Executive Briefing | by Sarah Threnhauser, MPA | August 12, 2017
As I’m getting ready to fly to California for our 2017 OPEN MINDS Management Best Practices Institute, I’ve been reflecting on “best practices” in the field. By definition, a best practice is “a procedure that has been shown by research and experience to produce optimal results and is established (or proposed) as a standard suitable for widespread adoption.” I think one the challenges for the field is there is not consensus about what is a best practice – and not a great motivation at the organizational level to adopt them.
A few years ago, Atul Gawande, M.D. wrote about the need to develop more of a “chain” mentality when it comes to health care – meaning that there are shared (and clear) processes, widespread adoption of the same best practices, and the adoption of performance measurements both at an individual provider organization level and at a health system level (for our previous discussion on this, check out Be Big? Be Like The Cheesecake Factory).
A good goal – but there remains wide (unexplained) variability in the delivery of health and human services and few new or widely adopted clinical guidelines and best practices. But the glacial move toward value-based reimbursement (VBR) of providers may bring the issue of best practices and decision support forward. VBR demands predictability in utilization and performance – which demands consistency in assessment practices, diagnostic procedures, and treatment planning.
I was reminded of this in my research on best practices when I read the recent article, Transitioning To Value-Based Care: 7 Best Practices, in Hospitals & Health Networks. Their framework for achieving optimal results in value-based contracting starts with the very issue of matching best treatment to specific groups of consumers:
Recognize that different populations may need different interventions – Just because consumers can be grouped by their conditions, doesn’t mean that services can be grouped the same way. Some treatments will work better than others depending on the community, neighborhood, city, or state they are deployed into. Specific population health demands equally specific population market intelligence.
Focusing care interventions on emerging risk – Key to value-based care will be some form of population health management, and the key to population health management has always been to address the highest-cost patients. The next evolution of cost saving will take place when health systems can intervene before health risks advance to the costly stage.
Invest in staffing for at-risk care – Adopting at-risk care will add consumer touch points many organizations aren’t prepared for. To prepare means ramping clinical teams with members from different disciplines (such as behavioral health, social services, or primary care).
Examine your ability to scale – Do you have a service that does all the things above? That’s good, but unless you can scale it to the level needed by payers, managed care, or accountable care, then it’s still not great. Without it you may not be able to replicate the services and savings for the needed market size, and you may not be able to negotiate for better rates.
Partner with other organizations to positively impact social determinants of health – Most provider organizations can’t be a “one stop shop” at the same time that value-based contracting may demand they absorb “one stop shop” levels of responsibility. The solution is to build the collaborations necessary to improve community health as a whole and manage consumers where they live – instead of just when they seek treatment.
Rethink how success is measured – Metrics-based management still reigns supreme for managing service and administrative operations, and keeping them running at a high-level of quality, efficiency, and replicability. But to succeed, you need to know what you should measure, how you will do that, and how you will use that information to improve the organization.
When in doubt, focus on improving quality – No matter what you do, if the service quality isn’t there you can’t compete. In this context, remember that value-based means quality-based. The transition to value is dependent on your organization’s ability to deliver quality services.
While consensus on treatment and supports for consumers with complex needs may be slow in coming, the shift to VBR may speed up the pace. Stay tuned this week as we explore more of these issues in detail at The 2017 OPEN MINDS Management Best Practices Institute in Long Beach California. You can follow us on Twitter @openmindscircle – #OMBestPractices