In today’s rapidly changing healthcare environment, hospitals are faced with a wide variety of factors to consider in the proper care of their patient population as well as their experience during that care. Now factor in that hospitals are also faced with the high stress demands of maintaining profitability. This complex proposition, dubbed the Triple Aim, has left both hospital executives and medical staff faced with a true dilemma of how to effectively balance one without sacrificing the other.

What’s the solution for hospitals? If there is a solution, can it be implemented quickly? Or is it just going to be a long, constant trial and error struggle to try and figure out what works and what doesn’t? Maybe the answer is not trying to figure it out alone, but looking for an outside source with a proven approach for efficiency implementation that drives operating costs down and healthcare outcomes up.

This is where the Sense Corp story begins.

We’ve deliberately organized the Sense Corp Healthcare Practice around the Triple Aim: improving the health of populations, improving the patient experience, and reducing the per capita cost of care. For the good of the patient and the providers’ bottom line, improving the health of populations has become a major focus of virtually every conversation about the state of healthcare. But even as reimbursement shifts from fee for service to fee for value, much of the patient outcome remains out of the providers’ control.

Specifically physicians and the care team cannot control patient motivation, cultural differences, language barriers, socioeconomic factors (including the ability to pay for medicine or attain transportation for treatment), and genetics. Unfortunately, to have the best outcome, these issues are often the ones we should be paying the most attention to.

The big question remains how to make this happen without the payment models supporting these efforts in place yet. Compounding this is constant change in reimbursement rules, regulations, and reporting requirements.

The following chart is a good representation of the challenges we face, the effect on population health, and the required patient effort/adherence.

Test Pilot Programs to Build Organizational Capacity.

It’s time for medical practitioners and hospitals to strategically adjust care delivery to address these obstacles to patient health. By methodically testing different procedures you can minimize changes to workflow and continue to execute, while also taking measures to affect the big picture.

Applying systems thinking to existing processes today is a good foundational start. The philosophy of the Theory of Constraints is one way to work on delivery processes. We like it because it’s succinct and easy for non-experts to understand, but Six Sigma, Lean, and other continuous improvement methodologies are appropriate as well. In short, the best results will be achieved by putting your energy and focus on the bottlenecks in any process that prevent it from achieving the larger goal.

As an exercise, forget everything you know about healthcare. If you could start from scratch, how would you build the ideal delivery system? What is keeping patients from getting as well as they can while avoiding costlier treatment?

  • Easy access to healthy food?
  • Guaranteeing every patient can afford their medication?
  • Following up with patients to ensure adherence with physicians’ orders?
  • Securing transportation for patients in need?

Certainly, we can’t change all of that, but we certainly could try.

  • Are there partners (community or otherwise) that can assist?
  • Are there individuals on your team who could serve as care coordinators for at-risk patients?

As you can imagine, the ideal way to tackle this challenge is to prioritize and stratify specific situations where you can likely have the most success. The following chart breaks down patient categories in descending order of high-cost/high-touch.

Source: “The Next “Top 5%”: Identifying patients for additional care through micro-segmentation.”

The truly high-cost/high-touch patients are those with acute issues like cancer or severe trauma events. While this category will not cease to exist, it’s unlikely the same individual will stay in this category for long. At some point, patients will recover or palliative/hospice care will become the clear option.

But the next group, those individuals who are caught in longer-term chronic illness, their issues tend to persist. They’ll likely stay in this category for several years (at great cost emotionally and financially). What’s holding them back as a group? Who can help these individuals if not you? A behavioral health professional? A care coordinator? Again, while we may not have all the resources at our fingertips today, understanding what would help will inform planning for the future and should impact how contracts and plans will have to be structured to address them.

We can’t truly be responsible for patient outcomes until we can understand the forces at play and make a change when possible.

As always, good data is key to testing assumptions. Identify the measures as you prioritize (i.e., cost, clinical markers, quality of life). Actuarial risk is driven by the cost of care and can point to patient outcomes in the broader population. Clinical risk assessment helps you identify which individuals are at risk, who is being impacted, and where ultimately the need will occur.

While the cost of more intensive interventions like dialysis or eye surgery in diabetic populations may not impact your reimbursement, it is core to the practice of being good caregivers to avoid these measures if at all possible.

One way for provider organizations to start to identify populations is by evaluating their contractual relationships with payers on a continuum that starts with Pay for Performance (P4P) all the way to full risk or capitation. Using these contracts as your guide will help focus activity, properly align incentives, yield feedback, and potentially aid in determining the operating capital necessary to further build the operational platform for population health.

How healthcare is financed will ultimately change how healthcare is delivered.

The strongest healthcare organizations will be those that are ahead of this change and leverage systems thinking, thoughtful technology, and the creativity of their entire team to create a high-performing system.

Healthier Patients and Bottom Lines.

Sense-Ability helps hospitals achieve operational excellence. Our evidence-based approach helps leadership identify, prioritize, and track their unique opportunities to achieve the Triple Aim in a positive and accountable fashion with active engagement of staff to continuously improve operations. We guarantee it.

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