Alliance operations tend to center around a theme. In 2017, we focused on trust and relationship building by regularly meeting with practitioners and their office staff. In 2018, our group tested the waters of targeted incentivization with projects like HCC Risk coding and the Q4 AWV payment program. This year the Alliance is focused on optimizing workflows so our network can reach its full potential. This theme has manifested itself through a series of process redesigns both internally and externally.

Last year’s incentivization programs, while effective (see figure 1),

put significant burden on primary care offices. The programs tended to require additional documentation and paper work, often in a compressed time window. This year we have consolidated the incentivized projects for AWVs, Care Gap Closure, and HCC Risk Coding into one holistic initiative: The Green Sheet Project. The goal of this project is to incentivize PCPs to perform key activities on our NextGen ACO patients, while shifting the lift of documentation and grading to the Alliance’s Clinical Documentation Specialist (CDS) team.

The project has a relatively simple design: At the start of the year the Alliance delivers Green Forms to the PCP. Each form represents one NextGen patient and explains what the Alliance would ideally expect from a provider during an Annual Wellness Visit (AWV) with that patient. Once a provider conducts an AWV for a patient, he/she signs and dates the form (no other documentation is needed). Each quarter the Alliance collects and grades the completed forms, then pays the office based on their work. The result is a process where physicians maximize their time performing the value-added activities, while our team of chart abstractors check for documentation.

Internally, the Alliance has redesigned its care coordination model. Our analytics team created a pool of high risk NextGen, Anthem, and MWHC Associates so we can narrow our focus. We then created an efficient workflow by altering the prior model at three key points.

First, we implemented a tool to help our RNCCs self-manage their workflow. This tool not only automatically assigns patients to the nurses but has a suite of dashboards to help them manage their patient panel. Next, we instilled a goal-oriented approach to care management. By focusing on achieving defined meaningful objectives with the patient, we can confidently graduate them from our care. Finally, we redesigned our Epic care coordination module to focus the workflow and reduce documentation. Once again, the goal is to ensure that our RN care coordinators are working to their full potential. The impacts of this process improvement project have been significant (see figure 2).

In 2019, our team is committed to continuing our work to roll out Alliance projects in a way that ensures providers work at the top of their licenses, minimizes time crunches, and curbs excess documentation. Ensuring that we have a network where physicians, nurses, and administration are working to their full potential is critical to sustaining our success in years to come.