Have a Heart—and Give a Boost to Your Provider Incentive Program

Blog Posts  |  27 February 2023

Your provider incentive program is a valuable tool, enabling you to reward providers for actively reaching out to your members. Incentives can help ensure that providers regularly see and assess members, document their health records, and, if needed, close care gaps or refer them to the appropriate specialists. Incentives can also foster provider engagement to capture chronic conditions through improved documentation and coding.

Most importantly, though, your provider incentive program can help improve providers’ engagement and interactions with patients—which helps to promote quality patient care.

Did you know the Veradigm Cardiology Registry can further strengthen your physician incentive program by helping your clinicians easily identify growth and improvement opportunities?

Veradigm Cardiology Registry

The Veradigm Cardiology Registry (formerly the PINNACLE Registry) is operated in partnership with the American College of Cardiology (ACC). It is the largest sample of ambulatory cardiology practices in the U.S., collecting data from cardiologists, primary care physicians (PCPs), endocrinologists, and other providers to create an overview of patients with cardiovascular disease. The Veradigm Cardiology Registry captures data on coronary artery disease, hypertension, heart failure, and atrial fibrillation to provide the largest outpatient quality improvement registry in the country.

The Veradigm Cardiology Registry provides an overview of the presentation, progression, management, and outcomes of patients with cardiovascular disease as they receive care and treatment from participating multidisciplinary teams. Doing so can provide essential insights into current processes of cardiovascular care. These insights are critical for helping you identify ways to improve your interactions with patients and support your providers’ interactions with patients as well.

Clinical vs. claims data

Traditionally, payers’ involvement in patient care and access to clinical data has been limited. Payers have had to rely on claims data and the limited clinical data found on claims forms to do things such as managing cost reduction programs and creating member outreach programs for high-risk patients (e.g., patients with chronic conditions.)

The problem is that it may take over a month for a patient’s hospital visit to be reported on a claims form. Even when it is reported, hospital-reported member information often lacks critical clinical details such as historical medical records. These details would help the payer identify high-risk patients so care management activities can begin earlier. However, clinical data provides greater insight into patients’ needs than information gleaned from claims data. Recently, quality reporting programs such as the Healthcare Effectiveness Data and Information Set (HEDIS) and the Medicare Advantage star rating system put pressure on payers to adopt more patient-centered approaches to member management—many of which involve greater access to and use of clinical data.

Even when clinical information can be made accessible, though, payers often find that integrating clinical data with their own systems presents significant challenges. Payers’ systems are generally incompatible with the systems producing clinical information. In addition, payers’ IT infrastructure may have numerous diverse applications operating on multiple technologies, making accommodation of clinical data extremely difficult. Payers may also face quality and terminology gaps when trying to integrate clinical data. Although payer systems may have stringently followed industry standards, numerous provider systems still struggle with compatibility.

Highlighting targets for improvement

The Veradigm Cardiology Registry can strengthen your physician incentive program by highlighting where opportunities should occur. This happens partly because practices participating in the Registry receive practice-specific data that enables them to gain deeper clinical insight, not otherwise available, for their patients with coronary artery disease, hypertension, heart failure, and atrial fibrillation. This enables providers to review their performance with individual patients.

This type of measurement is central to quality improvement because clinicians can compare, or benchmark, their patients’ care and outcomes to national standards only when data is being collected for comparison. Benchmarking helps to identify targets for performance improvement.

Registry participants can also access easy-to-interpret benchmark reports, which facilitate coordinated care, prevention, and treatment of cardiovascular diseases. Viewing the patient-level data in these reports enables clinicians to quickly identify opportunities for improvement so care management activities can begin earlier.

The value of clinical databases

Providers, hospital personnel, payers, government staff, and the scientific community—professionals in all these areas—are increasingly recognizing the value of clinical databases. Findings from clinical disease registries have been included in clinical practice guidelines and statistical publications such as the American Heart Association’s Heart and Stroke Statistical Update. Clinicians are starting to view registries as a valuable tool for assessing the quality of care they are providing to patients.

As a payer, you can leverage the clinical insights provided by the Veradigm Cardiovascular Registry to strengthen the incentive program you offer your provider network to improve documentation and coding of chronic cardiovascular conditions—which, in turn, will help your beneficiaries receive better medical care. The Veradigm Cardiovascular Registry also provides clinical insights that can help you bolster member outreach programs for patients with chronic conditions, far earlier than you could if only using claims as your sole data source.

Contact us to learn more about how the Veradigm Cardiovascular Registry can help you help your patients to receive better care.

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