What educational background should the health coach have? The education of your health coaches depends on the role you expect them to play. For example, if your health coaches are going to provide clinical education, a nurse or social worker may be a good option. If the health coach will reinforce the physician's plan of care and use phone calls to keep patients committed to their treatment regimens, someone without a clinical license could acquire that skillset.
Quantify impact and continuously improve Step 1 Identify your patient population and opportunity Quiz Ref ID Knowing your patients is the foundation of value-based care.
Patient populations that have the highest risk of hospitalization or are high utilizers of the emergency department ED tend to drive high health care costs and most often receive fragmented care. These populations include poly-chronic patients—those with chronic and complex conditions with multiple co-morbidities, such as diabetes, heart failure, cancer, kidney failure and chronic obstructive pulmonary disease.
Understanding which patients are driving your highest cost of care and are frequent utilizers of the ED will help you identify your target population and opportunities for improvement.
Once you have this information, you can begin to develop your model. What techniques can I use to hone in on the right patient population s? You can use private or commercial tools to identify the target patient population.
Using population health analytics from your own Electronic Health Record EHRa patient registry or other population health technology can help you target critical diagnoses and determine which patients need immediate intervention.
If you have the capital, you may also consider purchasing analytic software that can develop predictive risk stratification models or help you define priority based on volume. Regional health improvement collaboratives often maintain multipayer claims databases that can assist in this analysis.
Capturing the top five to fifteen percent highest risk patients from your current population will help you identify those at risk for future high health care costs. For more information on developing population health management techniques in your practice, see the panel management module.
Physicians may also want to consult with payers to identify patient population targets. Are there other considerations I should make when evaluating opportunities to implement value-based care?
Fast-start technology roadmapping Prague Thursday 9th October , - Dr Robert Phaal Useful references Implementing roadmapping Individual planning & discussion See planning sheet: Objectives, scope, stakeholders, architecture, process, information sources, key issues, next steps Individually (or with colleagues) work through ‘planning sheet’ - 10 minutes Pull out key points. Change the Script. Change the Script is a statewide program that connects town leaders, healthcare professionals, treatment professionals, and everyday people with the resources they need to face prescription drugs and opioid misuse. 1 Identify your patient population and opportunity. Knowing your patients is the foundation of value-based care. Patient populations that have the highest risk of hospitalization or are high utilizers of the emergency department (ED) tend to drive high health care costs and most often receive fragmented care.
Patients in the practice whose conditions are not adequately controlled are more likely to cost your practice through no-shows, are less likely to adhere to their medications and may call in more frequently for medication refills than patients whose conditions are well managed. Downstream effects to consider beyond ED and hospitalization costs include home health costs, durable medical equipment DME costs, the need for referral to skilled nursing facilities and pharmaceutical costs.
Does my patient's insurance plan matter? A patient's insurance plan does not and should not influence the quality of care patients receive.
However, the reality is that the insurance plan does impact referral patterns and benefits that can be offered to the patient in order to keep his or her out-of-pocket expenses to a minimum.
Additionally, insurance plans will have different quality metrics tied to value-based care. The way the practice is paid also impacts its focus where services are traditionally paid based on utilization of individual services.
Transitioning to new models is one way to financially support a new emphasis on value. Step 2 Design the care model Develop care models that are evidence-based and easy to follow.
You can consider the following elements in the development of your value-based care model: Identify the target patient population s. Identify which payers will be involved. Estimate how the type and volume of services will change. Identify the benefits expected for patients and payers.
Design the workflows required to provide the desired care to the selected patient population. Staff who will support the new model Roles and responsibilities of each physician and their support team Frequency of patient contact via phone call, email or portal messaging Frequency of patient visits to the practice Identify measurable success metrics for each population and determine your baseline in order to quantify your impact in the future.
Your metrics should be easy to capture in the EHR or population health registry to prevent having to manually extract them. Identify transition costs as a note, revenue needs to be addressed as well as risk-stratification. Depending upon the caseload and capabilities of your team, current team members could potentially fill the staffing needs of the new value-based care model with proper education and redistribution of responsibilities.
Utilizing current staff can be cost effective during the initial transition period, but additional staff may be needed as the model continues to be adopted by the practice, particularly since these new value-based models rely on effective care coordination and require a greater amount of data capture and analytics.
Quiz Ref ID Roles of the team members who care for patients in the model could include: Patient outreach coordinators Non-clinical team members who can utilize patient registries and analytic tools to reach out to patients who need:Having a well written and researched private practice business plan is a key step in gaining the medical loan you need to fund your business needs.
Some practices have recognized a positive business case for health coaching. This depends on several factors: Payment model, for example, a value-based payment model will incentivize focusing on outcomes, which can be impacted by health coaches and other team members; Availability of revenue from patient-centered medical home (PCMH) certification and/or pay-for-performance (CCM Code, .
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