Making Patient Attribution Easier in VBC Models

June 7, 2023



As the healthcare industry shifts from fee-for-service to value-based payment models, payers and providers need tools to ensure accurate patient attribution. The ability to identify the primary provider responsible for overseeing a patient’s care, and accurately assigning or reassigning patients if or when that provider relationship changes over the years, ensures accurate reimbursements, and helps avoid costly errors.

Cedar Gate’s Attribution Engine is a comprehensive solution that simplifies the process. With three options for patient attribution, healthcare organizations can efficiently manage patient panels for better health outcomes and streamlined revenue cycle management.


Key Challenges with Member Attribution in a Value-Based Care World

As any healthcare organization involved in VBC models knows, member attribution can be a tricky puzzle to solve. There are a wide range of attribution models – many payers have their own unique attribution methods – and patients can move in and out of attribution pools throughout the year. Since attributed members create a risk pool for providers and payers, accuracy is essential to be able to meet cost and quality goals throughout the year.


An Attribution Engine with Options for Any VBC Arrangement

Cedar Gate’s Attribution Engine is designed to support multiple attribution schemes for diverse scenarios, from modeling to analytics. Its dynamic capabilities allow providers to have a clear understanding of the attribution logic and why patients were attributed to them with:

  • Census Reports and Member Drilldowns: View comprehensive census reports and member drilldowns so you can see everything from the big picture of your attributed members to the intricate details of each patient within your risk pool.
  • Quality Assurance through Data Reconciliation: Cedar Gate reconciles data at implementation, then continuously updates it as new data feeds become available. You can feel confident that your attributed patient numbers are as up-to-date as possible at all times.
  • Refreshed Results: With Cedar Gate, you can choose the frequency of data refreshes. The most common options are annual or quarterly refreshes, providing providers with ample time to engage with their attributed panels.


Three Approaches to Member Attribution

Cedar Gate’s engine offers flexibility and customization, supporting three different approaches to member attribution. Let’s explore them:

  • Client-Provided Attribution Files: In this approach, clients provide a file attributing members to specific provider panels. Cedar Gate tracks the assigned provider as the member’s Primary Care Physician (PCP). Assignments can change monthly, offering dynamic and updated attribution.
  • Cedar Gate’s Default Primary Care Assignment Logic: Following the Centers for Medicare & Medicaid Services (CMS) model for Accountable Care Organization (ACO) attribution, Cedar Gate employs a hierarchy of provider specialties and allowed amount payments for Evaluation & Management (E&M) services to determine the primary relationship between a provider and member.
  • Custom Assignment Configurations: For clients seeking a more tailored solution, Cedar Gate allows you to specify one or more custom assignment configurations using algorithm logic. Organizations can design their own attribution models based on unique requirements and preferences.

Cedar Gate’s Attribution Engine is an invaluable tool for healthcare providers and payers seeking to optimize their patient attribution processes. With Cedar Gate’s engine in your arsenal, you can confidently navigate the complex world of patient attribution and focus on delivering the best possible care to your patients. Explore the power of Cedar Gate’s software tools today and transform the way you manage patient attribution.

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