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By George Braunstein, RN, FACHE

As we move away from pay-for-volume to pay-for-value, there is one important question – what is “value” in health and human services? Furthermore, who defines it, and how do managers gather and present data that proves their services “work?”

In my experience working with management teams, I find that most are “data rich” and “information poor.” I’m reminded of The Rhyme of the Ancient Mariner, “Water, water, every where, Nor any drop to drink.” Why is that? Part of the problem is a lack of a framework for understanding what data is meaningful for a specific purpose or stakeholder. Payers require a wide range of data from provider organizations – but this data goes in the bucket of “contract compliance.” Health plans are interested in data that reflects the immediate cost of services – inpatient stays and emergency room (ER) use. Financial and productivity data are useful for process improvement. Consumer experience data is great for understanding whether your organization’s processes and people are getting in the way of an engaged and satisfied consumer. But how to demonstrate clinical and service system outcomes?

Often outcome measures are too narrow to be useful to anyone but the most clinically trained stakeholder. But there are solutions in the works. A recent Institute of Medicine (IOM) publication, Vital Signs: Core Metrics for Health and Health Care Progress, provides an important step in the development of a defined set of health measures that can be used in any setting, with a 15-measure core measure set:

  1. Life expectancy – Infant mortality, maternal mortality, and violence and injury mortality
  2. Well-being – Multiple chronic conditions and depression
  3. Overweight and obesity – Activity levels and healthy eating patterns
  4. Addictive behavior – Tobacco use, drug dependence/illicit use, and alcohol dependence/misuse
  5. Unintended pregnancy – Contraceptive use
  6. Healthy communities – Childhood poverty rate, childhood asthma, air quality index, and drinking water quality index
  7. Preventive services – Influenza immunization, colorectal cancer screening, and breast cancer screening
  8. Care access – Usual source of care, and delay of needed care
  9. Patient safety – Wrong-site surgery, pressure ulcers, and medication reconciliation
  10. Evidence-based care – Cardiovascular risk reduction, hypertension control, diabetes control composite, heart attack therapy protocol, stroke therapy protocol, and unnecessary care composite
  11. Care match with patient goals – Patient experience, shared decision making, end-of-life/advanced care planning
  12. Personal spending burden – Health care-related bankruptcies
  13. Population spending burden – Total cost of care, health care spending growth
  14. Individual engagement – Involvement in health initiatives
  15. Community engagement – Availability of healthy food, walkability, and community health benefit agenda

I see this effort by the IOM as a great starting point for developing standard measures. (I expect these measures to evolve with use and input.) But as I apply these to the organizations that I’m working with, I think the key question is – what are the strategy/management implications for executives of provider organizations in the behavioral health and social service sector of the field?

I think the implications are many and fast developing. Executives of behavioral health and social service provider organizations will be challenged to identify their larger relevance to improving the overall health in the communities they serve if they don’t adopt broader health measures such as these. And they need to think of how to develop new services – for both public and private payers – that improve these “big picture” outcomes and prove that they have an impact.

For more on how to bake “value” into new service line development, don’t miss my colleague Joseph Naughton-Travers’ upcoming session at The 2015 OPEN MINDS Strategy & Innovation Institute, New Service Line Development From A To Z: Tips, Tricks, & Advice; and be sure to check out my presentation, Developing A Case Rate Model For Behavioral Health: How To Make The Numbers Work For Your Organization, from the 2015 OPEN MINDS Performance Management Institute.

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