With the shift to value-based reimbursement, quality has become an overwhelming focus for healthcare providers. This also brings new challenges in understanding and implementing the best solutions. But how can your system focus on improving outcomes, managing or reducing cost, navigating the impacts of an individual’s social determinants of health and continually enhancing patient experience? We recommend addressing each challenge with IHI’s Triple Aim Approach.
Let’s focus in on quality and discuss more in depth how your system can focus on improving outcomes, managing or reducing cost, navigating the impacts of an individual’s social determinants of health and continually enhancing patient experience. As you think about quality, it is important to always keep in mind the Triple Aim from the Institute for Healthcare Improvement (IHI): 1) improving patient experience, 2) improving the health of populations, and 3) reducing cost. It’s no secret the US healthcare system is the most costly in the world, accounting for 17% of the gross domestic product. According to the National Health Expenditure Projections, it’s estimated that by 2020 this percentage could grow to 20%.
Your Potential to Thrive
Let’s walk through each IHI aim and break it down further to determine more specifically how to address each challenge:
1. Improving Patient Experience
In the ever-competitive healthcare marketplace, do you have a plan to continually improve your patient experience in order to help drive more consumers to you? From the quality of clinical care received to the experience, a consumer has when registering for a service or receiving their bill, “good enough” cannot be considered acceptable. As you consider other factors affecting how consumers choose and utilize healthcare services, it’s equally important to understand how much of an impact providing sub-par service and outcomes will have on your bottom line. The quality of care and the services your organization provides must be explicitly linked in order to provide a truly memorable healthcare experience. Your team must be equipped with the skills to identify the issue, redesign the approach, monitor the changes and communicate the improvement.
2. Population Health Initiatives
Policy has been pushing the healthcare industry through payment reform to improve population health, which means it’s now your responsibility to continually think outside your local system walls for factors that affect health. Looking at the larger impact of social determinants on health must become your focus. Whether connected through a formal system or operating as individuals, providers and administrators across communities and regions must work together to achieve greater results in this area. What initiatives do you have in place to achieve positive population health solutions? Are you and your community partners aligned for success? What population health management solutions will you start to implement? Even if you’re not connected through a formal healthcare system, are you all focused on improving the population of the community you serve together? Population health success today requires better communication as individual providers, understanding and capturing the risk of those you serve and monitoring individual patients throughout the continuum of care.
3. Improving Value by Reducing Cost
Reducing cost for the care you provide patients is paramount as value-based care systems gain traction. To achieve success in this area, hospitals, providers, and communities alike must all be aligned. Focusing inward on your system, do you have the tools in place to identify your actual cost and understand the variance in care being provided? What inefficiencies are occurring that contribute to higher cost and increase the chance of a poor outcome? Is an interdisciplinary team connected on the issues at hand? What steps need to be taken in addressing them? Are your providers leading the change and helping the entirety of the care team understand the importance of value-based healthcare? There are well tested value-based care models that can bring success in this area:
- Consistent clinical protocols
- Establishing key processes to maintain all team members practice to the top of license
- Interdisciplinary rounds to increase communication and action
- Defining case management’s role in bridging gaps in care
- Strengthening the post-acute provider network to improve the care provided throughout the continuum
With these questions answered and putting the right systems and protocols in place, your organization will be on the road to improved quality outcomes and better population health.
The challenges health organizations like yours face when working to provide the highest quality care while also reducing costs can be difficult to master. Often, quality efforts are separated from initiatives including cost rebalancing, provider integration and consumerism. Without a strategic plan, it can be nearly impossible to integrate quality.