The road to a failed value-based program is paved with good intentions. Many ‘fee-for-service to value-based’ transformations stall because leaders can’t show their stakeholders the value of their strategy. Patiently building a strong business case can prove return on investment (ROI), secure buy-in, and build momentum. But, that’s only the beginning.
Many healthcare organizations launch their value-based initiatives with a broad aspiration to simply provide better care. Some leaders immediately kick off disruptive initiatives to satisfy and in some cases even delight their patients with bold new attempts at innovation.
Those that do, often fail to quantify and plan for the direct impact on their providers, so their efforts, unfortunately, transpire having clear costs and unclear short-term results.
What frequently goes unseen are the looming cross-functional priorities that may wound an organization when no attention is paid. In fact, without a calculated link to value and a sound business case, investments in innovation may halt before ever making the desired impact. But, is this issue merely a myopic short-term problem? Alternatively, is there a longer-term broader view, where near-term adjustments to the model equate to long-term benefits to our patients at large?
In my view, as in everything, balance is key. To build a successful value-based program from the bottom up, one must do so without inadvertently harming our providers during the transition.
It’s all about balance.
There is a better way, anchored in science with a structured methodology that can earn you a seat at the strategy table. An article from Hospitals & Health Networks states “developing clinically integrated delivery networks is an essential strategy for moving from volume to value. However, hospitals’ participation in or management of clinically integrated networks simply lays the foundation for care transformation. Once this structure is in place, various tactics — deployed across the network — shift the organization toward truly delivering value-based care.” This is because those who do make bold moves to innovate, often lose sight of the world around them, and what suffers most is their ability to sustain the innovation while keeping their providers from burning out.
Here are some best practices:
- Focus care interventions, not on the most at-risk patients but those with emerging risk.
- Invest in the staffing required to support care management of at-risk patients.
- Partner with other organizations to positively impact the social determinants of health.
- Recognize that different populations may need different interventions.
- Examine your ability to scale.
- When in doubt, focus on improving quality.
- Rethink how success is measured. As the adage goes, “what gets measured gets managed.” A focus on quality improvement may lead organizations toward a shorter length of stay, but the panelists agreed that a shorter stay isn’t the best goal — no stay is.
I’ve always loved this article published by Ernst & Young, titled “Connecting innovation to profit.” While there is no direct link between the idea of operating a successful business and transforming your organization to value-based care, there is a wonderful lesson on what it takes to create truly sustainable innovation. It asserts “Some of the best and most profitable business ideas have sprung from the classic ‘eureka moment.’ But that is not how sustainable innovation works. Innovation is a long-term process that’s not turned on and off as financial results vary; it requires consistent, long-term enduring support.” I like to think of this as ‘watering the garden.’ In my opinion, the grass is always greener where you water it. This mantra holds true in relationships, business, personal finance, and especially in building sustainable quality programs with multiple stakeholders.
Planting and Harvesting – A lifecycle.
Much like the products we build at Holon, good innovation requires a consistent season of nurture to yield value and a solid return on investment. Take Holon’s CollaborNet Insights solution for example. The beauty of this product is that it plants seeds all year long in the minds of providers as patients present in real time. We call this ‘planting.’ The workflow goes a little something like this: A patient presents for an encounter, a provider opens their chart in the EHR, and Holon’s Insights ribbon reveals essential information right within the workflow. For organizations who heavily focus on risk management and care quality, this product saves vast amounts of workflow steps when providers struggle to uncover the complete story of a given patient. Fast forward one year beyond the HEDIS® reporting period, and voila, you will see a bountiful harvest. A great read on this topic is “An extra 5 minutes per patient visit – what would you do?” by Julie Mann, Holon’s Chief Commercial Officer.
Still, harvesting takes a different form at times in the world of Holon. With Holon’s CollaborNet Connect solution as another example, we’ve decided to turn things upside down. Here, we acquire targeted data from the EHR at a fraction of the cost, time, and effort over traditional solutions and feed it to third-party analytics and payer solutions on behalf of the provider. The result is nothing short of incredible value. For one, providers may get more real-time feedback on how their organization is coding. Perhaps they have been coding and documenting incorrectly for their reporting needs for some time. When this is the case, their scores suffer. Quite often, these mistakes go unnoticed until long after the full adjudication process is complete. With Holon Connect, however, these innocent mistakes may be rectified immediately, and the engine of the practice may resume running smoothly.
As I began this post, I discussed the road to a failed value-based program. Well, I’d like to end by saying the road to a thriving value-based program is paved with consistent, sustainable hard work, vision, and a great partner who will help you focus on all aspects of what matters most – healthy patients AND happy providers. Remember, the grass is always greener where you water it. Contact our team to discuss how Holon Solutions can help you.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). Holon Solutions reports on HEDIS measures but does not calculate HEDIS measure results in its products, programs or services.