Embracing change: From volume-based to value-based healthcare

HRMR-blog-Maley-300x200.jpgSedgwick supports Healthcare Risk Management Week June 19-23 Sedgwick’s healthcare risk management team works alongside healthcare risk managers to reduce risks and improve safety by delivering cost-effective claims, productivity, managed care, patient safety, risk consulting and other services. Taking care of people is at the heart of everything we do. Caring counts.

Providers today are transitioning to a value-based world. Financial rewards are no longer reaped based upon the volume of services provided, sometimes regardless of necessity or outcome, but instead upon positive patient outcomes and pleased consumers. Accountability for patients’ total experience is being vigorously enforced and has risen to the forefront of providers’ responsibilities. Healthcare models are changing to focus more on the health and well-being of populations, rather than on the “break-fix” model of treating individuals primarily when they experience acute episodes of illness. Emphasis is on patients’ clinical, financial and emotional status, as well as their expectations, which are assessed on an ongoing basis. The needs of specific populations and cultures must be carefully considered.

The healthcare organization-provider relationship has also changed. Institutions, once focused on pleasing providers as a strategy for maintaining and growing market share, have shifted gears to become patient-centered instead of provider-centered.

For many providers, this transition is challenging. They must actively participate in cross-disciplinary teams, often as leaders, to implement measures designed to continually improve upon the value, cost and quality of patient care.

New attitudes and new models of care

Value-based reimbursement for services has gradually gained ground, but now is moving ahead full steam. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) forged the way for value-based payments, laying out specific payment plans for healthcare providers. Plans emphasize clearly that cost control and quality care are necessary in order for payments to be approved. As a result of the sea change focused on value versus volume, providers must change their methods and, most importantly, adopt a new mindset. They must actively partner with healthcare institutions to establish, promote, and practice within a culture of safety. These transformations in business models and ways of thinking require new skills and education. Many providers, anxious to understand the complexities of the new healthcare environment are going back to school, both literally and figuratively.

New roles, new job skills, new insights

The role of “physician executive” is fast becoming one of the most important roles in the healthcare paradigm. Innovative educational programs are preparing physician leaders and other providers to focus upon the importance of quality over quantity, patient safety and process improvement. These programs are often designed to take the provider out of his or her comfort zone by exposing them to the experiences of other industries, such as manufacturing, engineering, finance and even the airline industry.

A very strong focus has been placed on the impact of systems versus individual actions. Healthcare organizations now realize that poor outcomes can be improved when process improvements are identified and acted upon swiftly instead of blaming an individual for a patient harm event. This is not news to risk management, quality and patient safety professionals. However, concepts that promote the reduction of patient harm are not necessarily well-known to others practicing within the healthcare profession. Many clinicians may have seen risk management, patient safety and process improvement as administrative functions secondary to their provision of clinical treatments.

The role of risk managers, patient safety and quality professionals has changed, too, with increased emphasis on demonstrating value and quality. A major responsibility for these professionals is to teach all levels of healthcare workers how to implement safe, standardized and evidence-based processes that enable health interventions to reach those who need them on a timely basis. Proactive, innovative means to accomplish safety goals are imperative. Data collection is important, but the actions taken following the observance of trends and/or system breakdowns make the difference in ultimate outcomes. Herein lie the greatest challenges. Actions risk management, safety and quality professionals must take to help others embrace the value paradigm include the following:

Educate – Share knowledge regarding the science of patient safety, the principles of risk management and methods of process improvement. Multidisciplinary forums, including those used after serious safety events such as root cause analyses, present an ideal opportunity to share knowledge and problem-solve as a team.

Engage – Let team players know “what’s in it for them.” Value-added services are designed to eliminate waste and streamline activities. A more efficient and joyful workplace can equate to happier employees, better communications and better patient outcomes.

Strategize – Help members of healthcare teams and departments set goals through the establishment of benchmarks that support positive patient outcomes. For example, establishing objectives to reduce infection rates can support both patient safety goals as well as financial targets through reduced readmission rates.

Promote – Secure leadership support and make it well-known that providing value to patients is part of the overall mission and vision of the organization. Use social media, newsletters, broadcast emails, job fairs, posters and other means to keep the focus on providing value to patients.

Evaluate – Implement realistic success monitors and use technology to ease the workload as much as possible. Modify measures as changes occur so they remain meaningful and applicable to patient care and workflow.

Innovate – Support new technologies. Innovation is a clinical and cost imperative. Examples of innovations include artificial intelligence, virtual reality, telehealth and biosensors and trackers, to name a few. Innovations that target, track, prevent, monitor, and treat illnesses demonstrate value. Risk management and patient safety professionals can assist in the determination of return on investment when decisions are made regarding the purchase of new technologies by factoring in the likelihood for reduction in patient harm, improved patient outcomes and patient satisfaction.

Celebrate – Create reward systems to recognize providers, staff, teams and departments that are promoting value and achieving established goals and positive outcomes for patients.

Sustain – Build in systems that check for “slippage” in improvements.

The bonus

Risk management, patient safety and performance improvement efforts are bolstered by new mandates to demonstrate value. Now, goals are better aligned, and with the dedicated efforts of healthcare staff working in teams, costs can be controlled, the patient experience will be ultimately positive and outcomes improved – the overarching aim of value-based healthcare.

> Read more from Robin and other professional liability, healthcare risk management and patient safety experts in our Risk Resource newsletters.

Robin Maley, RN, MPH, MS, CPHRM, CPHQ
SVP, Healthcare Risk Management and Patient Safety

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