Show me the encounter data, pretty please
Show me the encounter data, pretty please
One IPA’s strategy for increasing reporting
Berkeley, CA-based Alta Bates Medical Group isn’t the only IPA that wishes its network physicians would provide more claims encounter data for its managed care patients (see related story, p. 1). Many IPAs in mature managed care markets are being asked by health plans to report clinical outcomes data, but often come up more empty-handed than they would like. The reason: Too many group practices lack the technology or the desire to report outcomes.
The solution at Mission Viejo, CA-based Monarch Health Care, according to senior vice president and chief information officer James Selevan, MD: financial incentives for physicians who rank at the head of the class. Monarch has beefed up its information systems to enhance its electronic medical records systems and to connect directly with the Internet. The goal is to make it as easy as possible for physicians and their staffs to report encounter data.
At the same time, Monarch has purchased software that includes a prompt to encourage physicians to adhere more strictly to the drug formulary of each patient’s health plan, Selevan says. Like many systems with a heavy Medicare HMO patient base, at-risk pharmacy costs are hitting Monarch hard, he explains. "We contract with 18 health plans, and thus have 18 formularies to keep up with."
Monarch’s network physicians use hand-held computers to dictate notes and prescribe medications for patients. The system issues a prompt when the physician keys in a name of a drug not on the formulary covered by the patient’s health plan, Selevan says.
Both measures have just been implemented, so it’s too early to tell if they have changed physician behavior. Physician’s Managed Care Report plans to follow up with Monarch in six months to see if the IPA’s investments in incentives and software have paid off.
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