Leveraging payer data to close care gaps for value-based care

DTC Family Health: Leading the value-based care charge

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 Dr. Lynn Joffe, M.D. co-founded DTC Family Health in south-metro Denver in 2002, her 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’re seeing a huge move currently towards value-based care, where the patient and the whole patient is valued.” Dr. Joffe said. “We realized that if we did it right, we suddenly had an opportunity to be reimbursed fairly for our work.”

Navigating value-based care with the right partners

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

athenahealth offers athenaOne primary care-focused practices and health centers multiple levers of value-based care support, including access to a Marketplace of connected ACO partners, including Aledade. Though athenaOne clients are welcome to join any ACO of their choice, benefits of selecting an integrated ACO could include:

• Data access and reporting obligations from your practice to your ACO are handled automatically, with no effort needed from you
• Key patient care information from your ACO, such as care and diagnosis gaps, are automatically present in athenaClinicals, at the point of care
• You can easily access key insights from your ACO, such as Annual Wellness Visit templates and high-value referral networks, where you need them within existing workflows
• Working with ACO staff who have been trained in best practices by athenahealth’s coaching team
• Your athenahealth CSM closely coordinating with your ACO to ensure your success

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. “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 right information surfaced in the right place

The athenahealth EHR brings payer data and diagnosis information to the point of care to bridge potential gaps. 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.

“athenahealth is getting payer data,” Dr. Joffe said. “They’re getting information from other sources that we don’t necessarily see. So they’re able to give us a bigger, broader picture of our patients and their true health status.”

According to Dr. Joffe, this approach of not only pulling in this data but also surfacing it right at the point of care has been, “really effective in enabling us to bring forward patients who are at risk and identify patients who need additional TLC.”

Tapping into a network of support

DTC Family Health’s partnership with athenahealth and with Aledade creates a network of support and information that frees physicians up to focus more on the patient in front of them. As Dr. Joffe puts it, “I think both athenahealth and Aledade are really working towards taking a lot of the workload off the clinician. Decreasing the clicks, being more intuitive, and bring in more AI systems.”

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

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