Is your Denominator really your Denominator?
Methodologies behind patient attribution are complicated. Too often we see where patients are attributed to a practice that has never communicated with the practice or are no longer active patients at the practice. On top of that, bring value-based care into the conversation and the practice is being held accountable for this patient’s metrics.
Consider for a moment that a patient is attributed to your practice that isn’t yours, and due to a pharmacy claim the insurance company had submitted somewhere on this patient they are now in a tripled-weighted medication adherence measure. You have no contact with this patient throughout the year and they fail the measure. The potential financial impact on the practice not meeting certain performance and bonus tiers due to this single patient can be significant.
Mining your data to know who your true active patients
are, versus who the insurance companies say are yours is a critical function to
value-based care. We’re already short enough on time to close gaps on the
patients who actually are active with the practice. Don’t spin your wheels and
take a huge financial hit over the ones you don’t have contact with. Partner
with someone who can assist with cleaning up your denominator.