Who is responsible for the care of a patient? This seemingly-simple question has become increasingly complex, and population health initiatives, such as Epic’s Healthy Planet, can act as a catalyst for improving the process of patient attribution.
Payors have typically defaulted to a response of “close enough.” Never seen the patient before? Close enough. Patient is deceased? Close enough? Most of the attribution is correct, so, for the purposes of the payor, their attribution is close enough. For a care provider or hospital system? Close enough is not good enough.
As you begin to plan a population health initiative, here are some things to consider:
Who are the decision-makers? There will be an initial need for a group to meet regularly to define policy and workflows. This group will typically need representation from leadership, providers and specialists, managers, and care coordinators. It could also include representation for nurses, reception, billing, and others, depending on your organization’s workflow decisions.
Who is “responsible” for the patient? Is it always a PCP? Are specialists responsible for chronic conditions (e.g. the Endocrinologist manages all diabetic care), is the PCP, or is that responsibility shared? Are patients of a specific payor/ACO attributed differently? Does your organization have care coordinators? If so, what is their responsibility? Is geography consideration? And, of course, what are the capabilities of your EHR? If you’re using Epic 2015 or 2016, there are a variety of options; on older versions, organizations are much more limited. This will certainly play a factor in decision-making.
Who is responsible for maintaining this information in the EHR? In our experience, this decision can be even more difficult than the previous ones. At every point of contact, there is the opportunity to verify and update care team information. Your organization will need to determine which users can/should keep the information current, which users should be proactive in soliciting this information from the patient, and who, ultimately, is the source of truth (hint: the patient is not 100% reliable).
What is the internal appeals process? Sorry to be the bearer of bad news, but no matter how much time is spent determining appropriate patient attribution, it will never be perfect. When Dr. A suggests that Dr. B should be responsible for a patient’s care, and when Dr. C points out that he hasn’t seen a particular patient in three years, how will your organization address this? At least initially, regular meetings of the decision-making group will probably be necessary as the process is streamlined.
Most importantly: What principles will the organization use to make these decisions? There are a number of ways to evaluate and prioritize. Our recommendation is to stay focused on how to best care for the patient. If that is the goal, the other priorities (MACRA measures, ACO metrics, etc.) will be addressed.
Every organization is different, and has different requirements; however, being prepared to tackle this issue while implementing Healthy Planet, or any population health initiative, addresses an important component of success. Optimum would love to help you reach your goals – if you have any questions don’t hesitate to contact us.
