ICYMI: How Geriatric Practices Can Bend the Cost Curve and Succeed With Value-Based Care

As the Centers for Medicare and Medicaid Services (CMS) have revised compensation rules, pressure on long-term/post-acute care (LTPAC) providers has increased to adapt to value-based care models. For geriatric practices, these pressures plus the challenges of the COVID-19 pandemic have accelerated the need to adapt business practices and technology to support collaboration and coordination with payers, health systems and care facilities.

In a recent webinar, executives from two successful geriatric practices shared what it takes to build and maintain a successful value-based infrastructure in LTPAC settings.

Amanda Tufano, MHA, FACHE, CMPE, is chief executive officer at Genevive, a geriatric medical practice and care management organization based in Minnesota. The organization holds multiple value-based payer contracts for dual-eligible patients.

Michelle Coffey, ACNS-BC, RN, MSN, is chief clinical officer at Austin Geriatric Specialists, the largest geriatric-focused medical practice in central Texas. The organization provides care to thousands of patients, following them through the continuum of care from hospitalization, to skilled nursing and assisted living facilities, to a successful transition home.

The presentation focused on three key areas:

• Embracing value-based care models
• Establishing a company culture that prevents burnout
• Supporting capitated payment models with the right technology and processes

Embracing value-based care models

Genevive wanted better alignment with payers and provider partners on clinical and financial goals.  As Tufano noted, facilities need providers who are more than “guests in their buildings,” and Genevive took action to forge closer partnerships:

• Developed two new Institutional Special Needs Plans (I-SNPs) to forge stronger ties with facilities and provide the infrastructure for alignment of clinical and financial incentives
• Evaluated existing networks and explored ways to provide innovative care and encourage more facilities to work with Genevive
• Shared metrics and goals with facilities
• Diversified ownership to build out additional value-driven contracts

Austin Geriatrics launched value-based care in 2018, and Coffey credits it with being the organization’s largest area of continued growth.

• Entered into capitated models and risk-sharing pools to drive growth in assisted living, home care and hospital-based settings
• Ensured partnerships aligned with Austin Geriatrics care goals, which include deprescribing, reduced invasive testing, holistic care, family involvement and advanced care planning
• Continue building relationships with value-based partners to support financial diversity for the practice and better care for patients

Company culture and burnout prevention

Genevive’s Tufano noted that requiring every provider to see a specific number of patients per day can cause providers to view their profession in a negative light. Instead of helping people, they feel pressured into meeting quotas in order to pay their bills.

To keep values and incentives aligned, Genevive uses a model that can be tailored to how providers prefer working:

• Providers are compensated based on the number of patients they can manage well on a panel size
• The entire practice and owners share in a performance incentive pool if the practice does well
• The model places emphasis on quality of care and supports Genevive’s belief that capitation should be held to a higher ethical bar

Austin Geriatrics takes proactive steps to combat burnout and staff turnover, as well as focusing on hiring providers whose goals align with its mission.

• Providing extensive training for employees that includes practicing to their highest level of licensure
• Establishing a dedicated after hours on-call team to ease pressure and time constraints on all team members
• Offering free counseling to providers and exploring ways to increase scheduling flexibility to improve work/life balance

Technology and process strategy

Genevive began its move to mobile technology in 2019 after a winter snowstorm caused major disruptions in service to clients. The upgrades put the organization in a strong position to adapt when the COVID-19 pandemic hit.

• Installed a new phone system that was compatible with iPad Wi-fi calls
• Changed to GEHRIMED, a geriatric electronic health record (EHR) designed to support iPads and iOS, and was specifically created for mobile practitioners
• When CMS released new rules for practitioners in 2020, Genevive could move quickly to provide and bill for services such as telehealth, virtual care and e-consults

At Austin Geriatrics, third-party solutions had been added to its existing EHR in an effort to decrease the time clinicians spent on documentation. But, according to Coffey, managing multiple vendors was inefficient.

Austin Geriatrics switched to GEHRIMED for processes and features designed to support how geriatric practitioners work. 

• Built-in functionality supports clinicians, with standardized reports, advanced search function and CPT code protection
• Dashboards with alert notifications for quality measures support value-based care models
• Integration features keep practitioners in sync with on-call and office support services

Risk-sharing payment agreements and value-based care models will continue to become more common, and CMS will continue to issue changes in compensation rules. To ensure their financial stability, LTPAC providers need to look ahead and be ready to adapt their processes and technology.  The result will be stronger collaboration with other care providers and enhanced quality of care, in addition to financial stability. Watch the full webinar here.