Key Ways to Support Membership Experience and Growth 

When a healthcare organization embraces the value-based care approach they accept the importance of supporting their patient membership experience, delivery of care and growth. What membership trends are important for a practice to track though? How do they position themselves to track ways to improve the delivery of care?

Read our newest resource below to find out these answers and more about key ways to support tracking trends that are impacting your membership experience and growth. 

1. Monitor Delivery of Care

An essential part of ensuring your patient population is continuously growing or staying consistent is tracking your membership trends. Tracking trends on a monthly, quarterly or annual basis for different trends is important. Trends Include:

• By Payor Relationship
• Practice Location
• Insurance PCP 
• Financial Class
• County 
• Chronic Condition
• Age Group
• New Enrollment
• Churn Percentage 
• Monthly Retention Rate 

Being able to identify trends with any of the above, allows your healthcare organization to identify room for improvement. For example, if you identify a loss in members two months ago at one of your locations, you may want to determine potential reasons this is happening. Maybe your marketing team stopped advertising for that location, maybe there’s a new competitor that recently opened up nearby or maybe the price changes you implemented recently have impacted the number of patients at that location. The only way to know this is to first identify the trend and then determine the reason why before it’s too late, too many members leave or revenue is impacted. Ensuring you have the right technology to identify these trends in real-time is something to consider as well.

2. Monitor Delivery of Care

Going hand and hand with maintaining or growing your membership panel by tracking, it is important to monitor delivery of care of your current patients. How does the delivery of care impact your patient panel? Over time if the delivery of care is not meeting or exceeding your members expectations, they will leave your practice and will also spread word of their experience.

Primavera’s technology provides you the technology and tools to monitor delivery of care through custom care gaps, patients risk stratification and alerting you of HCC code oppurtunity. As the healthcare industry shifts more and more towards value-based care, it is essential to ensure your organization is leaning into the change and being proactive with patients through not only monitoring care but intervening when necessary as well. 

3. Intervene When Necessary

Identifying trends in your memberships whether impacted by delivery of care or other factors, it is important to intervene when necessary. Having the right trends and data at your fingertips is essential to make decisions and intervene when necessary. A few examples of scenarios that you may want to intervene in include:

• When a patient care gap has been identified, being able to create a action plan/case plan to resolve care gap
• If you see a sudden increase or decrease in memberships for a specific group, determining what the reason may be 
• Identifying patients that frequent the hospital and if there are ways to improve delivery of care, ultimately preventing readmission

Primavera provides you the right technology and tools to intervene on trends impacting your memberships and ultimately their delivery of care

Manage Your Patient Panel and Delivery of Care with Primavera Health

Taking action as a healthcare organization once you have measured, accessed and evaluated the risk and growth trends of your patient population is extremely important to ensure your organizations success. Primavera Health partners with you through our technology and advisors – allowing you to identify patient trends associated with risk, intervene on a patient level, and make continuous improvement of your patient experience and panel possible.

Reach out to us today to learn how we support you to continually improve your risk management and value-based care strategy today. 

(888) 667-2219

[email protected]

Rapid changes in healthcare are emphasizing the need for you and your healthcare organization to lean into value-based care and we are here to help. Primavera advisors speak with organizations and providers that are either already in the value-based care setting and want to ensure they are successful or want to start value-based care but don’t know the next steps to take. Read below to learn more about the variety of ways we can help you embrace the industry’s shift to value-based care.

How Primavera Partners with You

1. Value-Based Care Starter

The shift to Value-Based Care is often viewed as a challenge for organizations to provide better quality and affordable care. Primavera’s Risk and Value-Based Care advisors work with you to face the challenge and equip you with the expertise and data insights to be successful in starting a new risk agreement. When you choose Primavera, you choose a team that holds extensive experience in helping you understand the payor options, hold the conversations with payors themselves and ensure risk agreements are mutually beneficial. 

2. Ensure You Are Taking Advantage of Current Risk Agreement(s)

Although a healthcare organization may already be involved in value-based care, oftentimes they don’t fully understand if they are taking financial advantage or the exact terms. We work with you to change that, providing you with the guidance to ensure you are taking financial advantage fully. 

3. Transitioning from Fee-For-Service to Value-Based Care 

Struggling to switch from a fee-to-service to value-based care model? You’re not alone! We empower you to diversify your revenue into capitation and create a fixed monthly income that is simply not possible with fee-for-service. Partnering with you to determine the most beneficial value-based care form to pursue with including: 

• Shared Risk
• Shared Savings
• Bundled
• Or Global Capitation

4. Develop Strategies to Hit Goals

When you choose our experts, they work with you to determine the right strategies to meet your goals for MRA, MLR, Membership, Patient Risk, Operational, Financial and Care Gap Goals. We partner together to make your organization’s goals a reality.

5. Professionalize Your Business for Selling or Retiring 

If you are considering selling your practice or retiring, determine the next steps to ensure the ultimate valuation during point of sale is very important. 

We work with you to strategize and determine:

• Correct Practice Valuation
• Prepping Your Practice For Sale
• Buy-Sell Agreement
• Practice Transfer Process

6. Improve Healthcare Results

• Revenue
• Cutting Cost
• Volume/Membership
• Revenue Cycle 

7. Data Insights to Make Decisions 

Primavera Health is proud to have the technology that allows you to run your practice proactively versus reactively. Our Advisory services and Analytics technology that empowers you to:

• Track monthly top utilizers and readmission rate of your patient population
• View care gaps as they occur, giving your team the tools to instantly resolve this gap
• Custom risk stratification to identify your high risk patients instantly
• Make proactive decisions backed by data 

Your Partner in Value-Based Care 

Transitioning to value-based care can be challenging; requiring resources, time, a priority shift, and evaluation but with a Primavera – it’s easier together. Let us map out the plan and tools you will need to be successful. 

Our solutions enable you to improve the quality of care and enhance the patient experience while helping you take control of your financial future. Reach out to us today or schedule your free consultation to learn how we directly support you in value-based care, creating a customized and sustainable strategy for your healthcare organization.

[email protected]

(888) 667-2219

Transitioning to Value-Based Care can be a challenge without the proper guidance and tools at your disposal. Many organizations struggle with elevated financial risk, transition to quality versus quantity of care, lack of system and data integration and shifting policies and regulations that are related to Value-Based Care. All of these challenges have one thing in common though – with the right tools and experts working with you, they can be overcome. 

Primavera Health’s team of Risk and Value-Based Care advisors work with you to Discover, Guide and Implement strategies to ensure your Value-Based Care success from the very beginning. Our team works with you to embrace Value-Based Care and the many opportunities for improving the quality and continuity of care for healthcare organizations and their patients that come with it. Transitioning to it can be a challenging and involved process, so let’s look at how our risk and Value-Based Care advisors work with you. 

Discover

Our risk and value-based care advisors first work with you through a Free Consultation to discover where you are at your value-based care journey. From the beginning, we understand each organization is different, so strategy and approach must be customized based on the needs and goals of your organization. During your consultation, our advisors will work with you to discover:

• What are your goals as an organization including membership, patient risk and financially
• How engaged in value-based care you are currently
• Determine specific metrics you may want to measure in improve, including MRA, MLR, Risk Stratification and Care Gaps
• How you may benefit from our value-based care advisory services 

This discovery consultation with our advisors is essential in order for our team to help guide you to being successful.

Guide

After the initial consultation together, your Primavera advisor will partner with you to guide you based upon your immediate and future goals. We develop a step-by-step implementation process that is manageable, intentional, and paced to succeed. Paving your path to success includes working together to determine what value-based care form to pursue from Shared Risk, Shared Savings, Bundled or Global Capitation.

Guiding you is just the first step to implementing your Value-Based Care strategy. 

Implement 

Having a risk and value-based care strategy and implementing that strategy can be seen as a challenge, and many organizations may not know where to start – our advisors work with you to change that. We enable you to improve the quality of care while helping you take control of your financial future. We work with you to:

• Provide data-driven insights and trends on Care Gaps, MRA, MLA and Risk Stratification
• Provide real strategies to focus on preventative care, which ultimately leads to less spending
• Implement overall cost-effectiveness strategies 
• Reduce the financial risk that comes with fee-for-service versus value-based care

Our goal is to make your organizational goals a reality by guiding and implementing a strategy that leads your healthcare organization to delivering higher-quality care while controlling your financial future. 

Real-Clients Real Results

Don’t just take our word for it, some of the results our Risk and Value-Based Care advisors have been able to achieve for organizations like yours are:

• Membership increased by 190% between 2018 and 2021
• MRA increased from 1.7 to 1.92 between 2018 and 2021
• MLR decreased 3% between 2018 and 2021

We can work side-by-side with you to help achieve similar results, improving the quality, value and the experience of care for patients, to make health care better for everyone. At Primavera Health, we pride ourselves on being your Value-Based Care partner.

No matter where you are on the journey to value-based care, we offer an integrated approach to flourishing under the new model utilizing the Primavera advisors and tools. 

Let us map out the plan and tools you will need to be successful. Schedule your introduction call today. 

A successful healthcare organization tracks patient trends in care, cost and prescriptions, making it possible to deliver quality and improved patient care. Technology has been developed to streamline patient tracking in real-time and allow you to intervene immediately based on the data is critical. The question is – How do you know what patient trends to track? How do these trends impact your healthcare organization? 

Transitioning and being successful in Value-Based Care can be a challenge, so let’s look at what patient trends you should consider tracking to overcome that challenge. 

Membership 

As your healthcare organization continues to grow, tracking membership trends is essential to spotting trends and planning strategic growth. To track important trends, you should ensure to track your patient memberships:

• Monthly, allow you to compare progress
• On different Levels. For example by Payors, Location, Primary Provider, Insurance PCP, Financial Class, County, Chronic Condition and Age Group levels
• View average for each group across the board 
• Down to members level, allowing you to spot trends you may not of been aware of
• Membership by Eligibility versus Revenue files from your insurance payor.

Whether your organization is looking to expand or maintain current memberships, having the right tool in place to automate this tracking is key and something to consider.

Care Gaps

Patient care gaps can have a tremendous impact on your patients health and related costs if not intervened promptly. Care gaps may include specific health screenings, tests, unseen new patients and missed annual wellness visits. Depending on your patient population and their needs, typically depends on the care gaps you will want to be able to track. With that being said, you need to have the technology in place that allows you to customize what your care gaps are. The technology you use should also automatically identify care gaps for you, giving you the tools to immediately intervene to resolve gaps before too much cost incurs. 

Cost

An essential part of value-based care is to keep the cost of your patient population down. Tracking specific cost drivers and trends can allow your organization to intervene when necessary. Cost drivers include but are not limited to: 

• High utilizers
• Patients with frequent hospital/er visits 
• Prescriptions
• High risk patients 
• Chronic conditions

All of these contribute to a high cost patient that should be closely monitored and have a related case plan to reduce cost. Depending on the number of patients you are serving, identifying the high cost patients and intervening can be seen as a challenge and a timely process. That is why Primavera offers the right tools through our Analytic technology to streamline and rid of the manual process for you. 

Patient Prescriptions

A continuous concern through healthcare is the rising cost of prescriptions. When an organization is in value-based care, this concern is no different. You need to have the ability to track the top prescriptions being prescribed, their associated costs and whether they are brand name or generic. Tracking these trends will allow you to identify room for improvement including the opportunity to switch current brand name prescriptions to generic. 

Technology to Streamline Your Tracking 

Our software solutions enable you to improve the quality of care and enhance the patient trend tracking while helping you take control of your financial future. Whether your healthcare organization is looking to track membership, care gaps, cost or prescription trends – Primavera’s technology has the tools to automate the process for you. 

At Primavera, our goal is to remove the challenge of transitioning to value-based care and help your continuous success in value-based care as well. 

Reach out to us today to learn how we support you to continually improve your patient tracking and value-based care strategy today. 

(888) 667-2219

[email protected]

Key Considerations in Healthcare Strategy when Transitioning to Value-Based Care 

Value-based care (VBC) is a holistic care approach and payment model, versus the fee-for-service model that largely still dominates the industry. VBC models have greatly increased in use and implementation and continue to become more widely used but it’s not an easy change for all healthcare organizations to make. Which leads to the question – 

What are the best strategies when transitioning to VBC? This blog will guide organizations towards strategies to consider when adapting VBC to ensure a successful transition.

Rethink Delivery of Care 

Transitioning to value-based care requires that healthcare system participants rethink how to deliver and compensate for healthcare. Delivery of care impacts patients and all healthcare providers involved in a patient’s circle of care. In current fee-for-service  models, healthcare is delivered and paid for by an individual patient’s visit or follow-up procedure. 

In VBC all of the services and visits necessary to treat the patient’s symptoms are bundled – and this extends across specialties to include all doctors, specialists, and nurses, as well as preventive and supportive therapies such as; doulas, counselors, and nutritionists. Delivery of care significantly shifts away from quantity to quality with VBC, with care centered around patient outcomes. Shifting to delivering quality care goes hand in hand with a holistic care approach. 

Defining “Holistic” Care

There are 2 facets to holistic care with a VBC model. One is the actual care continuum itself as we mentioned, where all services are combined. The other is the financial extension of that approach with a bundling method that combines costs for these services based on treatment outcome. In VBC models the incentive is on successful treatment and continued preventive care rather than step by step actions administered throughout the diagnosis.

Educate Healthcare Providers and Teams

Paving the path to success within an organization begins with education initiatives to accelerate the transition to VBC. The adjustment from fee-to-service to VBC can be a tedious adjustment for providers that have been practicing with the focus of quantity versus quality for years. Ensure that the entire healthcare organization is equipped to participate by educating them about the core tenets of value-based care, no matter how big or small of a role they will play.

Measuring Care Impact 

A new strategy that is needed in VBC models is to implement tools like real-time risk assessment and continuous patient evaluation through software and applications and platforms for two main reasons.

1. Hospitals and care facilities must be able to evaluate with up-to-date information from all involved care providers and practitioners within a patient’s treatment in order to coordinate care and create accurate and effective compensation practices. Patient data must be able to be updated and communicated within standard compliances, and communication channels must be maintained between both practitioners and patients. 
2. Providers must be thoughtful and clear. This requires a rethinking of how healthcare is delivered by providers but also all specialists the patient is going to see. It also requires that the communication between any provider and the patient is as seamless and accessible as possible. This means having a centralized method or platform that encompasses outreach, communication, provider connections, transportation logistics, and transactions across the full continuum of care.

There is no shortage of valuable data available to healthcare organizations and they must commit to quality improvements through reliable data. 

Why make the change

VBC causes healthcare leaders to rethink the processes and elements that have the greatest impact on a patient’s outcome. It also provides a clear format as to what is or is not a covered benefit for the patient. This approach leads to lower costs overall for facilities and providers through a few key shifts:

Risk analysis and shared responsibility

All providers and practitioners/departments work together to reduce collective spending. Risk is assessed and prioritization makes it easier to provide pertinent care.

Shared Savings

Financial load is shared among practitioners/providers so that saved funds in one department can be redirected to another to keep the collective on budget.

Bundling Cost

Bundling allows patients to have input on their care and opt out of services they don’t need. Patients don’t overpay, and providers can accrue savings from unused services.

Understanding the shared health needs of patients will make it easier to see how a VBC model can help you save on cost through bundling and shared savings across departments. With this information you can design your own unique solution to improving the quality of care for your patients. The analytics and data collected from Primavera’s Data Analytic platform to facilitate VBC success will make tracking health outcomes and patient data easy so you can justify and analyze cost and outcomes.

VBC creates great experiences and outcomes for patients, and generates higher bottom lines for providers. Though it is increasing in popularity, VBC is not dominating the entire market – but due to its flexibility and adaptive/integrative nature it is ideal for mitigating gaps in care that can be created by pay-per-service models. 

Patient-first care does not have to negatively impact revenue generation. At Primavera, we help you create the best strategies to implement VBC solutions into your practice. The goal is to close gaps in patient care and improve outcomes without incurring additional costs – and in fact, reducing them.

Through revenue optimization (driving down costs by improving efficiencies in coding and determining cost drivers), and identifying growth trends, we are able to help identify your specific benefits from switching to VBC. 

Reach out to us today to continue the conversation on how to position your healthcare organization to benefit from value-based care.