Last week’s article about the “Quadruple Aim” by my colleague Sharon Hicks (see To Hit The ‘Triple Aim’, You Need The ‘Quadruple Aim’) got me thinking once again about that eternal question – “what do clinicians want?” I’m not being cute or rhetorical here. If health and human service organizations can only improve the consumer experience, boost quality of care, and provide more effective health care by improving the satisfaction of clinical professionals – then we need a concrete plan to do just that.
The questions that come to mind are many. My experience is that most clinical professionals are highly invested in doing a “great job” for the consumers they serve. How to measure that – and how to measure that in ways that are in sync with the payer value equation is the issue. Cost is easiest to measure, but what are the measures that best capture the consumer experience and consumer outcomes? How do we measure the “art” of clinical practice? Can the new environment of value-based reimbursement coexist with “satisfied” clinical professionals?
One of the most thought provoking articles I’ve read on this topic appeared in the recent issue of The New England Journal Of Medicine – Counting Better — The Limits And Future Of Quality-Based Compensation by Christopher R. Dale, M.D., M.P.H., Michael Myint, M.D., M.B.A., and Amy L. Compton-Phillips, M.D. The article tackles the challenge of making performance-based compensation work in the era of value-based care – and addresses the inherit conflict many see in delivering measurable, high-quality, cost-saving care and an “individual clinicians’ worth as compassionate diagnosticians and healers.”
The authors laid out four systematic adjustments that managers of health and human service organizations can make to align individual clinical professional incentives with the larger systematic goals of a value-based system.
Measure what’s important to consumers – Improving consumer health is an outcome that clinicians and health care professionals can understand and support. These consumer-centered outcomes are a good starting place for aligning the goals of the clinician with the goals of the payers and system as a whole. We’ve discussed the importance of meeting consumer expectations before (see Another Look At Consumer Sovereignty), and by building a metrics-based system that is focused on what is important to consumers, we can move towards a high-value system of care that works for each part of the system. As the article notes, “A successful strategy is to set achievable performance goals, acknowledge the importance of clinician professionalism, and use metrics to create a culture of excellence in patient-centered care.”
Prioritize existing metrics that are the most effective – Developing new, better metrics is a key component to any data-driven endeavor, whether that is metrics-based management for you organization, or outcome metrics for value-based payment (see Sharing Data With Your Team As Performance Management Best Practice and What Is Metrics-Based Management & How Do You Do It?). But while there are already a lot of existing metrics available, not all of which are of equal value for improving health. The ability to prioritize these metrics by “effect estimation” is key to separating what works, from what works better.
Acceptance of quality-improvement science – The authors talk about their observation that clinical professionals often feel that process metrics are a fairer basis for compensation than outcome measures because they reflect actions they control (see For All The Performance Measurement, Are We Really Measuring Performance?), which is diametrically opposite of the payer’s view of health care value. Their recommendation? Including some process metrics that are directly under the control of the clinical team can serve as a way to balance the continuum of “things that can be counted well” to “things that matter but are hard to count.”
Acknowledge quality metrics’ limitations for compensation – Money can be a great motivator, until it isn’t. Simply paying clinical professionals more money for quality scores produces some change, but alone will not create the high-performance service system we’re looking for (see How To Tackle Performance-Based Compensation and 3.4% Of Physician Compensation In Primary Care Practices In ACOs Is Based On Quality Measures).
For more on these models, check out these resources from the OPEN MINDS Industry Library:
- Making Performance-Based Comp Plans Work
- Getting Your Team Ready for Performance-Based Contracting
- Compensation Model Second, Strategic Plan First
- Maximizing Clinical Staff Productivity: Performance-Based Compensation Models
- Would You Consider Paying Your Non-Profit Board?
As my colleague Sharon pointed out last week, in a market focused on value, the primary role of management is to facilitate the good work of great clinical professionals. For more on leading your team in a value-based market, follow our coverage of The 2016 OPEN MINDS Executive Leadership Retreat next week – Look for our daily briefings live from the event and follow our coverage on Twitter @openmindscircle – #OMleadership.