Teamwork Makes the Dream Work for Value-Based Care with Epic

At Bellin Health, teamwork was key to its recent recognition as the top-performing Next Generation Accountable Care Organization for excellent patient care by the Centers for Medicare and Medicaid Services.

A shared goal of uniting patient care and quality measures drove Bellin’s approach. PCPs, specialists, and IT collaborated to create one simple set of quality measures based on CMS standards and then incorporate them into clinicians’ day-to-day practices. A sidebar keeps each patient’s quality measures front and center in the Epic chart.

Teamwork is also key to each patient’s visit. As a patient’s physician asks about her health, a nurse or other member of the care team uses Epic to quickly review and address quality-measure-related care gaps. If the patient has a chronic condition, a care manager follows up with her regularly using Epic, and patients receive reminders to schedule their annual wellness exams using MyChart.

Bellin’s comprehensive approach to each patient’s care helps keep patients healthy—75% of all visits at Bellin are regular wellness visits. This focus on wellness, in turn, helped Bellin achieve top performance in the Next Generation ACO program.

“High-quality care attains shared savings,” said Chris Elfner, Bellin’s director of accountable care strategies. “You do that…by closing care gaps, by managing chronic conditions, and by making sure people are taking care of their health.”

Read more about Bellin’s approach to the Next Generation ACO program in HealthLeaders. Learn about their primary care teams in Modern Healthcare.