Need Help Driving Your Program to Value Based Mode? Read How One System Did Just That.
October 10, 2019
If you are like most program administrators and physician leaders, you are aware of the dramatic changes in payment models coming from both CMS and private payers. Too often the real challenge can be how do I move away from growing volume, which is directly affecting my bottom line, to a value proposition? The value proposition consists of two main components quality and cost. Perhaps the best place to start is looking at the quality practices and your benchmarking status within your own program. Driving best practices in quality is a tried and true method of improving financial outcomes, patient experience and loyalty, staff and provider satisfaction. In reading Suzette Jaskie’s article, “Outsourcing Is In” you gain insights on how Suzette, the Vice President of Ascension Wisconsin, is driving towards value by understanding each program's performance related to quality. As Suzette states in the article her concern was not the overall performance, as most program metrics were meeting or exceeding expectations, but how to work for that top decile ranking - consistently. Striving for that top decile in quality has many applications from private payer contracting to meaningful physician work. This laser focus on quality is measurable, marketable and creates pride in the clinical team that is hard to achieve through volume alone. I can’t help but mention a focus on clinical quality sounds a lot like a staff retention metric. What I mean by that is high quality programs have active staff engagement and physician ownership for clinical practices.
The article also addresses the reality of the resources required to do a review of program performance. Most programs we work with already have a quality data review on a monthly or quarterly basis. It is generally a multi-disciplinary team that reviews internal dashboards or formal registry results. First, in all fairness to program leaders, this monthly or quarterly meeting is a huge advancement from where we were 10 years when the data was only seen by a select few and acting on quality data was nearly impossible. The hard part for most programs today is to move from data review and discussion to action. It is difficult to take the next step for many reasons. The most common reasons are lack of confidence in the data, lack of focus on a specific metric or metrics, no one to do deep chart analytics making reviewing a fall out meaningful and lastly poor attendance resulting in an inability to decide a course of action. Suzette outlines in the article how she engaged Terumo Business Edge as an industry partner to accelerate and measure program quality including the process and practices that are really occurring. The assessment brought ownership to the data, created a unified focus and allows physicians and leaders to see best practices across multiple sites.
For the engagement described in the article the Terumo Business Edge team was able to take the quality metrics, identified by the system, and do a deep dive into actual care practices. For example, if the selected metric was AKI (acute kidney injury) we would do direct observation around key elements such as medication holds, pre and post hydration and contrast max dose calculation then look for adherence to best practices. In every program there are unique challenges to adherence around best practice protocols. As a program leader avoid assuming the staff or physicians are not compliant when what we find are deficiencies in education, capacity constraints, and lack of transparency around the goal or metric. The ability to see the full picture around a program goal is a powerful tool in driving change in a program.
About the Author
Sr. Manager, Care Pathway
Anne Beekman has extensive experience in new program development in interventional cardiology, peripheral, EP and structural heart as well as cost management, staffing model updating and office-to-hospital efficiencies. She has also opened and managed multiple cath and EP Labs, Prep and Recovery Departments and CCUs with a focus on process improvement and expense reduction. The past two years, Anne has been focused on redesigning PCI and device programs, helping teams understand the need to own the cost of care and be responsible stewards of the health care dollar. Recently she has been dedicated to improving safety in cath labs by reducing radiation dose to providers, staff and patients and has been the lead on two successful ACE accreditation reviews. Anne has a Bachelors in Nursing and is credentialed as a Nurse Executive by AACN.