How to Prepare Your Practice for Global RiskAuthor : Strive Health
In our previous pieces, we discussed lessons learned from primary care’s shift to full risk and outlined how these models work in Medicare Advantage (MA). So, how can you prepare your nephrology practice for this new opportunity?
Let’s walk through payor expectations, keys to success and the roadmap for readying your practice for nephrologist-centered full-risk models.
Payors Require Certain Capabilities
While MA full-risk contracts share many similarities with other value-based care (VBC) models familiar to the nephrology space — like the Comprehensive Kidney Care Contracting (CKCC) model — they are much more resource-intensive and complex.
The risk dollars (including the financial upside) and the bar for performance are often much higher for MA than other models. Therefore, payors shifting risk on chronic kidney disease (CKD) and end-stage kidney disease (ESKD) MA patients are looking for partners with a demonstrated commitment to risk models, significant capital to invest (and cover risk) and specialized capabilities to successfully participate in these models.
As you think about participating in these models, there are a few key questions you should ask your practice:
How Can We Access the Infrastructure to Be Successful?
Practices taking on full risk need to be equipped to manage their patients’ full continuum of care — not just kidney care services. Taking this holistic approach to patient care requires specialized capabilities. For practices already participating in CKCC, these requirements may seem familiar. However, full risk goes a few steps beyond the infrastructural needs for CKCC participation.
- Integrated care delivery: MA full-risk models require building out more core primary care provider responsibilities like annual health risk assessments, over 40 screenings and identification of Healthcare Effectiveness Data and Information Set (HEDIS) gaps. Practices need to also be able to coordinate across providers in a patient’s care network and—in the case of global risk—be the referral source for non-nephrology specialists.
- Technology enablement: Data analytics and technology solutions are critical to efficiently deploying resources across patients in full-risk contracts. Additionally, more in-depth risk-adjustment factor (RAF) score support is key to optimizing accurate hierarchical condition category (HCC) coding and patient acuity diagnosis — a core input that ensures more comprehensive patient care and appropriate revenue in these models.
- Management expertise: Full-risk contracts with payors can be complex, so understanding how best to negotiate in favor of your practice is key. These contracts require specialists who are familiar with the financial management of and enrollment within full-risk models. For example, unlike in CKCC where patients are automatically attributed to the model, MA plans require patients to actively enroll. Therefore, additional resources dedicated to marketing and enrollment must be developed.
Is My Practice Ready to Commit to Full Risk?
First movers into these full-risk models have the unique opportunity to access significant improvements in patient care, innovative care delivery resources, and increased practice revenue. While nephrologists are increasingly evolving their infrastructure to more successfully adopt VBC contracts, there is still much to be done to prepare to commit to full-risk models. Nephrology groups should ensure the proper due diligence is done before deciding to participate in full risk. Here’s how:
- Educate your practice on new models. Understanding how these full-risk models work and the impact of participating in them on your practice is critical. Based on that, evaluate your group’s risk appetite to take on these models.
- Build commitment within your practice. As we already said, these models are resource-intensive and complex. Success is heavily driven by securing buy-in from your physicians and your providers spearheading patients’ care.
- Align with a long-term partner. Choose a partner who can help your practice gain experience with early models such as CKCC and also bring the capabilities and expertise that will help you succeed in full-risk models over the long term.
Strive Can Help You Prepare
Strive Health partners with nephrologists, health systems, payors and medical groups to create integrated solutions that make value-based kidney care a reality.