Healthcare reimbursements continue to shift toward a value-based care model with an increased focus on the individual needs of patients, including preventative and chronic care management.
Piedmont Internal Medicine, an independent Piedmont Clinic primary care practice in Atlanta, recognizes the importance of value-based care. Practice-led programs such as WellTouch, which was developed by Piedmont Internal Medicine, improve quality metrics, address gaps in Healthcare Effectiveness Data and Information Set (HEDIS) measures, increase reimbursements, and ultimately, better serve their patients.
“We started looking at where healthcare was headed, and around the same time, some of the insurance companies were expressing some interest in the HEDIS measures and creating lists that identified patients who weren’t in compliance with wellness or managing their chronic diseases,” said Kelly Ladd, practice administrator.
Cody McClatchey, M.D., a primary care physician within the practice, also recognized the added value this program would create. “This was an opportunity to receive reimbursements for some of the care we provide outside of office visits,” Cody shared. “We knew this program would help support future efforts to proactively improve quality and lower the cost of care throughout our patient population.”
As the practice brainstormed how to develop this program, Kelly knew there was one element that was vital for success. “We needed a self-motivated person to champion this initiative,” Kelly explained. “Someone who could communicate with the payors, reach out to our patients who were not in compliance, schedule their appointments, fill out the risk assessment forms, and submit paperwork needed for reimbursement. Tiffany was the perfect person.”
Tiffany Bogle was already employed with the practice and had a unique skill set that was essential for this role. “We chose Tiffany to implement this program because she is a certified medical assistant, but also worked in our billing department and front office,” said Mary Phillips, practice manager.
Tiffany reaches out to payors who provide her with a list of patients who are high risk and have a significant gap percentage for preventative well-visits or chronic care management appointments. She contacts these patients to remind them that they are due or past due for appointments and gets them on the schedule.
Not only has the practice observed how the program positively impacts their patient population, but the patients themselves are sharing their experiences.
“They’re just shocked,” Kelly said. “They say, ‘Wow, you’re calling me. It’s not a text, it’s not an email, it’s not a machine, but someone is actually looking at my chart and realizing I haven’t been in for an appointment in 14 months.’ That’s made a world of difference.”