As more in healthcare move to value-based care models, independent physicians will need to find ways to keep track of the data and analytics needed to avoid lower reimbursements. Luckily, Shawn Purifoy, MD, owner of the Malvern Family Medical Clinic in Malvern, Arkansas, has found a solution for him.
His clinic is part of the Aledade Arkansas ACO. Aledade is a healthcare IT and services firm paid based on outcomes. It partners with primary care physicians to build and lead accountable care organizations that allow doctors to remain independent and thrive financially by keeping people healthy, Aledade said. The company operates ACOs across 11 states and in partnership with more than 110 practices.
"Value-based care is the primary focus of the work being done within the Aledade ACOs," Purifoy said. "As an independent, solo practitioner, I would be struggling to keep up with the rapid changes in the healthcare world. I joined Aledade because I want to remain independent."
Purifoy doesn't have a hospital or multi-specialty group to provide data and analytics and can't always count on the state medical society to support the clinic.
"Aledade provides the support and data analysis to help me continue to practice medicine independently," Purifoy said. "Our incentives are parallel, and I don't think I would be able to do this type of work on my own."
Malvern Family Medical Clinic's care manager uses the Aledade App on a daily basis to identify which of the clinic's patients have been in the hospital, either as an inpatient or in the emergency room. The clinic then can use the app to create call lists and reach out to these patients to get them into the clinic for follow-up in order to prevent readmission or a return to the emergency room.
Purifoy also uses the app to identify high-risk patients in order to help select them for chronic care management, when appropriate. Prior to Aledade, Purifoy said, the clinic had no actionable way to manage these patients until they showed up in the office.
The technology and services have the potential to reduce the time Purifoy spends working with paperwork and bureaucracy.
"One of the problems with healthcare today is the massive amount of forms and paperwork that seems to be growing exponentially," Purifoy said. "Every governmental agency and every different insurance company seems to have its own set of forms and requirements. I don't think any form of technology has figured out how to fix that problem."
What Purifoy will say, though, is Aledade is trying to help its practices streamline the process of duplicating work in different venues with one central application.
"As the concept of value-based care becomes more prevalent in the marketplace, Aledade should be able to help practices by leveraging their influence with payers," Purifoy said. "For instance, when an Aledade ACO can show a payer that the work they are doing is of high quality and cost-efficient, that payer might be more open to decreasing the requirements for things like pre-certifications for radiological tests, or prior authorizations for certain medications."
In this way, the work at the provider level is lessened while the outcomes are still favorable for patients and for the insurance company, Purifoy said.
The ACO technology has given Purifoy greater visibility into where the clinic's patients are receiving other care outside of the clinic, which is very important for Purifoy to know. But what's more, Purifoy also can see the cost of that other care.
"This is accomplished through claims data from CMS," Purifoy explained. "This allows me to identify duplicative labs, low-value procedures and services, and also differences in charges between specialists. I can identify care gaps and even see if a patient has had their flu or pneumonia shot at a pharmacy, as long as a claim was sent to Medicare."
Sometimes patients use more than one physician within the same specialty field. Prior to the ACO, Purifoy was never aware of this. Now, Purifoy can use this information to educate patients and cut unnecessary services and costs. It enhances Purifoy's role as the patient's primary care physician, something to which Purifoy has found patients very receptive.