Efficient and Effective Pathways to Value-based Care

By Dr. Kenneth Persaud

2021 Alliance sponsor feature article courtesy of Sharecare

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Partnering to Create an Expandable Framework
for Value-based Care Success

Summary:

White-Wilson Medical Center Fort Walton Beach, Florida employs 80 physicians and advanced practice clinicians and had a goal to move to value-based care contracts with payors to improve care and reimbursement.

About White-Wison:

Founded in 1946, White-Wilson Medical Center occupies a unique position on Florida’s Emerald Coast as the largest, multi-specialty, outpatient physician group in the region. With locations in Fort Walton Beach, Crestview, Destin, Navarre, and Niceville, White-Wilson has the community’s largest team of physicians, specializing in more than 20 areas of medicine. In addition to primary and specialty care, White-Wilson offers immediate care services for any urgent care needs at each of its clinics.

The amount we learned from Sharecare is incredible. I can’t say enough about how much they taught us about the value-based care business, the market, and how to apply that learning going forward. Sharecare has been crucial to that process.

Mark Wiacek, Chief Operating Officer, White-Wilson Medical Center

The challenge:

Decreasing reimbursements from the fee-for-service model was limiting growth in revenue and patient outcomes and satisfaction. It was critical to the practice to remain independently owned in a competitive market. Value-based care contracts with Medicare and other payers offered a path to greater growth and better patient care, but the White-Wilson team had no experience in this area and needed expert resources to help them drive these programs. They found that just hiring people didn’t work – they needed processes and technologies to support this transition to value-based care.

Creating an ACO involves putting a framework, including a governing board, into place to provide the coordinated, high-quality, efficient, and effective care that is the goal of the ACO program. The program also offers benefits to providers: when an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program. The program is not without risk, however, as ACOs that do not deliver effective care can lose money. Sharecare engaged as a full partner in this case, offering a contract that shared both risk and reward.

In addition, the coordinated care that is at the core of an ACO program increases emphasis on patient services that positively impact outcomes, such as wellness visits and transition care upon hospital release. These services also offer expanded opportunities for reimbursement and revenue growth.

Sharecare’s team offered expertise, guidance, processes, and technologies to support White-Wilson in their transition to value-based care. In 2016, White-Wilson started their journey by participating in the Medicare merit-based incentive payment system (MIPS), with Sharecare offering technologies that augmented the White-Wilson electronic health record (EHR) systems to produce the data required for value-based care. By 2017, the team had the data benchmarks they needed to create the White-Wilson ACO. In 2018, White-Wilson added risk-adjustment audit services to their ACO contract with Sharecare. By 2019, White-Wilson had won a value-based service contract with a major payor in the market.

Consultative collaboration was the key to success.

The augmentation of the White-Wilson EHR system with Sharecare technology bridged deficiencies in the EHR system to enable the value-based care reporting required by the MIPS program while putting off a costly upgrade to the EHR system that would otherwise have been necessary. The collaboration ensured that White-Wilson’s MIPS program stayed out of penalty and was awarded a “Top Performer” bonus.

The White-Wilson ACO, now serving around 100,000 patients, demonstrated quality improvement scores in the 94th percentile in each year, cost reductions of more than $3M over three years, and improved patient-satisfaction scores through the program along with over $6M in revenue on value-based payments with other payors. White-Wilson was able to put the necessary systems into place to ensure that they avoided penalties, and in those three years, 2017-2019, they saved between $700,000-$1,400,000 a year with Medicare.

White-Wilson’s ACO generated substantial revenue gains by doubling annual wellness visits and post hospitalization transition visits over the same period, with 2021 already on track to continue this trend. Most importantly, White-Wilson’s patients have received better, more coordinated, and effective care through these programs.

White-Wilson was able to develop payor-agonistic strategies and has already expanded the framework to private-payor value-based contracts. With this framework, they found that they could build an organization to manage a larger population and generate higher revenue without adding any full-time employees. In 2019, White-Wilson landed a sizeable multi-year agreement that will bring significant revenue to the practice. The momentum is built in the direction of more of these kinds of private-payor contracts in the future.

White-Wilson has adopted other Sharecare solutions, including diabetes management programs to optimize care, close gaps, and maximize revenue for their more than 24,000 eligible diabetes patients. The practice is also an early adopter of the Sharecare telehealth platform, which allows them to address patients’ important healthcare needs safely and conveniently remotely.

In the future, White Wilson is planning to expand to commercial private-payor value-based contracts and continue the partnership with Sharecare to offer more services to patients and expand revenue in key markets.

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Image 1 (left): Sharecare Value-based care patient population view
Image 2 (right): Sharecare Individual patient care gap closure view
(Click on each image for a larger view)

About Sharecare:

Sharecare value-based care enables payors to work with providers to offer the right care at the right time, improve population outcomes and the member experience while reducing per capita costs for healthcare. Sharecare is an all-inclusive value-based payments platform to help achieve better and more sustainable financial outcomes.

Sharecare offers the strength of many trusted individual solutions, with options to bundle each component and create unified actionable metrics that drive intelligent decision support for the entire healthcare ecosystem.

All together, better.

Want to know more about how to duplicate White-Wilson’s success? Contact us!

Improve Cash Flow, Reduce Receivables, & Improve Productivity with a Release of Information Provider

By Dan Bailey, Sharecare

Alliance sponsor article provided courtesy of Sharecare

Responding to payer requirements for copies of medical information to adjudicate claims has a direct impact on cash flow and carries the same risk for wrongful disclosure or inappropriate accounting of patient information released. The risks and operating costs surrounding Release of Information (ROI) for the Billing Office (Patient Financial Services) is no less daunting than that of the Health Information Management department. A true ROI partner can help covered entities improve their DSO (collection experience) and mitigate their risk.

Typical Challenges

This is a story you may know all too well. There are typical challenges a Billing Office faces while processing claims (W/C & MVA). The Billing Office starts by processing the claim and submitting it to the payer. When collecting on the claims, the payer requests medical records to support the claim. An uncertified Billing Office employee pulls medical records and submits the medical information to the payer. During follow up calls, the payer denies receiving the medical records. The Billing Office has to rework the request and resubmit the medical information. Follow up calls continue.

The Billing Office is also faced with fulfilling requests for Billing Statements. The risk is just as great when fulfilling these requests (typically from attorneys) as they also contain Protected Health Information (PHI).

Business Issues

In addition to the typical challenges faced by the Billing Office, there are also business issues to take into consideration. Cash flow is a big problem. When payment of claims is delayed, the impact to receivables is often unnecessary, and potentially significant. There is a productivity loss managing delays and denials. And there is risk of breach by uncertified employees submitting PHI. If paper records are involved, the process is further exacerbated by having to chase down these records. There are denials, delays, rework, rework, and more rework. Not to mention the space used by these non-revenue generating employees.

Requests for Billing Statements from attorneys are also being released without screening for sensitive content.

The Solution

A Release of Information service provider can improve this workflow by managing the claims process for fulfillment. A certified Release of Information specialist can abstract the corresponding medical information to support the encounter, screen for sensitive content, and submit the claim and medical record to the payer. If the Release of Information service provider has a secure portal, an electronic copy of the claim and medical information can be uploaded for the Billing Office staff to access. When the payer denies receiving records, the Billing Office employee can fax the supporting information directly from the portal immediately.

It’s plain to see how your cash flow can be improved, your receivables can be reduced and your productivity improved. The Billing Office staff can focus on the collection of claims and not the clerical support effort. The risk of a breach is mitigated, printing costs are eliminated, postage expense is reduced, and labor can be redeployed.

The same Release of Information service provider can support the requests for Billing Statements, thus eliminating the risk associated with this fulfillment process as well. And, all billing records are screened and fully tracked as required for Accounting of Disclosures.

Responding to payer requirements for copies of medical information doesn’t have to be so burdensome. Find a true Release of Information service partner, not just a vendor, who will work with you to streamline and protect this fulfillment process. A true ROI partner can help covered entities improve their collection experience while mitigating their risk and reducing operating costs.

About the Author

As Region President of Sharecare, Dan Bailey services over 700 client locations in New England. Dan built the Northeast region from the ground up in late 2002. Working in the electronic capture and conversion businesses for nearly 30 years, Dan has owned two separate companies built to provide solutions surrounding the management of medical information. Performing in leadership roles throughout his career, Dan has consistently performed at the highest levels maximizing both top and bottom line results. Dan grew up in Northern Minnesota but has resided in Beverly, MA since 1988. He is married with three children.