How should providers respond to the demand for value? The Healthcare Financial Management Association’s (HFMA’s) report, the Value Project (hfma.org/ValueProject) identifies four capabilities that organisations should develop to prepare for a value-based healthcare system. The report is based on interviews with leading provider organisations and surveys in the field.
- People and culture: The ability to instill a culture of collaboration, creativity and accountability.
- Business intelligence: The ability to collect, analyse and connect accurate quality and financial data to support organisational decision-making.
- Performance improvement: The ability to use data to reduce variability in clinical processes and improve the delivery, cost-effectiveness and outcomes of care.
- Contract and risk management: The ability to develop and manage effective care networks and predict and manage different forms of patient-related risk.
People and culture capability requires collaboration
The pursuit of value in healthcare will require new levels of interdisciplinary collaboration, new levels of accountability for results, a new focus on driving process improvement throughout provider organisations and an ability to communicate the value of a provider’s care to the community it serves. At a foundational level, providers should have the skills to perform the following:
- Define the role of value in the organisation’s strategic mission and communicate value to both internal and external stakeholders.
- Create engaged, integrated multidisciplinary teams that can plan and implement process change.
- Identify and effectively respond to patients’ concerns or issues that might affect their experience or safety.
Business intelligence plays key role in measuring quality and cost
For providers to deliver value in healthcare, they must have accurate, actionable data on the two elements driving the value equation: quality of the care delivered and cost of providing care (the basis for the price that purchasers should be asked to pay for care). They must also be able to link quality and financial metrics to quantify the value of care provided. To build this business intelligence, organisations must have skills to perform several functions:
- Accurately and consistently report data on appropriate metrics developed in collaboration with clinicians.
- Drive information sharing throughout the organisation by linking department-level dashboards and individual measures to strategic goals and executive dashboards.
- Report quality results against core measures.
Performance improvement rests on identifying and prioritising opportunities
Performance improvement capabilities comprise the skills needed to reduce variability in clinical processes and improve delivery and outcomes of care. To effectively improve performance, providers will need skills to be able to conduct the following:
- Identify and prioritise improvement opportunities.
- Develop well-defined processes to ensure that clinical redesign projects achieve their defined goals.
- Identify and create consensus around evidence-based practices (from both internal and external sources).
The organisations interviewed for the value project are actively engaged in clinical process redesign focused on reducing the variability of clinical practice patterns and identifying and removing waste from clinical processes. The success of these efforts depends on identifying the right opportunities, ensuring that projects stay on goal, and promoting the development and adoption of evidence-based practices. In many organisations, opportunities for improving clinical processes outnumber the resources available to implement process redesign, so the prioritisation of these opportunities is a critical first step.
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Contract and risk management encourage provider collaborations
Management of care episodes or the delivery of “accountable care” will, in many cases, require an extension of care across a network of providers. Providers will need to develop capabilities in assessing the potential risks and benefits of acquiring other providers or engaging with them contractually to build a care network. Considerations will include how to divide the care services, accountability for outcomes, and revenue among network members.
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Also, providers will need to predict and manage different forms of patient-related risk under different payment methodologies. For example, providers will need to evaluate performance risk for patient outcomes under an episodic or bundled payment system for acute-care procedures, or they will need to understand utilisation risk under a bundled payment system for chronic disease management or a per-member-per-month capitated payment system. In the near term, providers will need skills to perform the following:
- Create partnerships with payers to meet mutual needs, collaborate on payment system evolutions and discuss progress toward quality and cost goals.
- Develop cross-functional collaboration among clinical, finance and contracting departments to ensure that agreements can be successfully implemented and managed.
- Effectively manage utilisation among the organisation’s patient population, ensuring that the right care is provided at the right time at the right location.
To learn more about value-based care and the business of healthcare, join HFMA for a one-day educational session on October 31 at the Global Health Exhibition, sponsored by Selat, a Riyadh-based revenue cycle management consulting firm and its training firm Nawa. The educational content will be taught by healthcare business experts from the Saudi Ministry of Health’s National Casemix Center of Excellence, Nawa and HFMA.
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Richard L. Gundling, FHFMA, CMA, is the Senior Vice President, Content and Professional Practice Guidance, HFMA, Washington DC.
Much more awaits at the Global Health Exhibition in Riyadh this year. Register now to learn, network, and lead your business and practice into a revolutionary healthcare market.
Also, join industry experts in learning more about the latest trends in Saudi Arabia's healthcare industry by accessing the webinar "How innovation and tech are fuelling investment in Saudi Arabia's healthcare market."
