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Responding to a pandemic requires both public health and population health approaches.
Many of the capabilities that providers have implemented to maintain the health of their communities during COVID-19 are population health activities. From engagement via telehealth to risk-stratification of patients, these capabilities are routinely employed by providers in alternative payment models (APMs).
It’s little surprise, then, that in a survey this spring, Premier found that participants in APMs heavily relied on their population health capabilities to manage the COVID-19 pandemic and keep people staying at home healthy. Providers’ population health aptitude allowed them to leverage existing partnerships across the continuum of care, as well as claims data, to coordinate the care of their patients more rapidly than their counterparts.
More providers in APMs are employing strategies to recoup revenue in reopening, compared to others, per Premier’s survey. Some of these strategies include creating patient backlog plans (91 percent of APM participants versus 66 percent of others) and communicating plans to convey to the community when it is safe to seek care in facilities (85 percent versus 62 percent). As with managing populations during the crisis, more providers in APMs are also using historical data to define reopening needs (56 percent versus 35 percent).
The survey illuminated that providers see enhanced data analytics as a critical component to the new normal, managing demand for services, matching resources with patient needs, forecasting patient volume and mitigating risk for specific patient populations. And, it showed there is no time like the present to accelerate movement into a value-based care model. The country is facing unprecedented levels of deficit spending and a more rapid trajectory to insolvency of the Medicare Trust Fund. These organizations are future-proofing for a world with payment cuts in FFS and an emphasis by Medicare for providers to accept two-sided risk. Several of Premier’s member health systems noted they are using the reopening phase as an opportunity to accelerate population health redesign across their continuum.
Many APMs are built on a FFS chassis in which participant providers receive FFS payment, and costs are retrospectively reconciled by the payer. While APM participants have received provider relief funds, many will not be able to close revenue gaps created this year due to the decrease in encounters.
Additionally, the APM entity may face financial difficulty due to the surge in COVID-19 patients and the added cost associated with higher acuity patients who will now be seeking care as providers and facilities reopen. According to the survey, 54 percent of respondents in two-sided risk APM models across all payers anticipate incurring losses that must be paid back to some payers.
While Centers for Medicare & Medicaid Services (CMS) APMs have COVID-19 mitigation approaches in place, providers in APMs need COVID-19 mitigation approaches across all payers, as well as continued adjustments of these programs moving forward. These changes should reflect the evolving clinical and financial experience induced by the pandemic, both now and going forward – including programmatic elements such as financial expenditure benchmark setting and adjustment, and risk score and attribution methodologies.
Providers are giving consideration to the temporary regulatory flexibilities that CMS rolled out during the pandemic should be made permanent, and last week, President Trump signed an executive order to expand access to telehealth services during the pandemic. Premier’s survey showed that telehealth flexibilities (93 percent of respondents) and workforce flexibilities (59 percent of respondents), such as physician supervision and scope of practice requirements, ranked as top flexibilities providers wish to maintain after the public health emergency.
Providers in APMs have long been focused on strategies that help advance appropriate and necessary care, and empower the patient with methods, partnerships and tools to manage their health. COVID-19 has yielded a greater propensity for providers toward risk-based models. Population health strategies are ones the industry should continue to spread – and incent – moving forward.
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