How ilumed Helps Make this Veteran Value-Based Provider’s Job Easier

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By Dr. Abigail Barrera, M.D. FAAFP, Total Family Health Care

I’m a general practitioner who cares for patients of all ages. For more than 20 years, I’ve watched the patients at my San Antonio, Texas, family practice go from adults in their 20s and 30s to grandparents who are now eligible for Medicare benefits. As the families who have been with my generational practice through the years continue to grow and transition from one stage of life to the next, my practice has also transitioned to better fit the needs of my aging patients.

When I first started my practice, I followed the traditional fee-for-service (FFS) model, but about 10 years ago, I began transitioning to a managed-care model for my growing Medicare-eligible patient population. Last year, I partnered with ilumed to provide external assistance and resources to support our patients on the value-based care model.

We transitioned this practice 10-plus years ago into a patient-centered medical home model. Every patient who walks in the door gets the same thing every time, whether they’re an infant or 99 years old. It’s a metric-driven care plan. We data-mine our patients’ charts to ensure any gaps in their care are addressed, whether it’s an infant who needs immunization or a senior who needs coordination to prevent emergency-room visits or hospitalizations.

One of the biggest challenges can be managing the whole patient population as if they were all under one type of insurance, even though they’re not. They have a variety of different health plans that we have to work through. Doing this requires a lot of time, but we still make it work. Our partnership with ilumed helps lighten the load with our managed-care patients. We work with the case managers and care coordinators at ilumed to reach out to these patients and ensure that any care gaps are addressed.

Working to achieve health equity, one patient at a time

As a generational clinic, we’re fortunate to know the families in our practice quite well. This is especially important in a Medicare senior model; in fact, probably some of the most important factors that we need to know about our Medicare patients are who brought them to their appointment, who takes care of them at home, who lives in their households and whether they are able to pay for their necessary medications.

In addition, we want to be sure that they have enough food, clothing, housing security and, perhaps most important, transportation. It’s essential that seniors have access to someone who is going to be able to drive them to and from doctor’s appointments. It’s not necessarily due to a lack of financial resources; oftentimes, senior patients are no longer able to drive, and it’s important for caregivers or family members to have a plan in place for how to get them where they need to go.

Our partnership with ilumed has allowed us to go beyond our previous ability to help seniors in need of transportation. Thanks to the coordinated transportation and appointment-scheduling assistance they offer to our patients who work with them, we can ensure that more of our senior patients have reliable transportation to help them get the healthcare they need, when they need it.

As a provider who has been working within a managed-care model for over a decade, my staff and I are well-versed in population health and understand how big a role that social determinants of health such as food insecurity, loneliness and isolation or housing uncertainty can play in a person’s overall health outcomes. Partnering with ilumed has been a huge help to us in identifying these barriers and then helping us provide the resources our patients need to overcome them.

Our practice is located in an underserved area of a large, metropolitan city. In a city as big as San Antonio, even the transitional-care plans under Medicare can’t always accurately track the number of times a patient has accessed emergency care services at a hospital or stand-alone emergency room for a variety of reasons. Having ilumed in our corner allows us to look at the top 20 patients who have been in and out of the hospital or emergency rooms multiple times within a single month and see if we can spot patterns or trends that can help us keep them out of there.

This is information that we might not otherwise have been aware of if we are seeing our patients just once every three months, even with me taking my own patient phone calls 24/7, as I have been for more than 20 years. Having someone who can help us with that level of case management and outreach to our high-risk patients makes it easier for us to help them get the care they need through our practice without having to go anywhere else.

The benefits of transitioning to a value-based care practice

Because I run a traditional family practice, I have patients on both the FFS and value-based care (VBC) models. Ideally, I would like to transition completely into a VBC model practice; however, this can be difficult for providers like me who work with patients of all ages and don’t necessarily want to give up their pediatric and commercial-age patient populations.

Though it might initially be hard to make this pivot, there are some major advantages to becoming a managed-care provider. For example, less patient volume makes it less of a rat race for my staff and me. We’re not pushing through patients as fast as we can through the doors to see more patients and make more money. On a managed-care model, we have a smaller population, which means we are able to do more for each individual patient.

In addition, the value-based care pay structure for providers can help keep the practice up and running in the face of crisis, as we found out during the COVID-19 pandemic. In March 2020, we shut our doors and income basically came to a halt for our FFS patients. However, the money we received from patients on the managed-care model continued to come in once a month, allowing us to keep our practice in business. Since 2020, my managed-care patient population has more than doubled. I’m very confident that if we had another world crisis, my practice is going to be able to survive it. We were able to survive COVID thanks to managed care.

Transitioning to the ACO REACH model doesn’t have to be all or nothing

Transitioning to VBC can seem overwhelming for providers who have operated on a fee-for-service model for the entirety of their practice. Fortunately, transitioning to an ACO REACH model doesn’t have to be an all-or-nothing proposition. It is possible for providers to transition from FFS a little at a time, as I’ve been doing at my practice for the past 10 years. For instance, let’s say a physician currently has 2,000 active patients, and perhaps 200 of them can be moved into a managed care model. That would be a good place to start.

If I could give one piece of advice to a provider who is on the fence about transitioning to a value-based care model, it’s to look at the big picture. It’s important to look ahead at how things will be a year from now and the year after that. It’s definitely work, and it requires some patience and dedicated staff. In more than 10 years of transformation into this managed-care model, I have been blessed with staff members who have stuck with me through the entire transition. In fact, 70% of my staff has stayed with me for the last 10 years as we’ve worked together to bring this model to life.

Partnering with ilumed has put me into a good position to grow our managed-care model as my patient population continues to age into Medicare. Talk to the team at ilumed today to learn more about how they can help your practice make a smoother transition to value-based care.

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