Preventive care: Gauge potential to drive revenue

#5in5_Blog_BannerSay your patient population is the size of Cincinnati and Toledo combined, you might be able to fill up my beloved Buckeyes’ Ohio Stadium with patients who’ve skipped two years of well visits.

I’m talking about 18 percent of your patients missing out on preventive care.

What would closing that gap in care mean to patient health and to the financial goals of health systems?

A recent analysis of patient data provided some possible answers.

Using a cohort of about 451,000, I ran numbers against a deidentified patient database. I found 190,000 patients who had not had a well visit in 24 months.

My team was able to segment half of that group, or about 18 percent of the total cohort, by payer. Since commercial insurers, Medicare or Medicaid offer reimbursement for well-visits, we determined providing a yearly physical for those 85,000 patients could potentially mean $7 million in reimbursements.

Since the reimbursements are paid under both fee-for-value and fee-for-service models, preventive care can help providers earn revenue during the transition to value-based care.

You can see the potential. Football stadium-sized crowds of patients – or at least sizable percentages of patient populations – for whom you bear responsibility are available for outreach and care.

Finding patients in need of preventive service and getting them in for a well visit can be the first step toward coordinating care and hopefully improving patient experience and population health and lowering health costs.

Read more about the potential benefits of prevention in a #5in5 interview Preventive care can be a bridge to fee-for-value. There you can also read about tools for identifying patients most in need.

Explore more on the topic in the Optum white paper Prevention connects service and value.

About the author

Carl JohnsonCarl Johnson, MD, EdM, MSc. is a pediatrician trained at Boston Children’s Hospital. He completed a Medical Education fellowship at Harvard Medical School and was a faculty health services researcher at The Mount Sinai School of Medicine.

Before joining Optum Analytics he worked as a physician executive at Cerner Corporation. He is a graduate of the Mount Sinai School of Medicine in New York City and has held faculty positions at Harvard Medical School, University of California at San Francisco, The Ohio State University, and The Mount Sinai School of Medicine.

Dr. Johnson believes that healthcare can be transformed with the help of the right data. When he is not helping to transform healthcare, he can be found playing tennis, cooking, perfecting his French, taking photographs, reading historical fiction, listening to music, and watching Ohio State Football.

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