For healthcare providers today, it’s all about quality, not quantity.
This is great news for patients, and may help the country make strides toward providing a better standard of overall care. It also means that hospitals and health systems are taking on more risk, because providers who fail to achieve high patient-satisfaction scores, low readmission rates, and other quality outcomes mandated by the Centers for Medicare and Medicaid Services (CMS) face fines and lower rates of reimbursement.
The pressure is mounting
Not surprisingly, a change so fundamental has prompted insurance companies and CMS to design various models for quality reporting and reimbursement which are aimed at easing the transition to quality over quantity. These programs have, until recently, relied upon the voluntary opt-in of healthcare providers.
However, CMS recently announced a goal of moving half of the country’s healthcare providers to value-based care models by 2018.
Adapting payment models for certain patient groups or for certain types of procedures is a manageable challenge. But making a transition like this on a large scale, and eventually getting to new payment models for all patients all the time, is a major undertaking.
And now that CMS is attaching a deadline to this transition, the pressure is ramping up. No provider wants to be penalized for failing to achieve quality outcomes. Increasingly, hospitals are looking to one another, and seeking outside expertise, to develop best practices that all providers can use as they change their care delivery as quickly and efficiently as they can.
Looking at best practices
Several best practices have been developed by health providers as they partner with payers to come up with new reimbursement models. Payers are coming up with their own guidelines as well. Central to both sets of guidelines is a closer relationship with the patient.
Providers must get to know their patients much better if they hope to grow market share and maintain their margins. They’re being asked to produce quality outcomes and deepen patient relationships without added staff. To accomplish this, they need technology-enabled solutions that can extend their care management infrastructure and reach patients in new ways.
My experience working with dozens of health systems focused on maximizing care management performance to achieve quality outcomes has led to best practices that I’ve summarized below. As you move through your process, our partners recommend circling back to these every few months to stay focused.
• Focus on all patients, not just the most high-risk
• Invest in real-time risk assessment
• Recognize that different populations will need different interventions
• Determine your ability to scale and identify partners that can scale with you
• Prioritize improving care quality and service
• Rethink how success is measured
The key to implementing just about every one of these guidelines is the patient. Patients provide the data that informs the most important decisions that providers make, and patients are the key to achieving quality outcomes.
The use of new technologies
Implementing these guidelines would be impossible without patient engagement technology. It’s not possible for healthcare institutions to call every patient on the phone every day, to determine who is at the highest risk and who’s in need of a different care pathway.
But this is the level of detail that providers must adhere to if they hope to improve outcomes and margins. Other best practices, including investing in real-time risk assessment, scaling and redefining success, also rely on detailed information from the patient.
Fortunately, the technology exists today that enables this type of real time data-gathering from patients. Through daily, automated check-ins, that once could only be done with a call or in-person visit, care teams are able to ensure that patients receive the right information at the right time.
Finding the right technology
There are many patient engagement solutions on the market, but some still require that providers prioritize one group of patients over another when it comes to interacting outside of traditional care settings.
This isn’t necessary and, in fact, by expanding their panels of patients with automated remote guidance and monitoring, providers can better achieve quality outcomes by delivering an elevated experience to all patients. Measuring quality over quantity refers to an acknowledgement of patients’ satisfaction with the healthcare they’re receiving. That doesn’t mean just the highest risk patients, or the patients who are the most vocal on satisfaction surveys. It means all patients, all the time.
Achieving quality outcomes hinges on receiving continuous feedback from patients. Providers should identify solutions that treat all patients equally, by soliciting input from all of them every day.