I entitled this post “Collaborative Metrics,” because, during my ACHE seminar, Practical Strategies for Engaging Physicians, a healthcare executive said, “If we convert from fee-for-service too soon, we stand to lose millions of dollars. Help us figure out when to flip the switch.” Not feeling that I had the wisdom to be a market timer, I asked other hospital executives what metrics should we use as we move from volume- to more value-based care.
I entitled this post “Collaborative Metrics,” because, during my ACHE seminar, Practical Strategies for Engaging Physicians, a healthcare executive said, “If we convert from fee-for-service too soon, we stand to lose millions of dollars. Help us figure out when to flip the switch.” Not feeling that I had the wisdom to be a market timer, I asked other hospital executives what metrics should we use as we move from volume- to more value-based care. We agreed that, since we had multiple targets to hit at the same time, using the IHI Triple Aim provided a useful overarching framework.
Collaborative Metrics: Improved Care Experience
HCAHPS survey questions have empowered patients and encouraged physicians and nurses to pay attention to how well we are anticipating and meeting patients’ needs. At the same time, we must pay attention to disease-based metrics for quality, which take into account the appropriateness as well as the execution of care, as practiced at Virginia Mason. Hospital-acquired infections, falls, readmissions, and mortality, when shared with the public, can encourage transparency and healthy competition among providers. I hope that we can learn from near misses to the extent that we report them without blame, similar to commercial aviation.
Collaborative Metrics: Population Health
It is here where programs such as smoking cessation, exercise and obesity counseling, cancer screening, and diabetes and hypertension testing and therapy come to the forefront. So do number of covered lives, leakage of referrals outside the system, percentage of patients in capitated coverage and narrow networks, pay for performance incentives, and emergency room use.
Collaborative Metrics: Decreased Costs
If we believe that the role of 21st Century medicine is keeping patient populations well, then we must regard hospital admissions as a cost, which puts hospital administrators in the paradox of being seen as cost centers at the same time that they are called upon to finance large expenditures, such as electronic health records. As I wrote in Collaborative Learning, paradoxes cause less anxiety when viewed as processes to explore rather than problems to solve. Collins and Porra in “Built to Last: Successful Habits of Visionary Companies”quoted F. Scott Fitzgerald, “The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time and still retain the ability to function.” Clearly, we will still need to measure and act on parameters such as days cash on hand, operating margin, and cost per case as we progress.
Collaborative Metrics: Conclusion
Admitting uncertainty allows us to form new alliances, of which I hope physicians will play a role. The borders between providing care and operations and finance are blurring, which requires hospital administrators and physicians to unite around what attracted them to healthcare careers in the first place: the opportunity to make a difference in the lives of patients and families in their communities.
As always, I welcome your input to improve healthcare collaboration where you work. Please send me your comments and suggestions for improvement.
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