Risk Management for Providers

Forward-thinking provider groups are taking on risk-based contracts in which healthcare payers offer financial rewards for quality and cost management targets. Risk has its rewards, but how will you choose the right amount of risk? And how can you gain the support of physicians? McKesson Risk Manager™ provides clinical business intelligence to help you answer these questions and engage your provider network to help you meet quality-of-care and financial goals.

We understand the ins and outs of risk management. McKesson Risk Manager is an administration and physician-friendly financial risk management solution. McKesson Risk Manager helps provider networks to achieve operational efficiencies and measurable cost and quality of care improvements.

McKesson Risk Manager lets you monitor and improve the entire spectrum of cost and quality challenges presented by risk-based contracts.

McKesson Risk Manager can help your organization:

  • Evaluate the level of risk in your patient populations
  • Measure and improve the quality of care across your network
  • Provide credible data to physicians to influence quality of care
  • Increase generic utilization and adherence to prescribing guidelines
  • Influence physician and patient behavior with timely and clear communications
  • Track clinical measures and calculate physician pay-for-performance (P4P) incentives

McKesson Risk Manager supports:

  • Resource utilization management, including emergency department and hospital admissions
  • Pharmacy cost management
  • Physician efficiency and patient profiling
  • Population health management and outreach
  • Point-of-care decision support
  • HEDIS compliance management
  • Pay-for-Performance (P4P) program management

Physician profiling

When identifying areas for physician improvement, it's essential that physicians find your data and analytic methodologies credible. They must be convinced that you have addressed the "My patients are sicker" concern and all the issues associated with the methodology. McKesson Risk Manager helps you meet this need by providing:

  • Risk-adjusted efficiency profiles for primary care providers (PCPs) and specialists
  • Group and network benchmarks
  • Quality, utilization, and prescribing profiles
  • HMO and PPO attribution
  • Dashboards and menu-driven, ready-to-use reports
  • Multi-level drill down and companion reports to make the data actionable, identify where physicians can improve, and drive real, measurable change

Patient profiling and predictive modeling

Better care delivery and utilization management requires an understanding of your patient populations. This data lets you intervene with high-risk patients and provides:

  • Educated projections to be used in planning
  • A probability of hospitalization report to help physicians proactively optimize the health of high-risk patients and prevent avoidable admissions
  • An ED frequent flier report to identify which patients repeatedly use the emergency room and may benefit from proactive care management and education
  • Medication analyses to identify which patients could be switched to equivalent lower-cost drugs
  • Quality profiles for each patient over time that show metrics, relevant clinical events, and lab tests. Supplemental data and guideline eligibility exceptions increase data quality.

Performance reporting

Whether you need to meet national, state or specific payer or employer guidelines for quality, McKesson Risk Manager helps you improve your scores and reduce costs at the physician, practice and network level by offering:

  • Embedded evidence-based care guidelines — including HEDIS, state and payer-specific rules — which provide concrete, patient-specific recommendations to providers.
  • Integrated outreach tools can alert your providers and patients to gaps in care and screenings, and enable you to execute outreach campaigns.
  • Exception reporting that lets you provide system feedback, so incorrect patient-intervention recommendations aren't produced.
  • Advanced filtering to help you prioritize quality of care improvements.

Drug substitution program and staff of pharmacists

It's a challenge for busy clinicians to order the medication that's both the most clinically appropriate and the most cost-effective under multiple plan formularies. McKesson Risk Manager can help. We have pharmacists ready to help you design and implement your program.

Our system efficiently creates interchange forms, pre-printed prescriptions and patient communications. It supports multiple types of prescribing interventions, including:

  • Switching from brand-name to generic drugs
  • Options for formulary drugs
  • Switching from a non-preferred brand to a preferred-brand alternative
  • Dosage consolidation and split-tab opportunities
  • Custom drug substitution campaigns

P4P management

Our pay-for-performance (P4P) management program calculates and tracks clinical measures and can deliver patient-specific recommendations to physicians on an ongoing basis. This allows physicians to proactively manage their P4P scores throughout the year, meet their incentive goals, and reap the rewards. P4P capabilities include:

  • A modeling workbench for developing incentive programs
  • Ability to manage multiple P4P programs in parallel
  • Calculate P4P performance from your criteria and advanced metrics
  • Full adjudication to calculate payments or to audit payer reports
  • Export data to accounting systems
  • Advanced exception reporting to eliminate ineligible patients and better reflecting true performance

Want more information?
Let McKesson be the cornerstone of your clinical integration program. We'll help you find the right tools. Call 781.290.2500 or request more information.