CPC plus logo

As a participant in the Centers for Medicare & Medicaid Services (CMS) Comprehensive Primary Care Plus (CPC+) initiative, The Health Collaborative (THC) is responsible for supporting the 560 primary care practices comprising the Ohio & Northern Kentucky region. Our CPC+ team helps ensure that each practice is able to meet its care delivery requirements and milestone objectives as prescribed by CMS, and data aggregation is quickly becoming a key component of this work.

CPC+ is a unique public-private partnership, in which practices are supported by 61 aligned health plans (payers) in the 18 CPC+ regions of the U.S. This partnership gives practices additional financial resources and flexibility to make investments, improve quality of care, and reduce the number of unnecessary services their patients receive. (Source) The Ohio & Northern Kentucky region is the largest of the 18 regions and has one of the highest number of participating plans (14).

However, despite the obvious benefits of so many payers participating, it can also create unwanted inconsistencies and disparate reporting structures that can result in lost productivity and additional staff time & training to address at the practice level. In the traditional model, each payer submits its data to practices in different formats, representing only that particular payer’s covered lives (typically representing just a small portion of a given practice’s patient population). That’s where The Health Collaborative’s data aggregation co-op comes in to save the day.

Romi Wang, Senior Data Analyst

Romi Wang, Senior Data Analyst

Brian Kegley

Brian Kegley, Senior Data Analyst

Here’s how it works: health plans provide their attributed claims data to The Health Collaborative, reporting on 16 measures that cover cost, quality, and utilization. Our Senior Data Analyst Romi Wang carefully combs through the risk-adjusted measures to ensure all of the data is organized and correct. She then passes it along to Senior Data Analyst Brian Kegley, who prepares the client-facing reports and makes sure the data is meaningful to the end user. Practices and payers split the cost of aggregating the data 50/50, creating a shared, cooperative model that leverages co-ownership of the results.

 

With THC’s data aggregation capabilities, about half of a given practice’s patient population is now represented in a meaningful way. Clinicians and care teams can query and filter results down to a specific payer or provider, and can even drill down to individual patient information to gain more insight. Patient status can be categorized from “1” through “Catastrophic” to assist the practice in identifying where best to spend its time making conscious improvements and targeting outreach.

Perhaps best of all, payers and practices can now receive a consistent report in the same format, meaning they are finally speaking the same language and are “on the same page.” Think of it as a “one stop shop” for practices and payers to view all of the metrics in one place, in the same consistent format, with the flexibility to create custom views and filters as needed.

While not all CPC+ practices have bought into THC’s data aggregation services, those that have opted in now have access to 30+ data-driven dashboards that break down various pieces of data in one place. They can compare how their practice is doing compared to similarly-sized practices in the area or state-wide, and how their practice compares to others participating in CPC+ data aggregation.

Dr. Richard Shonk, Chief Medical Officer

Dr. Richard Shonk, Chief Medical Officer

Unique Business Model Offers Better Data Analysis, More Efficient Patient Care

Dr. Richard Shonk, Chief Medical Officer of The Health Collaborative and one of the primary architects of the data aggregation co-op model, reiterates that “as physicians become familiar with the dynamics of a ‘Pay-For-Value’ world it becomes clear to them that whoever defines and measures value will control payment. Thus, it is important that physicians are at the table when these decisions are made,” he emphasized.

“In our unique business model physicians pay for at least half of the cost of doing the data aggregation which makes them co-owners of the process,” Dr. Shonk continued. “This provides them a seat on our Data Work Group, where decisions are made about how the data is collected, attributed, risk-adjusted and presented. This is a major benefit of our approach in this new world of advanced payment methodologies.”

The data gathered and validated in these efforts helps to aid CPC+ learning sessions, which are required by CMS and staffed by THC, bringing together 560 practices across the state of Ohio and Northern Kentucky to share knowledge and best practices in meeting their CPC+ milestones as well as delivering better patient care.

The Health Collaborative CPC+ team will continue striving to offer premium support and learning opportunities through the end of the five-year grant period in 2021. By adding data aggregation to the services available to our region’s CPC+ practices, we’re working together to ensure collective success for practices and payers, and even better, more efficient care for patients.

Learn more about data aggregation and what it can do for your practice: contact Dr. Richard Shonk, Chief Medical Officer at rshonk@healthcollab.org or Sean Flynn, Account Manager at sflynn@healthcollab.org.