Guide to Optimizing Workflow Integration for Improved Provider Engagement
Written by: Cheryl Reifsnyder, PhD and Amanda Banister, Sr Manager Provider Performance and Technology Utilization, Veradigm
Research clearly shows that improving payer-provider communications can help improve provider engagement and, as a result, drive improved patient care. That’s because improving payer-provider communication delivers benefits such as:
- More informed decision-making: Improving payer-provider communications results in improved data sharing, which helps drive better patient care by giving providers access to actionable information, enabling more informed healthcare decisions.
- Decreased administrative burden: According to one recent survey, clinicians currently spend nearly 28 hours per week on administrative tasks. This can be minimized by streamlining payer-provider communications and administrative processes such as prior authorizations, claims submissions, and claims payments.
However, current healthcare workflows often interfere with effective payer-provider communication, which is essential to quality provider engagement. One common challenge is siloed data, such as occurs when payers and providers maintain a transactional relationship based on the fee-for-service payment model. In this model, providers are reimbursed for services provided regardless of patient outcomes. This model, although straightforward in implementation, often leads to fragmented patient care and climbing healthcare costs.
The result? Worsened patient outcomes.
Effective workflow integration—effectively integrating communications, data sharing, and other processes into providers’ existing workflows—is a pivotal solution to these problems. Effective workflow integration can improve provider engagement by facilitating seamless operations, reducing administrative burden, and minimizing procedural inefficiencies. These, in turn, give providers more time and resources to devote to patient care.
In this article, you will learn how workflow optimization and communications workflow integration are key to ensuring provider engagement, enabling payers and providers to work collaboratively toward improved patient outcomes.
Importance of provider engagement
Provider engagement is vital for improving the quality of patient care, partly due to the benefits provider engagement entails.
Helps improve clinical data exchange (CDE)
For instance, improved provider engagement has been shown to improve payer-provider CDE. CDE plays a critical role in payer operations. Payers require timely access to patients’ clinical data for processing claims, risk adjustment, evaluating necessity of requested services, and identifying potential gap closure opportunities. Payers also require patients’ medical records to make decisions such as whether specific treatments are medically necessary and whether to grant prior authorization for specific treatment plans. Rapid access to patients’ healthcare data enables payers to make treatment coverage decisions more rapidly.
Traditionally, payer-provider clinical data exchange occurred manually, often via extensive and time-consuming processes that placed a significant time and energy burden on both practice and payer staff while simultaneously introducing more errors into patient records.
Increases opportunities to identify and close care gaps
Gaps in care refer to the disconnects between the recommended medical care and the care patients actually receive—such as when patients fail to receive preventive care recommended by the Agency for Healthcare Research and Quality (AHRQ). AHRQ research shows only 8% of patients receive all recommended screenings and preventive care; nearly 5% receive none of these preventive services.
Payers frequently have access to more information about patients’ medical care than individual providers. They can use claims data to identify potential care gaps for patient members—but identifying potential care gaps is only half the battle. Closing those gaps requires the active cooperation of the patient’s healthcare team, and providers are not always aware of existing gaps.
That’s why improving provider engagement can improve identification and closure of patient gaps in care. Improved provider engagement generally goes hand-in-hand with improved payer-provider communications and CDE. These enable payers to communicate crucial care gap information to physicians—information those providers might not have been able to access otherwise—providing them with a more complete clinical picture for their patients and facilitating their ability to close gaps in care.
Improves patient outcomes
Streamlined payer-provider communications enable payers to communicate care gap information in the timely manner required for gap closure and accelerates payers’ ability to make decisions such as prior authorization and medical necessity. Patients can receive treatments more quickly, which helps improve health outcomes.
However, the process of closing patient care gaps remains plagued by difficulties. One issue is the lack of effective payer-provider CDE. This can result in the use of incomplete or inaccurate data when identifying care gaps, which can cause care gaps to be overlooked or misidentified.
Another common problem: Successfully communicating care gap information frequently requires providers to manually log into separate portals for various payers, increasing providers’ administrative burden.1 A recent survey revealed that 80% of U.S. clinicians avoid the extra steps required to access insights from these and other EHR-external tools—which may cause them to miss crucial care gap information.
Improving provider engagement
Poor provider engagement results in delayed and/or ineffective payer-provider communication, negatively impacting providers’ ability to address gaps in care. However that’s not the only effect. Poor provider engagement also creates an increased administrative load for providers, leaving them less time and energy to focus on patient care
Increased administrative load is associated with increased physician burnout. Physician burnout rates reached a record high of 62.8% in 2021; the Medscape 2024 Physician Burnout & Depression Report showed that physician burnout rates remain high, despite slight decreases. Sixty-two percent of physicians reported that the excess of administrative tasks such as charting and other paperwork contributed to burnout; 77% of clinicians reported that the need to use 6 to 20 separate solutions to access patient-specific insights contributes to fatigue and burnout and negatively impacts patient outcomes and quality of care.
Causes of poor provider engagement
One of the primary causes of poor provider engagement is the inefficiency of the workflows surrounding payer-provider communications about essential matters such as potential gaps in care, prior authorizations, reimbursement, and coverage questions. For instance, although 74% of clinicians reported changing diagnoses or treatment plans based on patient insights gained from various third-party solutions, 80% of clinicians surveyed admitted they often avoided the extra steps needed to access such tools when external to their EHRs.
EHR-external solutions are generally more difficult to access, resulting in missed opportunities to enhance patient care. Of those surveyed, 94% reported that the lack of user-friendly insights negatively impacted patient care, causing harmful effects such as delayed treatment initiation and use of incorrect treatment plans.
Integration & optimization of payer-provider communication channels
One key means of enhancing provider engagement is by streamlining payer-provider communications and CDE. To be effective, payer-provider communications and CDE cannot disrupt the provider’s workflow. Information exchange must be convenient and easy-to-use—which means moving away from EHR-external solutions. To maximize provider utilization, a data exchange solution must fit into the normal patient documentation process. Optimizing payer-provider interactions requires integrating communications into providers’ existing workflows in a way that makes payer-provider CDE as smooth as possible.
Veradigm solutions for improving provider engagement
Veradigm has designed several solutions to improve provider engagement. They optimize workflows for providers in numerous ways, integrating with existing systems to improve efficiency for both payers and providers by facilitating high-speed communications and CDE.
By integrating payer guidance and prior authorization management directly into providers’ existing workflows, Veradigm can help you positively impact point-of-care decision-making for improved patient outcomes.
Veradigm Payer Insights (VPI)
VPI facilitates provider engagement by integrating alerts into providers’ existing workflows, eliminating the need to log into multiple payer portals to access patient insights.
The process starts by enabling payers to identify potential care gaps using providers’ EHR data. Payers can then generate alerts containing relevant, patient-specific information for providers to evaluate, respond to, and potentially address with patients. VPI seamlessly integrates alerts into providers’ existing workflows, directly into patients’ EHR records, allowing potential care gaps to be addressed during patients’ existing clinical care workflow.
Alerts integrated into providers’ existing workflows are more likely to be seen and addressed when they can be of greatest benefit; conversely, when gap information is not accessible at the point of care, during providers’ normal clinical workflows, their potential positive impact on patient care is greatly reduced. Integration enables Veradigm’s data-driven insights to flow seamlessly within the provider workflow. This reduces the administrative burden on providers, enhancing decision-making within the EHR workflow and improving patient outcomes.
VPI’s reach also extends beyond the Veradigm EHR footprint, making it easier for payers to share information regarding potential gaps in care even with providers who don’t use Veradigm EHR solutions.
eChart Courier™
Veradigm eChart Courier is another solution designed to enhance payer-provider exchanges, thereby boosting provider engagement. This solution helps facilitate payer-provider collaboration by retrieving medical charts electronically and sending information in a secure, HIPAA-compliant format.
Typically, patient charts are pulled individually, then delivered to payers by mail or fax. Manual chart retrieval is a time-consuming process that diverts resources that could be better used supporting patients.
However, eChart Courier operates via a medical practice’s EHR system, allowing chart access without altering the provider workflow. Streamlining medical chart retrieval saves time, cost, and resources for both payers and providers. In addition, eChart Courier is available with the Veradigm and Practice Fusion EHR systems at no additional cost to providers.
Veradigm Collaborate
Veradigm Collaborate, one of a suite of solutions created to optimize payer-provider interactions, also serves to promote provider engagement. Veradigm Collaborate specifically targets gap closure efforts, helping make them as efficient and effective as possible. It can help:
- Facilitate payer-provider communications to help assess, address, and close open care gaps
- Improve patient quality of care by notifying providers of potential care gaps using consolidated alerts
- Streamline document transfer with easy-to-use, secure electronic document delivery
Veradigm Collaborate is designed to integrate into multiple different workflows to minimize disruption. It increases communication efficiency via consolidated alerts. Use of customized prioritization algorithms enables it to deliver only the highest confidence level alerts.
Veradigm Comprehensive Outcomes Realization and Engagement (CORE) program
The Veradigm CORE solution utilizes VPI, eChart Courier, Veradigm Collaborate, and other Veradigm solutions to help payers support provider engagement through delivery of prospective care reminders and potential care gap alerts while reducing providers’ administrative burden.2
The Veradigm CORE solution uses bidirectional EHR integration to deliver digital care gap information through point-of-care integration with Veradigm, Athenahealth, Vim, and Epic EHRs. When care gaps are addressed, bidirectional EHR integration enables supporting documentation to be extracted, coded, and delivered to the initiating payer.3
CORE ensures providers can focus more on patient interactions and less on administrative tasks, leading to improved health outcomes plus more efficient use of healthcare resources. Currently, Veradigm CORE reaches more than 400K providers, over 80K payers, and more than 40 million patients.4
Planning for successful provider engagement
Streamlining payer-provider communications and CDE is one of the most effective strategies for enhancing provider engagement—and gaining the benefits associated with decreasing providers’ administrative burden and increasing their access to patient-specific insights. Contact Veradigm to learn how we can help make your payer-provider interactions more efficient and more effective, so you can best support your providers in delivering the best possible medical care to your patient members.
References:
- Veradigm, 2024. Comprehensive Outcomes Realization and Engagement (Veradigm CORE Program). VDMP-1595-MAY-2024.
- Veradigm, 2024. Comprehensive Outcomes Realization and Engagement (Veradigm CORE Program). VDMP-1595-MAY-2024.
- Veradigm, 2024. Comprehensive Outcomes Realization and Engagement (Veradigm CORE Program). VDMP-1595-MAY-2024.
- Veradigm, 2024. Empower Providers with Services to Bridge Care Gaps: Comprehensive Outcomes Realization and Engagement (CORE). VDMP-1646-v2.