The healthcare sector is undergoing dramatic change. The rules around caring for patients—and being compensated for that care—are very different under the value-based payment models that are coming down the pipeline.
Here are four areas that organizations continue to stumble through in the pursuit of delivering high-value healthcare to patients, while also trying to ensure high-value returns.
1. Poor value proposition.
Payers and partners want lower costs and better clinical outcomes. Doing so creates a value proposition to payers, resulting in higher patient volume and more quality bonuses. Look for opportunities to improve your existing processes and technology solutions to better manage your quality measurements. Do you have time to do concurrent activities that improve quality of service? It’s not enough to look at data retrospectively, you need to be able to audit concurrently.
2. Lack of specialized staffing.
If your organization is like most others, it is unlikely that you have the staffing in place to understand all the components—and all the nuances—that go into building an effective quality management system and structure. After all, the healthcare quality measurement industry has grown from nothing into a fairly sophisticated and highly specialized sector in just the last few years. Many healthcare providers are turning to advisory services, consultancies and solutions vendors to help them analyze their performance and leverage their data to improve quality, patient safety, and clinical and financial outcomes.
3. Too much focus on reporting, not enough on improvement.
Quality measures are about more than meeting requirements and reporting results to CMS and the Joint Commission. Maintaining high performance on these measures is in the interest of quality of care and has an impact on patient outcomes, including readmissions and mortality. Quality measures are created based on studies spanning decades. The basic idea is if you implement this quality measure, you’ll improve outcomes. Many of the measures are around hospital infection. Infections cost money and lead to readmissions, both affect your bottom line. In a health care system with increasingly limited resources, it is important to shift resources from quality measurement and reporting to quality improvement, which is the ultimate goal of measurement.
4. Failure to look at big picture.
What we’re slowly moving into is an environment which the payer community will want to pay a group of providers, home health, pharmacy, physicians, hospitals, nursing homes by how well they take care of patients. All of those entities have to work in a collaborative sense to ensure ongoing communication across individual facility boundaries.
Executives who want to avoid these common pitfalls can push forward for high-value patient care and strong financial returns for their facilities or practices, but the time to act is now.
Our operational efficiency checklist, Checklist for High-Value Healthcare, addresses these four areas and more. We hope these action items encourage you to increase the quality of healthcare you deliver and simultaneously achieve higher returns for your organization.