Establishing Accountability, Clarity between Physicians and Specialists

It's a scenario that occurs time and time again, and is a deep source of frustration for all involved: a physician refers a patient to a specialist, but hears nothing back from that specialist. In fact, they learn that the visit happened only when the patient returns for his primary care visit, but without any necessary information.

Or, a specialist receives a patient who has none of the pre-work or test results necessary for an effective visit, which ends up delaying care for the patient. Or, on the flip side, the specialist receives patients who have had numerous unneeded and avoidable tests done prior to the referral.

The culprit? Lack of accountability and clarity, the foundations of the Care Compact, an agreement between two practices that outlines the roles and responsibilities of each in order to promote patient-centered care, says Robert Krebbs, director of payment innovation at WellPoint, Inc., during Care Compacts: Forming the Foundation of Care Teams with PCPs and Specialists, a May 2014 webinar now available for replay from the Healthcare Intelligence Network.

Robert Krebs

The Care Compacts (also known as Care Coordination Agreements and/or Referral Agreements) are key to WellPoint’s patient-centered medical home neighborhood (PCMH-N) pilot, Patient-Centered Specialty Care (PCSC). The program was launched in January 2014 with a select number of pilot practices, ranging in size from solo practices to large group practices in markets where there is a strong patient-centered medical home (PCMH) foothold, says Krebbs.

PCSC is a value-based reimbursement program developed for three types of specialties with clear care coordination alignment opportunities with PCMHs: cardiology, endocrinology, and OB/GYN. These specialists work with existing patient-centered medical home partners to improve quality and coordinate care guided by cost and efficiency measures, Krebbs continued, ensuring the following:

  • Effective two-way communication between primary and secondary providers;
  • Appropriate and timely referrals and consultations with prompt feedback of findings/recommendations;
  • Effective co-management of patients when necessary; and
  • Commitment to practice in a patient-centered fashion across all physicians delivering care to a patient.

In case you missed this webinar, you still have a chance to watch this highly-rated program.

Register to view the conference today or order your training DVD or CD:
http://store.hin.com/product.asp?itemid=4869

You can "attend" this program right in your office and learn: how WellPoint's PCSC program promotes coordination and communication with PCPs; the reward and recognition structure; how the PCSC scorecard works; care coordination expectations, goals and activities; care compact adoption, motivation and impact; referral preparedness tools; and lesssons learned.

It’s so convenient! Invite your staff members to watch the conference. We will send you a DVD or CD-ROM of the conference proceedings or a link to our web site with a username and password. You can log in and view the program right from your computer — any time of the day or night, whenever convenient for you and your colleagues — and benefit from the archived recording of the conference, including the Q&A period.

You'll get to listen to the question and answer session to hear how PCPs and specialists are selected to participate in the program; the care coordination capabilities that WellPoint looks for in a practice; examples of care compact implementation best practices; how savings are shared between the PCPs and the specialists; examples of he non-financial rewards that WellPoint utilizes; and the health conditions that are most impacted by care compacts.

To register for the on-demand re-broadcast, download an .MP3 file or order the training DVD or CD-ROM of Care Compacts: Forming the Foundation of Care Teams with PCPs and Specialists, please visit:
http://store.hin.com/product.asp?itemid=4869

I hope you find it useful.

Cordially,

Melanie Matthews
Executive Vice President
The Healthcare Intelligence Network

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