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By Heather Grimshaw

“Show don’t tell” is one of the first lessons journalists learn and one that’s increasingly applicable to executives of health care organizations. The increasing use of value-based contracts is changing communication between provider organizations and health plans to focus on data. Yet few executive teams harness their data in actionable ways judging by the discussion during the “Building A Data Infrastructure For Performance Management” town hall discussion at The 2019 OPEN MINDS Technology & Informatics Institute.

“With value-based purchasing, it’s even more essential for providers to understand spending patterns at the consumer level,” said Susanna Kramer, director of performance evaluation at Community Behavioral Health, a Philadelphia-based managed behavioral health organization. She stressed that using data in actionable ways is essential for success with case rates. Organizations need to identify how to optimize service delivery—the most effective processes, how to handle consumers who regularly reschedule or no-show, the best way to match consumer needs with treatment, and more—“so you can predict what your case rate payments are and what shared savings may amount to.”

Consensus from these three panelists was that provider organization managers need to understand utilization and costs to negotiate reimbursement rates and terms: Ms. Kramer provided a health plan perspective; Karen Fridg, director of EHR systems for Community Intervention Services Inc., offered a provider organization perspective; and Jaclyn O’Donnell, executive vice president for Credible Behavioral Health Software, gave a technology vendor’s perspective.

Understanding customer performance perspectives—This process starts with understanding performance expectations to improve success. “It’s key for provider organization executives to know exactly how they’re being assessed” and use those measures to improve care delivery and efficiency, said OPEN MINDS Senior Associate Joe Naughton-Travers. While most measures focus on processes, not outcomes, and reports are not public for now, executives who seek to build or retain a competitive edge understand what payers want, create data-driven cultures, and speak openly about how to improve their numbers. “We are very interested in understanding what payers are looking for and what constitutes quality of care,” said Ms. Fridg.

Start with actionable metrics—Identify a few metrics and assemble a small committee to review data and identify anomalies and solutions, Ms. O’Donnell suggested. While there’s no magic number of metrics, teams should seek metrics that are strategic and companywide. “You want to limit what you’re looking at to ensure that what you’re collecting is meaningful, informs changes, and how we look at staff,” she said.

It’s important to balance the number of metrics with diversity of delivery and service provision, added Ms. Kramer with a nod to the unique aspects of behavioral health. “It’s not like a knee operation where you know the surgery was a success because the knee healed or [the consumer] followed expected patterns of rehabilitation. However, we try to limit most providers to around three financial and quality targets outside fee-for-service (FFS) and value-based reimbursement (VBR) purchasing standards that they are required to meet.”

Start with what you have and make sure the data you’re collecting is actionable, she added. “You don’t need to have a shiny dashboard, which is great, but you can start with basic reporting. Create habits of using data and give in to that cadence. There are things you can do each day, each week to lay the framework to make that more manageable.”

Ms. Fridg agreed. “It’s never too soon to start talking about what your goals and expectations are, to see what data you have, and ask how you can utilize what’s already there.” Begin the conversation with your leadership team, start with a small set of metrics, and use that experience to develop the process of implementing from beginning to end. Then repeat the process as you identify and prioritize additional measures.

Her organization created metrics with a multidisciplinary team that sees monthly reports for the performance of its six affiliated organizations. It started with a scorecard created by the chief executive officer with more than 200 metrics in four domains (clinical, finance, people, and growth). The clinical team then selected three key metrics deemed to be most meaningful and actionable.

Being data-driven requires internal transparency—Making data visible and public was an important step for the Community Intervention Services team. Selected performance metrics were used to create standardized dashboards and presented organization-wide during monthly meetings, which allowed each team to benefit from the experience and success of others. “Managing by metrics has proven to be very effective” because it informs team members about their status and how to improve, said Ms. Fridg.

This type of transparency is key to gaining staff buy-in, said Ms. O’Donnell, who explained that more than half the company’s partners use a business intelligence reporting tool that allows organization-wide data sharing. “The ones who are most successful make data transparent, they build a data culture and show that data is not to be feared.”

Her advice: Acknowledge failures but focus on lessons learned and steps to improve. “You use it like a tool,” she added.

Townhall panelists wrapped up the session with a discussion of organizational competency in measuring performance, driving performance improvement, and public transparency of data. Improving operational efficiencies and clinical outcomes, regardless of reimbursement model, was at the top of their list for areas of focus but they all agreed that value-based reimbursement will increasingly drive strategy. On the transparency side, health plans and third parties are making provider organization performance and fee information public. This will emphasize the importance of data and the need for a data-driven culture will rise to a whole new level.

Get more information on using data for strategic success with these OPEN MINDS resources:

  1. The Critical Importance Of A Data Warehouse In Value-Based Reimbursement & Population Health Management
  2. For ‘Agile’ Organizations, Change Management IS Performance Management
  3. HHS Proposed Transparency In Coverage Rule
  4. The Age Of Priceline Health Care
  5. Medicare To Require Hospitals To Post Prices Online For 300 ‘Shoppable’ Services
  6. Is ‘Unblackboxing’ The Key To Reducing Health Care Costs?
  7. Why Guidelines Matter
  8. How Do You Measure Access?
  9. 5 Reasons Why ‘Consumerism’ Must Be Part Of Your Strategy
  10. Another Rating System—This Time For Addictions—Adds To The Search For Value

And for even more join us January 28 for “Beyond The Core 4: What You Need To Survive A Value-Based World—Results Of The 2019 National Behavioral Health EHR Survey” with OPEN MINDS Senior Associate Joseph P. Naughton-Travers, Ed.M., and Matthew M. Dorman, founder and chief executive officer of Credible Behavioral Health Software.


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