Collaboration around the business of health care is critical
In a recent marketplace survey by NEJM Catalyst on the transition from fee-for-service to value-based care, we gained interesting insight into the state of value in health care. These included snapshots of revenue distribution, models in use, barriers, important measures and more. All are important points in understanding health care’s current state. However, noticeable differences between the responses of clinicians and health care leaders struck as a fascinating side note that potentially hints to larger issues at hand.
Here I will explore the differing views and experiences of these two equally important groups. I’ll look at how developing team approaches, fostering collaboration and providing transparent leadership can work to help us all embrace the move towards value-driven care. I approach this from a unique viewpoint. My current experience is in designing recommendations to complex problems at the intersection of providers and the other players in health care, including payers, health systems and patients. My viewpoint is also informed by my past experiences working for and partnering with health systems and independent physician enterprises.
The business and delivery of health care has split
Many modern hospitals were actually begun by caregivers. They were not tasked with ensuring financial viability or setting up of vast networks of care. Their goal was to care for the sick, needy and vulnerable out of virtue, and today, our collective focus is still to deliver on the promise to a patient of providing the best care, quality and cost. However, in today’s health care landscape, we have clearly bifurcated the business and clinical delivery of medicine. Now it is seemingly natural that health care leaders know more about the finances and operating models of their organizations than clinicians. Clinicians care for patients while leadership ensures that care can be delivered systematically.
These delineations can make for easier management in the short term. Yet it may lead to blind spots for executives and clinical leaders as they transition their organizations to value-based care. Without a broad sense of how clinical decision-making affects the larger organization, it will remain difficult to lead people to common platforms, expectations and ways of thinking. For instance, some physicians would say they might need multiple medical device options for a particular treatment to serve patient needs. But these physicians may not understand the effect of increased inventory costs. These physicians are not inherently self-interested but have often not been united with executives and clinical leaders in the big picture.
Developing collaboration around the business of health care
Front-line clinicians’ buy-in to value-based care, both its purpose and its potential, will be necessary for health care organizations to truly operate successfully under these models. Let’s take a look at some data points from the recent marketplace survey by NEJM Catalyst to help us understand the differing perspectives of leaders and clinicians. We’ll also look at takeaways that could ease conflict and increase collaboration.
The differing perspectives: A higher percentage of clinical leaders (66%) and executives (64%) than clinicians (50%) know the percentage of revenue that comes from fee-for-service and from value-based care, and a greater share of executives (27%) and clinical leaders (25%) than clinicians (17%) say their organizations have made the transition to providing value-based care.
The takeaways: The terms and definitions around value are not universally understood. Executives and clinical leaders need to break this down and answer for their organizations…what does value-based care mean here? Is it contracting or is it a method of care delivery? Provide education on those definitions and provide clinicians with examples in their care setting of how they can engage in value-based care. Encourage executives and clinical leaders to involve both the clinical and business sides of the organization in the strategy development, evolution and implementation on the ground. Jointly plan for a long journey of transition that moves the needle over time while aligning incentives appropriately and providing visibility into outcomes at all levels.
The differing perspectives: Executives are more bullish than clinicians about value- based care: whether it significantly improves quality of care (executives 55%, clinicians 38%) or lowers cost of care (executives 50%, clinicians 36%); and whether there is enough evidence about the positive impact of value-based care that the system should move toward it aggressively (executives 55%, clinicians 38%).
The takeaways: Some of the differences in opinions may lie in the access to outcomes and population data between clinicians and executives. Being transparent within an organization about what is working and what is not is essential to common understanding. In addition, the use of standard change management principles including two-way communication of necessary changes, setting the vision, providing education and celebrating quick wins can further bridge the gap regarding the perceived effectiveness of these models.
The takeaways: Some clinicians are not exposed to the national data or enmeshed in the issues surrounding health care costs, which are currently exceeding revenues on a global level. Providing exposure to this data and educating on the realities of the current state of the industry can help clinicians better understand the need for significant change. In addition, highlighting examples of how many organizations are taking these models on (per the NEJM Catalyst survey, 22% are already there and 64% more state they will be there in the next five years) assists in framing the urgency and importance of this transition.
The differing perspectives: A greater share of clinicians (38%) than clinical leaders (34%) and executives (25%) cite administrative detail as a top barrier to implementing value-based reimbursement models.
The takeaways: This particular pain point is typically seen from two very different lenses between executives, clinical leaders and clinicians. The differing roles crossing over from leader strategy to clinician execution is where we can see much of the conflict. It is important to recognize that an administrative and a physician viewpoint will be opposed at times and that the remedy is collaborative strategy development, transparent feedback mechanisms and shared incentives. Importantly, helping clinicians understand that bearing risk can directly benefit them in having more investment opportunities in the health of the patients and the community they serve is a worthwhile incentive.
Achieving balance in value-based care
We are moving towards value-based care at a rapid pace. While increasing quality and lowering costs is the right thing to do, this transition inevitably comes with its own particular set of challenges. Moving forward, medicine with a narrow focus on the individual patient and the autonomy of an individual physician may evolve as the shift to value continues. We may also find that moving away from autonomy could make some clinicians bristle. However, the move towards population- and team-based care may lead to a better balance of care standards and system efficiencies for all.
Ultimately, value-based care models can offer clinicians more time and incentives to allow deeper engagement with patients. This is in contrast to volume-driven models (often seen today), which can limit these much-needed patient interactions. Population data and outcomes in the hands of clinicians can also allow clinicians to more specifically target those patients who are in need of their care. Deeply engaging with the right patients, in the right way and at the right time is a win-win for all. Managing the perceptions of value within your organization by clearly communicating what it means, how you achieve it and why it is important to leaders and clinicians can go a long way in leading a true team approach to the transformation of care within your organization.
For more insights on creating value in health care from executive and clinical peers, visit www.optum.com/valueinhealthcare
All survey results and charts reproduced with permission from NEJM Catalyst (catalyst.nejm.org) © Massachusetts Medical Society. https://catalyst.nejm.org/transitioning-fee-for-service-value-based-care/. November 2018.
About the Author
Michele Molden, MBA, FACHE
Practice Leader, Strategy and Provider Enterprise Services
Michele Molden leads the Provider Enterprise Services and Strategy practices within Optum Advisory Services. Michele partners with health systems, as well as employed and independent physician enterprises. Her comprehensive and focused consulting approach enables organizations to achieve financial and operational sustainability. Previously, Michele served as Executive Vice President and Chief Transformation Officer at Piedmont Healthcare in Atlanta, GA, where she was responsible for strategic design and corporate business development initiatives for the five-hospital system. Michele also served as founding President and CEO for the Piedmont Heart Institute. In 2009, Michele was voted a Top 25 Women in Healthcare by Modern Healthcare. Her educational background includes a Master of Business Administration from Kennesaw State University in Kennesaw, Georgia, and a Bachelor of Arts from Miami University in Oxford, Ohio.