While the shift to value-based care is often presented as an unqualified good, the foundational change in healthcare’s business model has made it difficult for independent providers to survive, as evidenced by the large-scale consolidation of the industry.
Michael Supino is the CEO of Midland Medical, a privately-owned primary care provider in Oakland Park, Florida with more than 6,500 patients, many of whom are on Medicare or Medicare Advantage plans.
More often than not, Supino’s clinic experiences regulatory changes meant to improve patient outcomes as burdensome administrative challenges.
“With a practice that size things get missed, especially with all the requirements around quality reporting and coding,” Supino said. “The things that actually improve outcomes and care are actually sometimes reduced because of the sheer waterfall of things you need to face everyday with each encounter.”
His story is not an uncommon one. A recent survey from medical malpractice insurer the Doctors Company found that 61 percent of doctors say that value-based care will damage their practice with many citing the creation of an additional stressor to already falling reimbursement rates.
But Supino has recently started to move past the headaches of juggling scores of spreadsheets and jury-rigged administrative tools by enlisting technology from New York-based startup Stellar Health, which was founded earlier this year with the mission of “supercharging value-based care” by helping to facilitate better care coordination.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
In a nutshell, Stellar’s platform works by connecting claims and clinical data to highlight information and specific actions that can be taken to close gaps in care. If doctors complete these tasks they get an additional payment on top of the formula used by Medicare to reimburse care.
Say, for example, a diabetic Medicare patient comes in with a complaint about bronchitis. Stellar’s platform provides a checklist of actions for the clinical care team to look beyond the acute bronchitis and help manage the other chronic condition like scheduling a diabetic eye exam and confirming medication adherence, in addition to treating the initial complaint.
The company’s organizing thesis is that the shift to value-based care has led to more responsibility for doctors without the tools and associated financial incentive to actually follow through.
Providers and payers purchase the platform as an initial investment meant to generate better care for higher risk and managed care patients, leading to better outcomes and higher reimbursement. So far, the company is working with health plans and recently added a referral management tool to the platform to give additional support to primary care physicians.
“The sharp transition to value-based care has meant that insurers are trying to get doctors to fundamentally change their behaviors from ABC to XYZ,” said Stellar Health CEO Ben Kraus. “The problem is if you don’t get them to see the financial reward upfront, there’s too much white noise and other financial pressures.”
Supino said Stellar’s technology plugs directly into the clinic’s EHR and allows doctors and clinical staff to easily see what potential actions need to be done beforehand for the day’s scheduled appointments to meet care coordination goals.
“What it did for us was illuminate all of the needles in the haystack and lays everything out very cleanly,” Supino said. “Stellar has aided in putting everyone into alignment to target those high value preventative efforts.”
Midland Medical has seen measurable value from the platform which has helped the provider improve quality metrics and earnings per patient. Specifically they’ve been able to increase their diabetes composite scores, colon cancer screening rates and shrink their patient panel coding gap, leading to thousands more in increased revenue per patient.
Supino also highlighted his ability to hire more physicians and sign higher value risk-oriented contracts because of the increased confidence of being able to address the needs of higher risk patients.
“If you think about where the industry has gone and all the layers that have been put between the provider and the health plans they’re serving, you get a paralysis by analysis,” Supino said. “Stellar makes it feel like we have a fighting chance, while also improving care for our patients.”
Picture: Getty Images, Hong Li
