Forbes, in conjunction with AllScripts, interviewed a bunch of “C level” (took me a while to figure out this means Chief Operating Officer, Chief Medical Officer, Chief anything else) folks to ask them how they felt health care change would happen and in which direction it would go. They all agreed it would move from “volume” to “value” and agreed it would move in the next 3-5 years. The full report can be found here. The summary, informed by the “Cs”, on getting from here to there is worth a read:
Invest in knowledge acquisition.
Information is not power; knowledge is. Consistently producing measurable, high-quality, cost-effective outcomes for a defined population across the care continuum demands an enormous amount of information synthesis, often in real time. Having advanced analytics serves a reactive and proactive purpose. Insurers, consultants and others are constantly analyzing and comparing different providers on quality and cost metrics. “If you don’t know what your physicians and group are doing and are not able to track your performance, your future will never be in your control,” advises Dr. Robert Nesse, CEO of the Mayo Clinic Health System. “You will be victimized by new payer contracts and pilloried by public displays of your performance data.”In other words: “You can’t manage what you can’t measure”Distribute responsibility.
While senior management can accumulate one kind of knowledge through IT, there’s an equally important type of knowledge no printout can provide. “Engaging” physicians and patients can be a euphemism for, “Get with the program.” But though shared goals are a necessity, care processes ultimately cannot be improved unless those in the front lines are given explicit authority to use their practical experience to do so and are provided with the tools to carry out that mandate. Front-line teams can be any combination of clinicians, staff and patients.Lead Culture ChangeUltimately, the alternative to preparing for VBP is not prospering under the status quo. The Medicare physician fee schedule and prospective payments to hospitals are failing to keep pace with medical inflation and will fall even further behind in an era of budget austerity. More and more private employers are cutting back or even abandoning health benefits. “The system cannot and will not pay what it has in the past,” says economist Michael Chernew, a professor of health care policy at Harvard Medical School. “The boat is sinking.” As that happens, it is the responsibility of senior executives to lead their organizations to safety. “There are no great men, only great challenges that ordinary men are forced by circumstances to meet,” said famed World War II Adm. William F. “Bull” Halsey. And there may be no greater challenge than taking a health care organization whose clinicians, staff and managers have all grown up with the autonomy and economic rewards of visit-based, fee-for-service medicine and helping those people change the working assumptions of their professional lives.
“Our heart and soul is not a mission of financial value,” said Banner Health CEO Fine. Added CMO Hensing: “Technology is a vehicle. But this, in fact, is about commitment, mission, governance, organizational design, clinical leadership. It’s about a culture that embraces performance as a measure of its success.”