Whether it’s an employer, a health insurer, or a health care provider, all have an essential role to play in delivering quality care. The key is to find a strategy that goes beyond traditional cost reduction and puts patient care at the forefront.
For decades, health care organizations have been focused on increasing volumes, achieving margins, and maintaining the status quo. This approach has resulted in an environment of unsustainable costs. Rather than lowering costs, providers have shifted the burden to patients. This has resulted in a culture of self-dealing.
In order to achieve value, health care providers must adopt a new clinical organization. This will require a shift to patient-centered care, a shift to a patient-centric care tenor, and a shift to a measurement system that can accurately measure health care outcomes. The best measurement system is likely to be one that includes a full set of outcomes, covering the entire health care cycle.
A patient-centric approach to health care involves a multidisciplinary team of clinicians who spend a significant portion of their time working on a specific medical condition. The team will include a physician team captain who will oversee the entire patient care process. Other members of the team will include an orthopedist, a primary care physician, a rheumatologist, and a physical therapist.
A health care provider who is successful at value transformation will achieve a strong contracting position. It will also enhance patient satisfaction and decrease the likelihood of complaints and litigation. But, if it fails to transform, it will be left behind. Providers that do not master this new clinical organization and measurement system will find themselves under attack.
Health care providers often worry that their reimbursements will not fully reflect the diversity of patients. This is a legitimate concern. However, as a provider grows more sophisticated and understands the value of outcomes measurement, this worry will dissipate.
A health care provider should be asking the right questions. These questions can change how clinicians perceive patients. The question “how might this make a person feel?” should be part of the health care provider’s clinical repertoire. As a result, clinicians are better able to attend to the patient’s needs and make improvements in care. The health care provider can then begin to focus on the most important indicators.
The value of a health care provider’s clinical performance can be measured by its HEDIS score, which includes easy-to-measure clinical indicators, as well as process measures. While these are not always accurate measures, they are useful to a health care provider. For example, a health care provider in the diabetes field will measure the reliability of hemoglobin A1c and LDL cholesterol checks.
Health care providers should also take advantage of tools like bundled payments to improve care quality and efficiency. These types of payments can be used for both acute and preventive medical conditions. These payments will also give providers a strong incentive to reduce costs and improve outcomes. In addition, the bundled payments can encourage teamwork and improve provider efficiency.