Making the shift to value-based care: Principles before processes
Don’t make the transition to value-based care without understanding these key principles to transformation.
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In his blog post Maximizing Value-Based Care: Six keys to financial and workflow success, Mason Beard, Chief Solutions Leader for Philips Population Health Management Group and co-founder of Philips Wellcentive, acknowledges a lingering cloud of skepticism around the transition from volume- to value-based care among today’s providers. COPD insider recently sat down with Beard to learn more about his insights into value-based care and how best to increase your momentum to implement it. Contrary to what many believe, this doesn’t start with organizational processes. It starts with principles, such as elevating organizational culture.
Contributor
Mason Beard
Chief Solutions Leader for Philips Population Health Management Group Co-founder of Philips Wellcentive
As healthcare reform evolves, we can’t just
change our processes, we must transform our whole way of thinking to successfully adapt to the disruption that value-based care represents.”
Chief Solutions Leader for Philips Population Health Management Group Co-founder of Philips WellcentiveMason Beard
Establish a culture of value-based thinking
The shift to value-based care begins with a shift in mindset. Before operational change can begin, people need to understand the need for change and develop an openness to it. This is done through organizational culture and is most effective when it starts at the top with management and senior leadership.
Change does not come about with differences in functional processes alone, but by differences in culture."
Stuart Pollack, M.D. Medical director Brigham and Women's Advanced Primary Care Associations
According to John P. Kotter and James L. Heskett, researchers of culture and organizational performance, culture is defined as "…a gained knowledge, explanations, values, beliefs, communication, and behaviors of a large group of people at the same time and the same place." They also maintain that differences in culture can be why one company succeeds and another one fails within the same industry.1 Stuart Pollack, M.D., medical director at Brigham and Women's Advanced Primary Care Associations, suggests that, "Those who try to replicate the results of successful Triple Aim initiatives have the wrong focus—looking at raw processes instead of shifts in culture and principles."2
The value of shared context
Before teams can get engaged in your initiative, they need to know the context. The shift to value-based healthcare stems from changes in care delivery and consumer expectations. By grounding teams in the following information, you can help them get a better understanding of why your organization needs change.
Reinforce the vision
Before you can live the culture of an organization, there must be a clear and concise articulation of its vision and values. An excellent example is that of the Mayo Clinic. In an article from athenainsight about the “Mayo Way”, Stephen Swensen, M.D., Medical Director in the Office of Leadership and Organization Development, says, “I have 61,000 colleagues at Mayo and virtually every one of them would say, “I’ll tell you what our primary value is. The Primary value is that the needs of the patient come first.”3
Understand that consumerism is here to stay
According to the Institute of Healthcare Communication (IHC), consumerism is defined as “transforming an employer’s health benefit plan into one that puts economic purchasing power—and decision-making—in the hands of participants.”4 Beard goes on to explain, “We are not just treating patients anymore, we are servicing consumers. That means we must shift our thinking to create a culture that improves the patient experience, and ultimately increases patient loyalty.”
Remember that medicine may be an avocation, but healthcare is a business
Beard explains that the shift to value-based care is putting business and administrative responsibilities on providers who may not want to accept the challenge. “Accepting the business of healthcare must be part of the fundamental culture change,” he explains. “To be clinically relevant today requires that providers be financially viable. Those who are able to embrace this change are likely to see results in market share.”
Move the food bowl
Beard recalls a famous quote made by a chief medical officer who was commenting on the difficulty of change relative to value-based care. He said, “What’s the best way to herd cats? You move the food bowl.” Beard concurs that helping providers make cultural changes requires incentives to guide and reinforce behavior. He explains, “Because providers touch every aspect of healthcare, we're asking them to be cultural leaders in the transformation to value-based care. Like it or not, they are being thrust into the position of change agent.”
Building upon culture
Beard maintains that, while culture is at the heart of transformation, further opportunities are vital to explore. This refers to a series of actions, which range dramatically in scale. You don’t need to embrace them all at once, but successively, depending on where you are in the transition process.
Key actions to complement culture on the road to value-based care:
Fund transformation by finding revenue leaks
- A 2% reduction in bad debt can recover tens of thousands of dollars5
- $40 million in revenue is being lost per year due to 35% of patient cases going to specialists and facilities affiliated with another health system6
- A 2% reduction in bad debt can recover tens of thousands of dollars5
Embrace claims data
- 20-35% of average medical claims are rejected5
- 31% percent of providers still use manual claims denial management7
- $15,000 is spent on the phone calls, investigative work, and claims appeals associated with reworking claim8
- 20-35% of average medical claims are rejected5
Capture reporting data:
- Simplify data preparation for exploratory analytics
- Increase productivity by reducing time required to sieve data and facilitate better utilization
- Bring data directly to analysts to reduce the workload on the internal IT infrastructure
- Improve organizational data usage
- Simplify data preparation for exploratory analytics
Manage risk
- Identify care models and alternative payment opportunities
- Build relationships among providers
- Manage financial risk and utilization to fuel the transformation required to provide value-based care
- Design initiatives that focus on quality at a lower cost
- Establish quality metrics for patients who are vulnerable stakeholders
- Identify care models and alternative payment opportunities
Positioning care teams
- Get the right data to the right people at the right time
- Allow care coordinators to help their patients navigate the system to close care gaps
- Help highly trained clinical staff focus on the most complex cases
- Get the right data to the right people at the right time
Improve patient retention
- Implement a system to collect, organize, and present price reporting to employers and employees
- Interact with patients to help measure patient satisfaction and patient experience
- Use comparative performance data to reveal important and relevant information
- Be champions of the performance assessment
- Implement a system to collect, organize, and present price reporting to employers and employees
Some providers equate the shift to value-based care with turning the Titanic around in a bathtub. But with the proper resources and support, and most importantly, a change in culture and mindset, meaningful change is not only possible, it’s inevitable.”
Chief Solutions Leader for Philips Population Health Management Group Co-founder of Philips WellcentiveMason Beard
Embracing value-based care
The shift to value-based care will take time. But, by creating a culture for change, sharing context to keep care teams engaged and operating more effectively, you can ensure that your organization is poised to succeed in the future of healthcare.
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Further reading
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References 1Zenger J.Forbes. Change your leaders. Change your culture. Nov 2017 https://www.forbes.com/sites/jackzenger/2017/11/25/change-your-leaders-to-change-your-culture/#6c1e880867d5. Accessed April 30, 2018. 2Pollack S. Health Affairs Blog. When health care transformation fails. April 2015. https://www.healthaffairs.org/do/10.1377/hblog20150427.047232/full/. Accessed April 30, 2018. 3Sweeney-Platt J. athenainsight. The Mayo Clinic’s culture of ‘Socialism run by Republicans’. September 2016. https://www.athenahealth.com/insight/mayo-clinic-culture-stephen-swensen. Accessed April 30, 2018. 4nrc HEALTH. What is consumerism in healthcare? April 2016 https://nrchealth.com/what-is-consumerism-in-healthcare/. Accessed April 30, 2018. 5Advanced MD. 3 tips to stop revenue leaks in your private practice. http://imaging.ubmmedica.com/all/editorial/physicianspractice/pdfs/3_tips_to_stop_revenue_leaks.pdf. Accessed May 16, 2018. 6Doc halo. The Clinical Communication Company. The Clinical Communication Quick Course: what health systems really need to learn about interoperability. On-call management and information overload. https://www.dochalo.com/wp-content/uploads/Doc-Halo-White-Paper-Physician-Alignment.pdf. Accessed May 16, 2018. 7Belveau J. RevCycle Intelligence. 31% of providers still use manual claims denial management. An HIMSS analytics survey found that less than half of providers use an automated claims denial management system, but adoption rates are expected to rise in the future. https://dochalo.usdphosting.com/resources/white-papers/physician-alighment/. Accessed May 17, 2018. 8Tohill M. RevCycyleIntelligence, 8 tips for avoiding denials, improving claims reimbursement. For many practices, reducing the denial of claims can put them on the path to improved claims reimbursement. https://revcyclinintelligence.com/news/8-tip-for-avoiding-denials-improving-claims-reimbursement. Accessed May 16, 2018.
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