundamentals of the volume-based reimbursement environment.
Traditional fee-for-service healthcare was simply not designed to withstand such a disruptive event, commented Emily Maxson, MD, chief medical officer at Aledade, during a recent MGMA webinar.
However, value-based care models such as accountable care organizations (ACOs) can offer vital protection from the financial and clinical impacts of such a significant event. In ACOs, participating providers have the opportunity to earn financial incentives for meeting clinical quality and spending goals.
“With accountable care, providers don’t have to rely solely on the number of visits that come through the door,” she explained. “ACOs help providers diversify their business and protect themselves from uncertainty.”
Accountable care also helps to protect patients and ensure continuity of care, added Jennifer Brull, MD, a physician at Post Rock Family Medicine in rural Plainville, Kansas.
“Building and maintaining strong, proactive relationships with high-risk patients is a core component of accountable care,” she said. “That’s even more important during COVID-19, when preexisting conditions raise the risk of poor outcomes if a patient contracts the disease.”
“Even if patients aren’t coming into the office like usual, our ACO is staying focused on serving those patients with different strategies, such as telehealth. We already have the skills and strategies in place to stay connected in creative, data-driven ways. That’s a huge advantage.”
Leveraging telehealth to keep primary care practices thriving
Telehealth has quickly become one of the most important tools for PCPs looking to connect with patients and maintain their revenue streams amid the pandemic.
At Post Rock Family Medicine, remote consults have taken on a central role in the care delivery processes, said Brull.
“At the beginning of March, I was seeing an average of 28 patients per day,” she said. “By the last week of the month, I saw an average of 9 patients – and about 70% of those visits were by telehealth.”
“Aledade helped us go live on our telehealth platform within 24 hours of practice consent, which was critical for our business continuity and reassuring our patients that we are still available for everything they need. It brought real hope to everyone during a time when everything seemed uncertain.”
Telehealth allows patients with suspected or confirmed COVID-19 to communicate with providers safely from their own homes. Remote consults also support ongoing accountable care activities, including chronic care management, mental healthcare and Medicare Annual Wellness Visits (AWVs).
“When we think about reducing unnecessary spending and improving patient experiences, telehealth should be part of that conversation,” said Maxson. “It’s a very effective way to address many of the routine complaints of primary care that don’t necessarily need a hands-on consult. It’s also becoming very important for (behavioral) health – a huge concern during a time of such widespread change."
Proactively managing transitions of care
After a hospitalization or ED visit, transitional care management (TCM) brings numerous advantages to both patients and providers. TCM is a structured approach to care coordination that involves phone calls and visits designed to ensure patients understand their diagnoses, have access to medications and can care for themselves after a major event.
“TCM helps us understand what’s happening with our patients outside of the primary care environment,” said Brull. “We always want to make sure people land safely home after an event and that we know what happened in the hospital so that we can take care of them afterward.”
Post Rock Family Medicine uses the Aledade App to gain visibility into ED and hospital events so clinicians can reach out to patients within a series of timeframes prescribed by Medicare. Patient prioritization features ensure care teams connect to the individuals who need them most.
By working with high-risk patients quickly, providers can achieve two goals. First, they can improve continuity of care, bolster patient-provider relationships and avoid unnecessary costs.
Second, they can bill for specific TOC codes to earn enhanced reimbursement from Medicare and support the financial health of the practice – an added benefit for an activity that is demonstrably good for patients already.
“TCM gives us an added window into the patient’s world, which is so helpful for avoiding complications after an event,” said Brull.
Maintaining patient health with data-driven care management
Whether conducted by video chat, by phone, or in person, patient-provider conversations must be guided by timely and relevant data.
“Value-based care contracts come along with unprecedented access to data, allowing practices to see outside their walls, stratify patients by risk, and develop strategies to proactively identify vulnerable patients so we can conduct outreach,” said Maxson.
Access to complete, timely and accurate data becomes even more important during COVID-19. Along with advanced age, inflammatory conditions and some chronic diseases, including diabetes, high blood pressure and heart disease, can contribute to worse outcomes in patients with COVID-19.
“We found very early on that our providers were desperate for a way of understanding who among their flock needed extra attention during this scary time,” said Maxson. “Because all of our ACO partners have access to our App already and are used to working with the tool for their accountable care initiatives, we were able to develop and deploy a new COVID-19 vulnerability score relatively quickly.”
The vulnerability score helped to guide outreach and care for patients at risk of serious outcomes from the virus, added Brull.
“The vulnerability score toolkit emphasized four principles that align completely with our established approach to accountable care: educating patients about COVID-19, addressing chronic disease management, discussing what they should do if they got sick and making sure their socioeconomic needs are being met,” she said.
Brull and her colleagues focused particularly on medication adherence, which is challenging for many patients at the best of times.
“For quite some time, we have had data about patient refill patterns. We were able to take our existing medication adherence information and match it up against our high-vulnerability COVID-19 patients to see where there may be trouble spots,” said Brull.
“In many ways, this event has opened the door to really difficult conversations about social determinants of health. If you were struggling before the pandemic with paying bills or finding transportation, you can imagine how much harder it is to overcome those issues now.”
As COVID-19 continues to impact the US, accountable care stands out as a way to deliver high-quality care to patients while supporting the financial wellbeing of primary care practices.
With a range of innovative tools and strategies, including telehealth, preventive care delivery and data-driven workflow enhancements, PCPs can remain efficient, effective and proactive as they serve their communities.