After the CMS announcement in January of a major push towards value based care, we can expect private payers to follow this course aggressively as well. In our recent article Value for Independents, we suggest that rather than viewing value based as threat, this model can level the playing field for independent providers of care who are willing to re-think their business.
For the next few days, Sense Corp will offer up a few ideas for providers that not only want to survive, but thrive in the new value based world.
#1: Establish Strong Data Governance
Data must drive decisions at the clinical level. Well-applied technology is a “force-multiplier” for the clinician. An algorithm cannot replace good decision making, but it can reduce cognitive load and help stratify populations and thus prioritize efforts. What is critical is that information must be relevant, timely and delivered at the appropriate context.
What satisfies the requirements for good data warehousing may not serve the clinicians and other staff on the front lines in reports, or may be difficult to interpret. Pull in data sources first that help teams assess and execute on contract metrics; make the reports as individualized as possible, eliminate as many distractions from reports as you can. If the data is unreliable, consider how it can be augmented with staff or simply eliminated.
#2: Apply Design Thinking to Processes
As part of the evolution of Accountable Care from the primitive HMOs of the 80’s and 90’s, most contracts have a patient satisfaction component, with patients surveyed about their care experiences and the resulting scores used as part of the measurement criteria. In many cases, these ratings can have a direct impact on reimbursement. Additionally, social media provides a source of information for consumers of healthcare that will need to be managed as well. Facebook ratings have been found to be surprisingly correlated with some quality indicators. These may ultimately influence consumer preference, perhaps even more than established healthcare benchmarks.
Using the lessons from hospitality, retail, and other industries, provider organizations will need to consider various touchpoints with the patient, particularly introductions to your organization and most recent experiences prior to the survey being delivered to the patient. A proactive strategy in this regard can help manage patient issues before they become negative reviews.
#3: Use Pilots to Build Out Organizational Expertise
Depending on the geographic market, many payers are experimenting with “kinder and gentler” approaches to contracting that allow providers to ease into value based care, including minimizing downside risk. Seek out opportunities to pilot with new payer arrangements to create an organizational incentive to invest and optimize operations early. This is the time to drive physician engagement in the process, align care appropriately and craft a population health strategy. Lower risk contracts give your organization the opportunity to invest in information systems, gain experience and create accountable leadership teams at all levels.