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The PACN Podcast - Wendy York

The PACN Podcast - Wendy York

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 In this episode, Dr. John Pagan sits down with Wendy York, PACN's Senior Director of Clinical Outcomes and Quality, for an inside look at what it takes to help independent physician practices succeed in today's value-based care environment. Wendy shares her journey from medical assistant to quality leader, explains why independent physicians need network support more than ever, and walks through the practical strategies her team deploys to help practices maximize their quality performance and reimbursement.Key HighlightsWendy's Path to PACN Wendy began her career as a medical assistant in a busy primary care family practice and worked her way through healthcare management over many years. A pivotal role as an office-based coordinator for the University of Pennsylvania's Disease Management Program — where she educated physicians on best practice guidelines — sparked her passion for quality care delivery. She later served as practice director for a large Lehigh Valley hospital system before joining PACN. What drew her in: the opportunity to make a real difference for independent physicians who wanted to stay in control of their practices.An Evolving Role at a Growing Network Wendy joined in 2018 as Director of Practice Support and Partnerships, traveling the state to introduce and recruit independent physicians to PACN's clinically integrated network. In 2019 she moved into the role of Director of Clinical Outcomes and Quality, helping build the physician committee infrastructure. As the network secured seven value-based contracts and expanded, she stepped into her current role as Senior Director of Clinical Outcomes and Quality in late 2020.Why Independent Physicians Need Collective Support Independent practices carry burdens that employed physicians simply don't face: hiring, training, credentialing, billing, and liability insurance are all sole responsibilities of the independent doc. Beyond operational challenges, small practices also lack the clout to negotiate favorable contracts with health plans on their own. By aggregating the patient lives of all independent PACN practices into one unit, the network gains collective negotiating power — resulting in more lucrative value-based contracts and increased reimbursement for practices already delivering excellent care.The Role of Technology A single electronic data backbone linking the varied EMR systems across member practices is what makes participation in quality programs possible. Without that infrastructure, independent practices couldn't access these contracts on their own.Key Elements of Practice Success in Value-Based Care Wendy outlined four critical focus areas her team emphasizes with member practices:Annual Wellness Visits — Getting patients in early in the year, especially those not seen the prior year, ensures care gaps are identified and addressed with enough time to complete screenings and routine tasks before year-end.Pre-Visit Planning — Reviewing charts one to two weeks ahead of each appointment — pulling consult letters, labs, diagnostic tests, and discharge summaries — so nurses or MAs can complete a comprehensive review and pend any outstanding orders in the EMR. This dramatically improves daily patient throughput and overall quality performance.Risk Coding and Hierarchical Condition Categories (HCCs) — Identifying and coding chronic conditions at the most specific level, including complications, and revalidating conditions year over year to ensure a complete picture of each patient's health. This includes flagging conditions coded through ER visits, hospitalizations, or specialist encounters that may not yet appear in the primary care record.CPT II Code Billing — These supplemental billing codes carry no dollar amount but report to the health plan that a specific service or measure has been completed. They're essential for closing gaps on measures that require a documented result — blood pressure readings, A1C values, depression screenings, and more.The Quality Team Wendy's team is a high-performing group with deep expertise in HEDIS and Stars measures and extensive knowledge of health plan operations. They have produced over 40 tip sheets and 20+ resource handouts to help practices navigate measure requirements and improve workflows. Each practice receives tailored outreach, monthly guidance, and all-payer gap reports — with Wendy's team serving as accessible, on-call subject matter experts for any practice that needs support.Looking Ahead Wendy expressed pride in the work being done to support independent Pennsylvania physicians and optimism about what's ahead — not just helping practices survive in a rapidly changing healthcare landscape, but positioning them to genuinely thrive in the evolving world of value-based care.Key TakeawaysIndependent physicians face unique operational and financial pressures that make network membership not just beneficial, but in many cases essential to financial ...
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