Provider Insider

Issue 10

Table of Contents

Leadership Message

Welcome to springtime!

It has been a busy time here at C3 as we adjust our focus to the new single scorecard and continue to adapt to the ever-changing landscape of the COVID-19 pandemic. Thank you for all the hard work you are doing to keep your communities healthy.

In this newsletter we are presenting first quarter data results for single scorecard metrics in addition to the standard updates on network activities.

A few things I want to call out:

  • We appreciate the engagement from our practices this past quarter. We are seeing providers attend our monthly practice meetings, and many are asking pointed questions about the work, why it matters and how we can improve.
  • Providers are watching the new educational videos and offering great feedback for future topics. We are excited to announce the release of our newest video: Coding Patient Complexity.
Value-based Primary Care* Survey
Single Scorecard Survey
Medicare Annual Wellness Visits Survey
Optimizing Generic Dispensing Rate Survey
Coding Patient Complexity* Survey
  • We see the hard work you are doing to get your patients in for their annual visits, and in closing care gaps.
  • Finally, the cost data, though undoubtedly affected by the COVID-19 pandemic, is evidence that your hard work, both to keep patients out of the ED and move toward generic prescriptions, is working.

Our teams continue to work on improving the tools we have to offer practices to help them succeed in value-based care. We continue to believe that focusing our efforts on scorecard metrics will drive success in our value-based contracts, keep our patients and communities healthier, and increase revenue opportunities for your practice.

As always, overall success of the network is dependent on the excellent work you do every day in your practices. We applaud your continued efforts toward improvement.

Amy Scanlan, MD

Single Scorecard and Metrics

Commitment: As you can see, we are making slow but steady progress in our commitment measures. The majority of practices have had providers attend our monthly meetings, which has changed the conversations we are having around the metrics and the data. Also, many providers have started watching the educational videos and are providing great feedback. We are excited to see the success and engagement. Please keep up the great work!

Capabilities: We continue to focus our efforts on getting patients in to be seen for their annual visits, and we are seeing the numbers slowly rise. We know that by focusing on these sort of visits, and getting patients into our practices, we will improve all of our other quality measures. We continue to hone our analytics to be able to better support your practices in doing this work, and we are working to create a collection of tools that can be used at the practice level to improve.

Cost: We are doing well as a network with regard to our cost metrics. While we recognize that COVID-19 has undoubtedly affected ED utilization, we also know that many of our practices have been working hard on this metric. Efforts to increase the number of generic prescriptions have removed over $4 million in unnecessary costs in 2020 resulting in an increased opportunity to achieve shared savings for our network. 

Education Series

The first videos in our education series have been published and are available for viewing. Click the links below or visit our website to view each video. As approved by the clinical committee, viewing of these videos will count toward single scorecard goals and may also count toward CME credits for interested providers. After watching each video, please complete the corresponding survey. Each survey requires providers to include their NPI to receive single scorecard credit.
Value-based Primary Care* Survey
Single Scorecard Survey
Medicare Annual Wellness Visits Survey
Optimizing Generic Dispensing Rate Survey
Coding Patient Complexity* (NEW) Survey
Strategies for Improving ED Utilization (coming soon)
*Viewing of these videos is your key to success on the new single scorecard. Watching Value-based Primary Care and Coding Patient Complexity is required for your practice to qualify for full shared savings from the “commitment” portion of the scorecard.

Care Management

The C3 care management team supports network providers by outreaching patients following hospitalizations and ED visits. This helps reduce the risk of readmission by ensuring patients have the resources they need to self-manage at home. In Q1 2021, the C3 care management team reached out to more than 1,000 patients across the C3 network. Our team is made up of the following individuals:
  • Nurse care managers focus on patients requiring more complex care interactions. They contact patients after a hospitalization and specialize in interventions that reduce the likelihood of the patient returning to the hospital. They also work with patients who have complex health conditions; high ED usage; or complicated social situations that may create need for extra support navigating the health care systems, understanding how to self-manage health conditions, or obtaining supportive services. Our nurse care managers are Michael Uhrman, BSN, RN, CM; and Analisa Cole, BSN, RN, CM.
  • Population health specialists contact less medically complex patients after emergency care visits to reduce the possibility of those individuals returning to the ED. They also provide education on appropriate ED usage. Emergency follow-up calls is a strategy supported by our payers to decrease cost and utilization. Our population health specialists are Angie Cook, NCMA; Heather Hubach, NCMA; and Alfonzo Munoz, LPN.
  • Clinical pharmacists focus on medication issues that affect patient outcomes. They collaborate with care managers when a patient expresses confusion about their medication regimen or have difficulty obtaining medications. They also identify patients on high-cost medications and work with providers to switch them to lower-cost alternatives. Our clinical pharmacist is Keri Hogan, PharmD, BCACP, CLS.
If your practice is not currently receiving care management support and would like to utilize this free service, please contact Jenn Countryman.

Contracting

New Participating Provider Agreements (PPA) Required by July 1, 2021 Over the past year, C3 has seen changes to our name, participation requirements, single scorecard and single funds flow—to name just a few. These changes warrant your practice/organization signing a new participating provider agreement. As a reminder, these agreements formalize the relationship between C3 and you as a practice. It allows C3 to then negotiate payer arrangements that help provide revenue opportunities to your practice for value-based care. These agreements are signed at a tax ID level and not an individual provider level. Your transformation coaches, Katie Woodward and Christy Howell, provided the appropriate contact names for your organization to Kelly Henry, Senior Director of Value-based Contracting. Kelly emailed those contacts last month to provide the new PPA and answer any questions. She will be outreaching again later this month if she has not received an executed copy, and you will also be asked about the status of these agreements in your May monthly meetings. If you have any questions regarding the agreement, please feel free to contact Kelly Henry directly.

Pharmacy

Copay Cards Negatively Impact Generic Drug Usage


Increasing the generic dispensing rate is a key area of focus to drive lower cost. The use of generic medications lowers overall drug costs and improves medication adherence, leading to better control of chronic diseases and reduced health care costs.1

Pharmaceutical manufacturers distribute copay cards to eliminate the barrier of higher patient out-of-pocket cost for brand-name medications.  This strategy can encourage a patient to start a brand-name medication in place of a generic alternative, or incentivize a patient to keep taking a brand-name even when the generic equivalent becomes available.2

Copay cards are beneficial when the brand-name is the only medication the patient can take.  However, the use of copay cards often leads to unnecessary use of brand-name medications. One study estimated that for brand-name drugs facing generic competition, the use of copay cards can boost sales of the brand-name drug by at least 60%.3


Unintended Consequences of Copay Cards:

  • Copay cards have a maximum savings limit and expire. Patient then pays full price.
  • Copay cards can reduce cost to patients, but payers still pay their full share of brand-name medication, increasing medication spending. The chart below provides an example showing higher costs to the payer for brand-name Januvia, compared to the alternative generic option of alogliptin (see chart).
  • Copay cards most often do not contribute to deductibles or out-of-pocket maximums. As a result, they are not actually reducing out-of-pocket spending in many situations.

Key Takeaways:

  • Copay cards increase use of brand-name drugs, driving up medication expenditure and lowering generic dispensing rate.
  • Use of copay cards can result in unintended costs for payers and patients .
  • When a generic equivalent becomes available, it is best to utilize the generic formulation and avoid use of copay cards.

References:

  1. Choudhry N, et al. Improving Adherence to Therapy and Clinical Outcomes While Containing Costs: Opportunities from the Greater Use of Generic Medications: Best Practice Advice from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. 2016;164:41-49.
  2. Dafny L, Ody C, Schmitt M. When Discounts Raise Costs: The Effect of Copay Coupons on Generic Utilization. American Economic Journal: Economic Policy, 2017; 9(2): 91-123.
  3. “Prescription Drug Coupons Actually Increase Healthcare Spending by Billions.” October 3, 2017. https://insight.kellogg.northwestern.edu/article/prescription-drug-copay-coupons-hurt-generic-competition.

Transformation

UnitedHealthcare MA Annual Wellness Visit Incentive Program C3 has entered into an ACO agreement with UnitedHealthcare Medicare Advantage that includes annual shared savings and stars bonus opportunities. To jump-start performance in this agreement, C3 has launched an annual wellness visit incentive program, in conjunction with the UnitedHealthcare MA contract, for performance year 2021. From 1/1/2021 – 12/31/2021, C3 will provide an additional incentive payment for completion of an annual wellness visit for each attributed UnitedHealthcare MA patient. This payment will be paid quarterly and is in addition to your regular fee-for-service reimbursement for these services. Eligibility will be determined by UnitedHealthcare Medicare Advantage as noted with a completed Annual Care Visit (ACV) and includes visit types billed as G0402, G4038-G4039, and any other codes that qualify as an UnitedHealthcare Medicare Advantage ACV.