Increasing MCR and Consumer Engagement for a Provider Group

For this client, Lumeris collaborated to revise provider incentives to support transition to population health management. The payer was encouraged to compensate providers based on shared risk among the physicians. In order to manage their populations, the ADSP was provided, along with the tools to support Care Management. Care coordinators and staff were trained on the importance of member engagement using the Nine C’s®.

Client Profile

  • 49 PCPs
  • Full-risk contract
  • Combination of individual and group risk, plus quality incentives for PCP compensation

Opportunity:

  • Align hospital, medical group and payer to achieve population health management

Specific Solutions:

  • Continued collaboration to revise contract incentives to support transition to population health management
  • Encouraged compensation to align with payer contract to include shared risk among providers
  • Established processes to share comparative data, best practices and identify opportunities
  • Supported the investment in Care Management and care coordinators and trained staff on the Nine C’s®
  • Trained Care Coordinators to coordinate hospital and skilled care, high-risk patients and transition management
  • Enabled providers to perform Enhanced Encounter® assessments on high-risk patients

Outcomes:
Cost

        • 67% follow-up after high-risk discharge
        • 6% reduction in inpatient utilization
        • 4% reduction in hospital length of stay
        • 8% fewer ER visits compared to other risk medical groups
          * Results per 1000 from years 2010-2013

Quality

                    • Highest performing group on 8 out of 12 HEDIS® contract metrics

Patient Satisfaction

                    • Over 98% of patients seen annually
                    • Increased care alignment
                    • Reduced out-of-network usage

Physician Satisfaction

                    • 66% MCR (before physician compensation distribution)
                    • Savings shared among plan, providers and hospital
                    • Resources available for investment in population health management