Practice Notes

WellSpan Medical Group: The case for interdisciplinary incentives


Rivka Friedman

Many of the early ACOs are beginning to reward care management activities through new incentives.

Incorporating these care management incentives into compensation has proven to drive greater focus on the preventive care tasks at the root of cost minimization efforts.

But before offering up new dollars, executives must consider a key question: who in the care continuum should be rewarded for chronic care management?



The case for interdisciplinary incentives

It's true that many key activities—like checking HbA1c levels, or counseling patients about smoking cessation—happen at primary care. And some specialists have raised concerns that interdisciplinary incentives hold them responsible for behavior they can’t control.

But health care is a team sport, and we’re more likely to see gains on outcomes where care is well-coordinated and treated as a true team effort.

A 2009 study published in the Annals of Family Practice makes a strong case for interdisciplinary incentives. The authors examined data from the National Ambulatory Medical Care Survey and found that nearly half of visits to specialists were for routine follow-up and preventive care, much of which could likely be managed in a primary care setting.

In many of these cases, specialists are stepping in for their PCP peers to discuss and manage patients' chronic condition(s). That’s part of the reason so many early adopters of value-based payment have attempted to incorporate specialists into care management efforts.



Interdisciplinary incentives in practice: WellSpan Medical Group

WellSpan Medical Group, the employed medical group of Pennsylvania-based WellSpan Health, has undertaken a comprehensive focus on diabetes care across its medical group.

For some time, PCPs have been measured by their ability to reduce the number of patients with unmanaged diabetes (defined as having an HbA1c level above 9). But this year, as part of a broader diabetes-management effort, the medical group has tied hemoglobin A1c management not only to compensation for PCPs, but to the entire medical group.

To facilitate more comprehensive education of diabetes management and HbA1c control, WellSpan is highlighting the "diabetic status" field in its EMR. The highlighted EMR field will trigger PCPs to check HbA1c, but it also should induce specialists to check in with their patients about certain chronic conditions and to encourage patients to follow up with a PCP who can help manage those conditions.



The outcomes

Incentivizing specialists for chronic disease management has two potential effects.

First, if a specialist does serve in primary care capacities, as a cardiologist might for a patient with severe CHF, that specialist now has incentives to help the patient manage his chronic conditions more comprehensively.

Second, interdisciplinary care management incentives promote general communication and coordination of care between specialists and PCPs—a lynchpin of successful care management.

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