News

Joining Western Clinical Alliance

By Melissa Panks, Director of Network Performance at Renown Health 

As we continue our journey to value-based care, we are excited to announce our open enrollment period to onboard new community practices and providers will be Sep. 15 – Nov. 15, 2021.

In preparation for our 2022 performance year and open enrollment period, we want to share with you the benefits providers and practices receive when they join Western Clinical Alliance.

  1. Access to Data: Members of Western Clinical Alliance have access to multiple data reports. These include a Per Member Per Month (PMPM) Analyzer, a Western Clinical Alliance Performance Dashboard and a Provider Comparison Report. Learn more about data sharing through Western Clinical Alliance here.
  2. Care Coordination: Western Clinical Alliance members have access to care coordinators to help manage at-risk patients. The care coordination team can provide “wrap-around” services such as post-visit follow up calls to patients, community resource identifications and more. These “wrap-around” services and better coordination of care aim to exceed people’s expectations for access and affordability.
  3. Electronic Medical Records Through Epic: Renown Health offers members of Western Clinical Alliance the opportunity to join the premier electronic medical record system, Epic. Through this program, Renown is able to offer scalable solutions to partners that result in greatly enhanced patient, provider and practice experience. If you would like to learn more, please email Josiah Dixon, Director of EMR Outreach at Renown Health.
  4. Population Health Statistics: The Healthy Nevada Project is one of the largest community-based population health studies in the world, with over 50,000 Nevadans already signed up. The Healthy Nevada Project is looking to healthcare leaders in the community to bring the impact of this project to a new level. By combining genetic, clinical and environmental data the Healthy Nevada Project can deliver personalized, actionable results to participants. This includes their risk for certain cancers and heart disease in an effort to enable quicker disease diagnosis and more precise treatment for community members and generations to come. As a member of Western Clinical Alliance you have the ability to provide your patients’ materials regarding the Healthy Nevada Project in your office. To learn more, please email RenownIHI@renown.org.
  5. UNR Med Affiliation: The University of Nevada, Reno School of Medicine and Renown Health have affiliated to establish the first fully integrated health system in Nevada. This affiliation is a 50-year commitment for combining the clinical practice, teaching and research programs of both institutions. Learn more about what this means for our community here.

Open Enrollment Details: The open enrollment period to apply to join Western Clinical Alliance is Sep. 15 – Nov. 15. We are excited to increase our membership and continue our journey to value, improving patient experience and outcomes.

To provide the information potential members need to consider joining Western Clinical Alliance, two Town Halls will be offered to provide an overall update as well as the opportunity to discuss details around participation. More information will become available when these Town Halls are scheduled. If you have any questions, please email Melissa Panks, Director of Network Performance at Renown Health.

 

Increasing Access to Data

By Dr. Bret Frey, Contract Performance Committee Chair of Western Clinical Alliance 

Through Western Clinical Alliance, a clinically integrated network (CIN) powered by Renown Health, physicians and practices maintain their private status and operational autonomy while sharing the benefits available through Renown. One of the benefits available to members of Western Clinical Alliance is data sharing.

There is now new data available for Western Clinical Alliance members! Here is what is now available:

Western Clinical Alliance PMPM Analyzer

The PMPM Analyzer tool provides access to paid claims data from the payer (currently Hometown Health). This tool allows for:

  • Analysis on claims spend and utilizations of our CIN members.
  • Identifying opportunities to shift utilization to a lower cost of care.
  • Straifying CIN members into different categories of risk to identify high utilizers who might benefit from care coordination.
  • Analysis of healthcare utilization by Care Progress Families and disease groups to determine which services would help decrease emergency and acute encounters.

LeadingWisely WCA Performance Dashboard

This dashboard monitors Western Clinical Alliance’s key performance indicators (KPIs), which are the outcome measures aligned with the strategic goals of the CIN. 

Provider Comparison Report

The Provider Comparison Report provides a high level comparison by specialty, group and provider for the members they have seen based on claims data. This tool allows for:

  • Network analysis to determine which specialty and provider groups receive the most healthcare claims activity.
  • Comparison of the average member risk between different provider groups for the patients they have cared for.
  • Identification of the provider groups who have had a positive impact on managing the total utilization of the members they have cared for.

 As part of our compliance guidelines, each participating must print, sign and return this Data Use Agreement to Melissa Panks prior to viewing the data. After receiving the completed Data Use Agreement, a notification will be sent out to each provider confirming access to the data tools has been approved. Please be aware this process can take between two and three weeks. Instructions will also be provided on how to navigate the tools via Citrix.

Western Clinical Alliance is very excited to offer these reports and dashboard to members and continue our journey to value.

 

Building Relationships to Improve Care

By Dr. Rahul Mediwala, Chief Medical Officer, Health Services, Renown Health

Health care organizations and hospitals across the nation are in the midst of transitioning to value-based care. The new “value-based” care system bases care providers’ pay on quality of care, health outcomes and patient satisfaction.

A value-based system will help improve health outcomes for our patients and our community while also driving down the costs of healthcare services. Renown Health has implemented the Building Relationships to Improve Care (BRIC) model as part of the roadmap to help transition services to value-based care. The BRIC model is also a driving force to exceed people’s expectations for access and affordability.

Renown Medical Group plans to structure primary care clinics using the BRIC model to support patients with “wrap around” services, such as post-visit follow up calls to patients, community resource identification, and more. These “wrap-around” services will better prepare teams to navigate patients through the healthcare system, improving our patients’ experience.

Providing these “wrap-around” services aims to drive down the cost of providing care as well as make services more affordable to patients. This also aims to help Renown Medical Group – Primary Care grow their services to provide high-quality and efficient care to more people in our community.

The BRIC model is also using innovations Renown has already put in place to help patients. For example, the pilot genomic medicine program (Renown’s Healthy Nevada Project) is being tested in primary care offices. Learn more about how providers and practices can partner with the Healthy Nevada Project to help patients.

As we continue the transition to value-based care, the BRIC model aims to give providers more time with patients, ensuring patients get all of their questions answered and leave feeling confident in the care they are receiving. Transformational change is not easy – but putting the patient at the center is worth it.

Welcome from Tony Slonim

We are excited to have you and your practice be a part of this groundbreaking endeavor to enhance the value of care delivered to those within our community.  Over the past 9 months, we have created northern Nevada’s premier clinically integrated network.  This could not have happened without tremendous support and involvement from community providers.

We are thankful for our medical community’s passion for value-based care.  As we work together in this journey, we value your input. We will be open in our lines of communication and committed to continued investments in driving population health.

One of our first steps to opening these lines of communication is developing an ongoing newsletter.  We are looking forward to sharing great topics about value-based care and thoughts from members of our board and team who have been working behind the scenes to stand up Western Clinical Alliance.

Our hope is to have a regular cadence of communication and we invite participation from physicians and practices in development of the content for this newsletter as we move forward.  If you have topics you would like to see or stories you would like to share in future editions, please contact Lyndsey West (Lyndsey.west@renown.org) with your ideas.

Again, we thank you for the amazing work you do every day to deliver outstanding care to people throughout our community.  This journey will not always be easy but we look forward to being in it together and are excited about the future.

 

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Healthy Nevada Project: Prevent, Plan, Live

By Heather Braginton, Genomics Representative, Healthy Nevada Project

The Healthy Nevada Project is a population health study that is combining genetic, clinical and environmental data in new ways to deliver personalized health data to participants. By giving a simple saliva sample, participants receive a no-cost genetic screening test that can detect genes linked to heart disease and certain cancers.

The Healthy Nevada Project is partnering with Western Clinical Alliance to achieve our goals of improving patient outcomes, bettering population health and lowering the total cost of care. By working together with physicians and practices like those in Western Clinical Alliance, we can deliver on the future health needs of our community. With a simple genetic test, patients and physicians can become aware of unique health needs for their patients and take a step closer to making us a healthier Nevada.

Want to learn more about how your practice can be involved in the state’s largest population health endeavor? Learn more about how the Healthy Nevada Project can help your patients and improve outcomes, please contact Amberly Diets, Renown Health Director of Clinical Research & Genomics by phone or email.

 

We encourage you to participate and spread the word about the Healthy Nevada Project. Visit HealthyNV.org to learn more about how the study has already helped patients in our community or to register to participate in the study. All Nevada residents 18 years of age and over are eligible to participate.

The Importance of Value Modifiers

By: Dr. Bret Frey, Contract Performance Committee Chair of Western Clinical Alliance & Karen Massey, Executive Director, Emergency Physicians 

Focusing on controlling costs and improving patient outcomes are important goals of Western Clinical Alliance. These goals highlight the need for alignment in provider compensation and a shift toward value-based payment structures. Through a value-based payment structure providers are paid based on the quality rather than quantity of care provided and support three main goals:

  1. Improve care for patients
  2. Better health in populations
  3. Lower total cost of care

To effectively move to value-based payment structure, selecting value modifiers is an important place to start.

How Do Value Modifiers Work?

In general, most physicians are paid based on production charges, usually reflected in relative value units (RVU). A value modifier associates a value component to RVU and allows the practice to better align with value-based contracting. This structure mimics how the Centers for Medicare and Medicaid (CMS) now pays physicians with their merit-based incentive program (MIPS). A physician’s payment is modified by a percentage based on the physician’s performance against certain measures. Within a clinically integrated network, like Western Clinical Alliance, this can make a significant financial difference to the bottom line and create a triple win for the patient, the practice and the network.

For example, if a physician generates 1,000 RVUs/year but has poor metrics, a value modifier of 5-10% could help that physician improve in the areas which are mutually beneficial to the practice and the Western Clinical Alliance. If that physician doesn’t improve and continues to be an outlier with poor metrics, the group could say that physician’s “value-based” production was only 900 RVUs (less 10%). In contrast, a physician who has improved and has excellent metrics could be compensated 1100 RVUs (plus 10%).

The idea behind choosing a value modifier and the value-based compensation model is that revenue is neutral within the group. If everyone meets the thresholds of performance set by the group, everyone receives 1000 RVUs. Well-chosen thresholds can help ensure neutral revenue for all physicians while providing higher quality, overall patient value, and shared savings distribution.

Selecting Value Modifiers

Access to relevant and reliable data, and understanding and identifying appropriate metrics are important steps to selecting a value modifier. The value modifier selected for each group will vary and depend on the group’s specialty and their chosen goals. For each group that adopts this approach, they should tailor it to what makes sense for their practice based on these considerations:

  1. The group’s current compensation structure
  2. What is a valuable measure in their specialty
  3. What fits within the group’s culture

Groups that have adopted the value-modifier and value-based payment structure approach have identified the following key components to success:

  1. Create a small committee of respected physicians to select the value modifier
  2. Identify measure that are both relevant and reliable
  3. Commit to an accountable feedback loop and realistic thresholds with clear messaging that helps everyone succeed

Adopting this approach can help practices modify their compensation model, improve patient outcomes which aligns with the goals Western Clinical Alliance has set for 2021 and beyond with respect to high-value medicine. The risk of not adopting this approach or using an in effective value modifier is that providers who are historic outliers with poor metrics may continue to practice in a misaligned way in the manner they are accustomed, making it a challenge to best address low-value and high-cost medicine within a practice.

Physicians have always had the patient at the center of their daily mission. The value modifier is a way to encourage physicians to improve and continue value-based care and keep the patient at the center of their health care journey.

Benefits of Clinically Integrated Networks

By Bethany Sexton, Chief Transformation Officer, Renown Health

Across the United States, doctors and hospitals are implementing clinically integrated networks not only for reasons of antitrust compliance, but also for the benefits to physicians, hospitals and patients.

Western Clinical Alliance, a clinically integrated network powered by Renown Health, is a collaboration of healthcare providers improving patient care, patient outcomes and better managing the total cost of care.

Physicians and practices maintain their private status and operational autonomy while sharing in the benefits available through Renown, including: improved coordination and the opportunity to experience new levels of transparency in data sharing, goal setting and collaborative clinical decision making. In addition, Western Clinical Alliance has access to services like electronic medical record platforms (such as Epic) and group purchasing discounts.

Clinical integration allows physicians to:

  • Demonstrate quality to current and future patients;
  • Develop clinical measures;
  • Pursue enhanced revenue through better management of chronically-ill patients;
  • Access collective support services and infrastructure;
  • Seek appropriate reimbursement that reflects the higher demonstrated value furnished to patients and health plans.

Clinical integration gives hospitals the ability to:

  • Demonstrate quality to current and future patients;
  • Enlist physician support for hospital initiatives, including compliance with “core measures,” clinical pathways, standardized order sets, and supply chain management initiatives;
  • Develop a better, more collaborative relationship with physicians and other care providers;
  • Improve performance on hospital pay-for-performance measures;
  • Create a differentiated position in the market on the basis of quality.

Clinical integration provides patients with:

  • Better value for their health care dollar;
  • More effective care management and outreach from a trusted source, their physician;
  • More reliable information to support their choice of health plans, physicians and hospitals;
  • More accurate and meaningful provider ratings;
  • Greater stability in their relationship with their doctor and hospital.

Read more industry insights about the value and benefits of being a part of a clinically integrated network from Health Catalyst.

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