Practice Management Solutions: The Key to Efficient Primary Care Delivery
It’s no secret that it is a difficult time to be a primary care provider (PCP) in the United States. Primary care practices are being asked to treat more and more patients—while reimbursement levels shrink. These practices need practice management solutions that drive efficient care delivery under these pressures. In this commentary, we’ll outline some of the challenges facing primary care practices today. Then we’ll discuss how practices can face these challenges successfully.
The Primary Care Conundrum
Our country is on the brink of a primary care access crisis. Here’s why.
Many areas of the nation are experiencing a primary care provider (PCP) shortage. Trends indicate that this shortage isn’t going away anytime soon. The Association of American Medical Colleges predicts that our nation will need 45,000 more PCPs by 2020. But the number of medical school graduates opting to pursue primary care specialties has steadily decreased.
At the same time, the demand for primary care access is expected to grow exponentially. This increase is driven by:
- The aging baby boomer population. By 2030, the Medicare-eligible population is projected to grow to 69.7 million—compared to the 35.1 million documented in the 2000 census.
- An increase in the incidence of chronic diseases (particularly multiple comorbid conditions among the aging population). Currently, more than 80 percent of Medicare patients have one or more chronic conditions. More than 20 percent are treated for five or more chronic diseases. Multiply that by the growing Medicare population and the numbers becomes daunting.
- An influx of newly insured patients into the healthcare system as a result of the Affordable Care Act. Some estimate this figure to be 32 million new patients.
This strain on primary care is paralleled by an increased emphasis throughout the healthcare industry on population health management. Population health management seeks to reduce the number of patients treated in emergency rooms and inpatient settings by doing a better job at preventing, identifying, and managing health problems throughout the community.
This emphasis on prevention is a wonderful thing. It is designed to keep people healthier and reduce costs while increasing the quality of care. But population health management involves a shift from care centered in the acute environment to care centered in the ambulatory space—and puts more responsibility on primary care practices.
PCPs are already busy. On any given day, a practice scrambles to coordinate scheduling, assess patient needs (before, during, and after an appointment), refer to specialists, collect clinical information from a variety of sources—while being paid less per patient visit. Then, at the end of the day, the provider must document all of this activity in the EMR to meet documentation and billing requirements. Because it adds to their work burden, the electronic medical record (EMR), which was supposed to help practices take better care of their patients, has become an object of frustration for many clinicians and staff.
It’s no wonder the thought of taking on a larger patient panel is a daunting prospect for many practices.
Making Population Health Management Possible
What every primary care practice must ask is: how can we treat more patients while increasing the quality of care at the same time?
One of the best ways to tackle this challenge is to make sure that every member of a clinic’s staff is empowered to operate at the maximum level of his or her qualifications. This means creating dynamic care teams where each member of the practice contributes to streamlining and improving the patient care process.
For these teams to succeed, a system for coordinating care across the patient panel is necessary. And that’s where technology solutions come into play. Imagine having a solution that combines data from the EMR, lab systems, pharmacies, financial systems, human resources, the supply chain, and more—and then operationalizes it so that your practice runs more efficiently. A solution built on the foundation of a healthcare enterprise data warehouse (EDW) can do that.
Here are just some of the things an EDW platform with analytics applications can do to help practices operate and manage populations more efficiently:
- Generate near real-time lists of patients who aren’t compliant with recommended, evidence-based care guidelines.
- Show clinicians and staff a patient’s health status at a glance—particularly any gaps in care that need to be addressed. With this information in hand, staff can efficiently and accurately manage the patient’s visit. And physicians know exactly what to focus on during their one-on-one time with the patient.
- Increase efficiency and accuracy of working with healthcare data, allowing more time for the PCP to address the reasons why the patient scheduled the appointment. Decreasing the need to hunt and peck for data gives the provider a few extra minutes with each patient—with the added benefit of improving the overall patient experience,
- View clinical, operational, and regulatory information about your patients all in one place.
- Track and manage patient volume. You can track how many patients visit each clinic in an organization. You can examine how full each provider’s panel is and compare that to staffing and other operational metrics. You can sort by care coordinators and see how many patients each one is responsible for. You can analyze each provider’s patient mix and severity indexes to assess productivity and balance panel size.
- Analyze performance of your patient panel as a whole—and your performance on various regulatory measures. Many solutions allow you to view and assess a population affected by a certain regulatory measure. The limitation of such solutions is that they can only present those specific populations. Very few solutions enable you to assess the health of your patient panel as a whole and your performance on any number of regulatory measures. An EDW platform and analytics applications feature sophisticated filtering logic that lets you view your entire patient panel and then filter down to see how you stand with different regulatory populations.
- Drill down into data for further insights into practice performance. Being able to report about your practice’s performance on regulatory measures is one thing. Being able to drill down into the data to understand what is affecting your performance on these measures is another. An EDW platform enables you to analyze data to discover the root cause of any performance shortfalls.
Health Catalyst’s healthcare enterprise data warehouse and analytics applications are helping primary care organizations efficiently manage the health of their populations and increase their practice’s operational efficiency. You can learn more about how our solution is transforming primary care at:
- Using Advanced Analytics to Manage Population Health in Primary Care Clinics
- Improving Population Health Through the Use of Data and Reporting
- Landmark Review of Population Health Management Companies
- Population Health Management: Implementing a Strategy for Success
What has your organization done to tackle population health management? Do you have the infrastructure in place to manage a larger patient panel?
1. http://www.wsj.com/news/articles/SB10001424052702304506904575180331528424238, accessed February 6, 2014. 2. http://content.healthaffairs.org/content/23/2/282.2.full, accessed February 6, 2014. 3. Anderson GF. Medicare and Chronic Conditions. Sounding Board. New England Journal of Medicine. 2005 July 21;353(3):305-9 4. http://medicaleconomics.modernmedicine.com/medical-economics/news/modernmedicine/modern-medicine-feature-articles/affordable-care-act-brings-in, accessed February 6, 2014.