In this episode of the Move to Value Podcast, we talk with Marque Macon, MBA, FACHE, Assistant Vice President, Atrium Health's Collaborative Physician Alliance, who discusses the importance of using support teams to assist providers in value, including accurate documentation and coding.

Hi Marque. Can you give a brief overview about the Collaborative Physician Alliance?

Sure thing. Well, Collaborative Physician Alliance, or CPA as we like to refer to ourselves as, we are a physician-led, clinically integrated network, focusing on collaboration to redesign healthcare for better quality and efficiency, better health for our patients, better satisfaction for our providers, and better value for all. We are made up of about 2,700 physicians, 2/3 are employed by Atrium Health, and about 1/3 are what we consider affiliates. These affiliates are community physicians with whom we share patients. Together, we have about 300 physician practices and over 370,000 covered lives in our value agreements, and we are anticipated to grow to over half a million covered lives by 2023 and 2024. Since our first performance year in 2017, we have achieved over 136 million dollars in total savings and over 8 million dollars in pay-for-performance incentives.

How does CPA use population health data and analytics to create strategies to promote health equity and access to care?

Well, we often like to say that we have the holy grail of data. Through collaboration with our payer partners, we have access to robust claims information which is really helpful as we understand the disease prevalence of our population. We also leverage real-time clinical data through our Electronic Health Record and will have even more capabilities as we transition to a standard Electronic Health Record across our enterprise. Additionally, we lean into the expertise of various teams in developing strategies to promote health equity and access to care, by including Atrium Health’s Population Health and Analytics team, our Center for Outcomes Research and Evaluation (CORE), and our community and social impact team. For example, based on our research, we know that when it comes to hypertension, there is a higher prevalence of uncontrolled hypertension among African Americans within our Greater Charlotte region. This data also shows that there is a higher prevalence of patients in hypertensive crisis among this population as compared to white patients. And we see similar trends in our diabetes population. So, Atrium Health’s Equity Executive leadership, in partnership with the Quality & Equity of Care Committee of the Charlotte Mecklenburg Hospital Association. These boards requested a focus on Health Equity. And as a result of our findings, the Greater Charlotte Region selected Hemoglobin A1c control and Diabetic Blood Pressure control in African American patients as areas of focus.

Healthcare mergers and practice acquisitions are happening with greater frequency. What impact can this have on the provider and the patient?

Yeah, sure. So, for the most part, healthcare mergers and practice acquisitions have had favorable impact on providers and patients, particularly within Atrium Health. Since 2018, we have expanded our footprint through strategic combinations with Atrium Health Navicent, Atrium Health Wake Forest Baptist, and most recently, Atrium Health Floyd. So, now Atrium Health has over 70,000 teammates across the Carolinas, Georgia, and Alabama and have 38,000 patients encounters each day – that’s about one patient encounter every two seconds.

We’ve also leveraged our economies of scale to experience a cost avoidance of overhead and IT expenses, provide greater access to care, and increase our influence with our payors. These efforts have allowed us to move closer to achieving the triple aim: improving the patient experience, delivering high quality, and managing our medical costs.

And by expanding our Atrium Health enterprise, our physicians have increased access to clinical expertise. For example, we now have access to the large academic network at Atrium Health Wake Forest Baptist. And as a result, we are building the first medical school here in Charlotte in collaboration with the Wake Forest School of Medicine. Patients can benefit from this increased clinical expertise by way of their health outcomes and overall quality of life.

However, I’ll have to mention that favorable results to patients and physicians may not be the case in all mergers and acquisitions. So, many M&As have failed across the country due to disparities in organizational culture, poor communications, and unengaged physician leadership. It’s important that organizations do appropriate due diligence prior to pursuing an M&A with an organization.

Next, I have a question sort of piggybacks on that a bit. So, we hear a lot about physician burnout and many providers view value-based care contracts as administratively intensive. How do you view CINs like CPA aiding providers in the coming years?

Certainly. Well first, we have to be aware, and acknowledge, the fact that physician burnout is real, particularly through the past few years of this pandemic. And so, as we implement our strategy and roll out initiatives through CPA, we are very mindful to leverage the teams and resources that surround and support the providers. For example, we have increased registered nurse and coding resources to assist in identifying opportunities in coding and documentation accuracy. So, we know that physicians aren’t coders and not the experts in coding, so we had to think of how to best support them while minimally impacting their workflow. Another example is the investment in a new Electronic Medical Record across the enterprise. So, this will allow physicians and care teams to more readily identify critical clinical needs during that patient visit.

Also, our affiliate groups with small administrative staff, or frankly no administrative staff, rely on CPA to submit required documentation and clinical information to CMS on their behalf. I predict that CINs like CPA and also Accountable Care Organizations across the country will continue to provide value by reducing that administrative burden through these efforts.

So how do you get provider buy-in for these new models to drive performance? Is there any way that you measure provider buy-in?

Yeah, so, provider buy-in and engagement has been essential to our success in performance to date. We are fortunate to have engaged physicians on our board of managers and on our various committees to drive performance and help inform our strategy. To foster physician engagement, we have an annual citizenship process where participating physicians are required to review our policies and procedures, watch a video created by Doctor Jennifer Brady, our CEO, which gives a thorough review of our performance across our various agreements, and review an educational video on a key topic critical to our success in value. Over the past few years, there has been a large focus in documentation and coding accuracy, so this has been our educational topic for the past few years. Completing citizenship is required by physicians in order to receive any performance incentive, and we are able to track and measure performance at the physician level.

We also track the usage of our Care Team Enablement Hub, which is a tool that provides actionable information related to a physician’s performance in value.

Next, I’d like to ask, how important is data at the provider’s fingertips and what is CPA doing to affect that?

Yeah, so, data at the provider’s fingertips is very important. In order to change physician behavior, it is important that we provide robust and personalized data directly to them that provide actionable insights to help deliver better care. We’ve heard this from our front-line physician leadership, as well as our care teams. And as a result, we have developed the Care Team Enablement Hub. This interactive tool provides visibility into a physician’s performance in value, including provider- and practice-specific scorecards, which summarize their panel sizes, their quality measure performance, and several contract-specific cost and utilization measures, such as Emergency Department usage and High-Cost Imaging rates. It also includes a comprehensive patient-level summary intended for supportive information in visit planning and our clinical office huddles. We continue to iterate the Care Team Enablement tool to provide valuable information to our physicians and the care teams.

Additionally, we are working with our EHR partners to leverage clinical decision support technology. Stanson is a tool that we have implemented to reduce physician alert fatigue, eliminate unnecessary orders, and suggest HCC capture opportunities during the patient visit. As a result, we have experienced $98,000 in canceled alert savings, reduced over one million nuisance alerts, and have had an additional 2,000 HCC categories documented.

How does CPA approach all the different quality metrics for these contracts and help the provider focus on what is important?

As suggested in our new name, Collaborative Physician Alliance, our success is due to our relentless collaboration with physicians and the care teams. We have developed what we call our Value Metrics Marathon, which was an outcome of the 2020 pandemic to ensuring our highest risk patients received the care that they needed. We created a “quick glance” document which allows us to view performance across each quality metric in each of our value agreements. Those measures that are at target are highlighted in green, those that are not at target are in red, and those that are within 5% of target are highlighted in yellow. So, this is a quick, easy view of our performance at a high-level. We share this quick glance on a bi-monthly basis with physician and operational stakeholders as an easy, visual indicator to view where additional focus is needed. In addition, we attend physician level meetings on a monthly basis to communicate our performance, we share the quick glance, and identify specific areas of focus for the month based on our most recent performance information.

Marque, what advice do you have for the provider who is beginning their journey into value-based care and is trying to deliver the best outcomes for their patient?

Sure, so I have three things that come to mind. Number one is, one understanding truly where you have opportunity. It’s really important to have accurate data. Payors often aren’t the source of truth, so ensuring that the data that you have internally is in alignment with documentation that the Payors are providing is really critical.

The second piece of advice that I would give is establishing productive relationships with the payors. We have to work with the payors in a different way as we move forward. Many of the payors have support systems and tools that you all can leverage to improve patient outcomes, such as in-home nursing visits and the ability to address quality gaps.

The third piece of advice I would say is documentation is key. Often, it is easier to focus on appropriate documentation of a patient’s condition than to try to reduce their medical spend. If that cancer patient, the medical spend is what it is going to be, but where we can impact is making sure that we are appropriately documenting and coding that patient’s true condition. Showing your work, if you will, to payors by accurate documentation and coding so that you are truly demonstrating the complexity of your patients is essential. Show that you are closing those care gaps, like breast screening and colon cancer screening. Ensuring that you’re documenting that Annual Wellness Visit. Risk Adjustment is really often how your per member per month spend or your medical loss ratio targets are set in many of the value agreements.

Marque, is there is there anything that I didn't ask that you would like to contribute to this conversation or is there any closing words that you'd like to provide to our audience?

I truly believe that this move to value and value-based care is really the way of the future. So, it’s important for physicians and care teams to really embrace it and really position yourselves for the future. As we look at medical expenditures across the country, CMS and the funds that they have available to them, is becoming less and less. Right, and so CMS, other payors, are really looking at not only are we just seeing patients to see them or is there truly that care, that quality of care, being impacted. And so, we’re going to be paid on that accordingly. So, it’s important to kind of get in front of that, understand all the parts and pieces, and I would just again double down on the importance of showing your work. Right, that documentation and coding, and the accuracy therein, is key to achieve success in the future in value-based care.