Conquering Uncertainty: How to Succeed Amid Change
The healthcare landscape is changing rapidly, thanks to a new president and Congress, as well as a growing shift to value-based care. In this interview, Dr. Byron C. Scott, MD, MBA of Truven Health Analytics®, part of the IBM Watson Health™ business, offe
Byron supports hospitals, physician groups, health plans, and employers to improve overall healthcare and clinical performance with quality and leadership initiatives using health analytics. He also serves as a board member for the American Association for Physician Leadership® and is on staff at Northwestern Medicine’s Immediate Care Center.
How can healthcare organizations maintain reimbursement and outcomes amid change that may come from a new president and Congress?
BS: We’ve always had government and commercial policy changes that have impacted providers, and the reality is that these organizations adapt to survive. DRGs were implemented many, many years ago, and obviously created a lot of angst, but organizations adapted to them, and later did the same thing when Meaningful Use and the Affordable Care Act came along. Obviously it’s important to think about the future and for providers to be concerned. I also think organizations are on much better footing today than prior to the ACA, because the ACA required organizations to become more efficient and focus on improving quality, safety and outcomes.
How do hospitals move into the future while having one foot in fee-for-service and the other in value-based care?
BS: Most organizations are still generating most of their revenue from fee-for-service, but this is changing. Organizations who want to prepare for a shift toward value-based care need to make several key investments. First, they need a strong information technology infrastructure. Organizations have already done this in creating enterprise-wide data warehouses that can perform data analytics on the populations that are at risk under certain models. They also need to create strong partnerships with physicians, community leaders, skilled nursing facilities, and nursing homes. Connectivity between these organizations is crucial when you’re working with at-risk populations and being reimbursed under value-based care.
As providers explore alternative reimbursement models, why is it important to identify patient populations?
BS: Population-level data is going to be very important with emerging payment models. Many organizations are using tools that combine claims and clinical data to help them think of populations in terms of cost, specific patient demographics, and understanding gaps in care. This can help providers identify certain patients who are at a high risk for consuming a lot of resources, including those who may be at a high risk for being admitted to the hospital. It’ll be important to identify and track social determinants, which can affect these patients who are at risk.
What role does standardization play in maintaining financial health during times of change?
BS: Providers must make an effort to reduce variation if they want to bring down costs and ensure a consistent quality-of-care. Standardization also sets organizations up to be able to manage various bundled payment initiatives, especially around joint replacement. Trying to standardize medical devices or drugs that are going to affect the entire supply chain is going to be crucial in achieving success. It’s not necessarily cookie cutter medicine – it’s a way to create best practices and reduce variation by providing cost-effective means to achieve the highest-quality patient care.