Smart Organizations Use Value Based Health Care as the Business Model of the Future

Smart Organizations Use Value Based Health Care as the Business Model of the Future

Part One: The One Thing Organizations are Doing Now to Ensure Longevity in a Consumer Healthcare Market

As we enter 2019 we are seeing the shift from volume-based care to value-based care now more than ever. The proposition set in motion by government initiatives like HMOs and managed care really laid the ground work for the value-based transformation of the health care industry. Enter the affordable care act and the rapid adoption of electronic medical records, coupled with informed consumerism and suddenly, quantity over quality is a thing of the past.

It is predicted by many healthcare analysts that organizations that maintain the “status quo” and do not focus on quality initiatives and improvements will eventually see less and less payers willing to work with them; the few payers that do will demand higher rates than quality driven organizations.

Quality driven organizations will be able to easily pass on cost savings to their patients and thanks to the data transparency and online hospital and provider rating systems, they’ll be able to do so while also increasing their patient volume.

The model is simple:

As a patient I would rather receive higher quality care at a lower cost to me.

As a payer I want my patients to be at lower risk of developing conditions that will cost me money, so I will incentivize them to seek higher quality care.

As a hospital or practice I want to provide high quality care so that more payers will refer patients to my organization at a lower cost.

So how do we increase quality of care at our organizations with ever changing government initiatives and mandates? Can we do so without micromanaging our providers and adding hours of mandated documentation to the end of their already lengthy shifts? Is it possible to prevent alert fatigue and physician burnout and still send meaningful for reminders to encourage compliance?

The answer is yes.

Continuous optimization initiatives are ever so important to a healthcare organizations longevity in the era of Value-based care. Optimization is the preventive medicine of the EMR. Like vitamins, regular doctors visits and routine oil changes, optimization keeps your system running smoothly. It catches potentially life-threatening issues that could cause serious complications and  keeps your providers and patients happy and healthy.

At this point in my career I have been optimizing EMRs for over a decade. In collaboration and partnership with several prominent hospitals, I’ve helped have saved millions of dollars by simply enforcing data capture for required fields needed on claim forms. I’ve rapidly increased physician compliance to help hospitals meet quality measures and avoid unwanted penalties. I’ve implemented clinical decision support initiatives that undoubtedly have reduced never events and increased positive patient outcomes.

Although I am proud of all of these aforementioned achievements, I am most proud that the users actually like these improved workflows. This is because they are involved in the design process from the very beginning.  We can do all of these things and more while preventing physician burnout because the  key to a successful optimization is customer collaboration.

In marketing we ask, Why is it awesome?, in optimization we ask, Why is it awful? and typically, the retort to that question is How much time have you got?

Taking the time to listen to the frustrations of the front-line users makes all the difference in figuring out what the underlining issues are and designing an intuitive workflow to alleviate those frustrations. The work doesn’t just stop at collaborating however. Forward thinking organizations will also:

  • Consult both internally with their Quality Department and externally with industry optimization experts.
  • Identify quality indicators that align with payers expectations
  • Have strong organizational governance to enforce the adoption of new technologies
  • Seek out Physician champions to provide design feedback and boost morale during roll out
  • Apply data analytics to measure performance and ROI

In part two of this article we’ll explore how we worked with our MEDITECH focus group: Operation Nerdywork and the providers at Valley Health System in Ridgewood, NJ to increase compliance for VTE Prophylaxis Ordering by a whopping 14% in under 2 months.

The result of our efforts is an intuitive protocol that alerts select users about missing orders or assessments, lets the provider know how much time they have left to get those orders placed, reduces the amount of time and clicks it takes to complete the assessment and place orders, adheres to the AHRQ’s best practice guidelines for this measure, and has warranted zero provider complaints since go-live.

If you’d like to dive deeper on VTE Prophylaxis ordering protocols and other rules-based clinical decision support toolkits, please contact me to schedule a complimentary executive brief.

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