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Physician engagement key to value-based contracting

By Shannon Geis
March 2, 2017
Body of Knowledge Domain(s): Financial Management

As the healthcare industry moves toward value-based compensation, many practice administrators may be wondering if they should just wait until they have to switch.

“No,” says Max Reiboldt, CPA, MGMA member, president and chief executive officer, Coker Group, Alpharetta, Ga. “That’s not a good idea for anyone at this point.” He says the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has started to change the dynamics, with the industry moving to a value-based system.

If you make the move toward value-based contracting, there are a few things that you should have in order before you do, according to Mac Knight, MD, MBA, senior vice president and chief medical officer, Coker Group, Alpharetta, Ga. “Clinical integration between your providers is absolutely necessary,” he says. He also recommends that if you are going to work with a hospital system, that the hospital and the physician have aligned intentions. “Not only must you produce high quality care at a lower cost – you will be at risk for doing so, so make sure you can deliver,” he says. 

There are a number of key capabilities that Knight recommends a practice have in order to deliver high value. One of the most important is engaged physician leadership. “Physicians are in the best position to drive quality and efficiency,” says Knight. “Without them, the switch can’t occur.” He also emphasizes the importance of having a care management program, including care coordinators, chronic care managers, wellness coaches and social workers. “Value-based care is truly a team sport,” he explains. 

If you are a primary care practice considering a switch to value-based compensation, Knight recommends the Comprehensive Primary Care Plus (CPC+) program. “This is an example of a true population health management-type reimbursement model,” he says. It promotes innovation and incentivizes primary care to practice capitated population health management, according to Knight. 

The key to implementing a capitated population health management contract such as CPC+ is to train primary care providers in the essentials of population health management. Practices also must engage patients before the patients engage them, says Knight. “You can no longer passively engage with patients; you have to be proactive.”

Check out our recent webinar, “The Perils and Pitfalls of Value-based Contracting” (available on demand), to hear more of Reiboldt and Knight’s tips on value-based contracting.

Shannon Geis, Staff writer/editor, MGMA

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