In this second edition of our three-part series, Wellcentive’s Paul Taylor explains how to strategically shift your network from engaged to a coordinated health network for true care transformation.
Your improvement efforts may be well underway, but are they headed toward a true transformation of care for your healthcare network? The answer to that question could help you understand how close you are—to not only recognizing your potential to improve—but realizing it. And that isn’t the only good question to ask when embarking on your reform plans, according to Wellcentive’s Paul Taylor.
“Are you attempting to change too much too fast? Are you trying to perfect too much before making any changes at all? Those may seem like obvious questions, but people often forget to ask them when things get complicated,” said Taylor, CMIO and cofounder of the Atlanta, GA-based population-health-management (PHM) solutions company. “The reimbursement opportunities are out there for many networks, but they won’t realize them overnight. Network maturity is a long journey, and you need to use your organizational compass to steer and stay on the right course.”
The course Taylor speaks of is one paved with responsible PHM practices, which create cost efficiencies and quality improvements via targeted disease management and preventive health efforts. To take advantage of those opportunities, you will need to move beyond the comfort zone of EMR/EHR implementation and on to greater organizational objectives that can lead to improved clinical and financial outcomes, a subject we began exploring with Taylor in our first edition of this three-article series: Three Mission Critical Pieces of Network Maturity.
Establishing a PHM model may seem like a tall task, especially for those who are currently spending a lot of time and resources implementing their EHR/EMR technologies to achieve meaningful use (MU). However, Taylor says that the two objectives do not have to be mutually exclusive. In fact, employing the right community-wide PHM solution can create a natural synergy and sense of direction across your network when it comes to implementing change.
“One of the difficulties of EMR/ EHR implementation is it’s difficult to achieve ROI, which can stall or stifle morale, said Taylor. “However, by employing your PHM efforts at the same time, you can engage your physicians in clinical workflows that can start creating results more readily by taking advantage of the available reimbursement opportunities. Yes, you will need to put more solutions in place, and yes, the investment and workload can be substantial—but so can the results.”
Modeling Maturity
That lengthy process (from early EMR/EHR implementation to a high-level interoperable PHM system focused on improving clinical and financial outcomes at the community level) is outlined in great detail in Wellcentive’s Network Maturity Model, which was developed to help organizations find their place in the improvement process by breaking it down into four strategic stages: Affiliated, Engaged, Coordinated and High Performing.
The model, which Taylor describes in more detail in his three-blog series on the topic, depicts the gradual climb that organizations can make to provide efficient and effective quality care by enacting the essential network-building initiatives along the way. In our first article, Taylor provided the mission-critical pieces of moving from an Affiliated to Engaged network, outlining what’s required to move forward from EMR/EHR implementation to prime organizations for participating in quality improvement programs. Those pieces included aggregating and normalizing data, engaging physicians, and measuring and benchmarking performance.
Although each phase of the maturity process is important, Taylor points out that Affiliated and Engaged networks are primarily in the information-gathering and physician-engagement stages. It’s the leap to the Coordinated stage that often puts an organization’s potential for progress to the test, and without the right components, even the networks with the best intentions will fall short.
“This is definitely the most challenging transition in network maturity evolution,” said Taylor. “You are stepping off the platform of just aggregating and measuring data to proactively using that data and new workflows and processes for performance and improvement. There are more and more complicated workflows involved. There is quite a bit more money involved at this stage, too. And this is the stage where organizations will undergo a true transformation of care, moving from a physician-focused to team-oriented care delivery. It’s a big shift, but it’s really the stage where all your efforts up until this point are about to pay off. Remember, the data is only as good as what you do with it. It’s time to do something valuable with it.”
Stay the Course: Engaged to Coordinated
So what do you do with all that data? We turned to Taylor for the answers. As a result, here are the four core components that put that data to good use and transform your network from Engaged to Coordinated:
1. Targeting High-Value Opportunities
Now that you are successfully aggregating your data from disparate sources, and have your physicians on board with the quality improvement process, it’s time to start putting the pieces of improvement in place. This is where Taylor cautions that you can take on too much too fast if you’re not careful. “Boiling the ocean is not going to yield great results. It only creates major headaches and organizational upset, but not a lot of impact,” said Taylor. “Instead, pick some low-hanging fruit. Where can you be most effective without disrupting existing workflows?”
While some organizations seek to take on too much too quickly, some don’t act quickly enough out of waiting for perfection. That can also be a big mistake, said Taylor. “Some organizations want to wait until they have 100% data quality to implement improvements, but the vast majority of the outcome improvements can be realized with lower data quality. What they don’t realize is that the incremental cost of going from very good data quality to perfect data quality is substantial. In addition, if you don’t put the clinical workflows into practice, you won’t know all of your data-quality issues or where they are emanating from. Your data quality should be good enough that your network and providers can trust it— but it doesn’t have to be pristine to make significant progress.”
2. Identifying Care Gaps
One of the easy and obvious pieces of low-hanging fruit to start the improvement processes is identifying care gaps; once identified, you can enable your preventive care and disease management outreach efforts. It’s a common practice that seems simple enough, but Taylor says don’t let the data alone drive the priority of your improvements.
“You really have to let the quality programs you are participating with provide the anchor for your care gap analysis,” said Taylor. “Yes, all care gaps need to be addressed at some point, but to implement a successful improvement program to engage physicians, you have to make sure reimbursement is part of the equation. You can’t do it all at once, so you want to make sure you are making marketable improvements on what you are being measured against. Focus on payer-specific care gaps first, rather than national standards like HEDIS or NQF.”
To ensure your care gap analysis is accurate, make sure you know where your data lives, added Taylor. You may need to work carefully and methodically with your EHR vendor, hospital system, or e-prescribing vendor to gather everything you need. “Collecting that focused set of actionable data pertinent to your quality improvement programs is going to give you a better understanding of what workflows you need to implement to align your objectives and tie your improvement efforts together,” he said.
3. Enabling Patient Outreach
Once you have identified your gaps it’s time to start closing them with outreach and education interventions to improve your outcomes. Taylor said it’s easy to employ outreach efforts via automated technologies or a high-touch personalized approach by enlisting staff members to make calls. Regardless of what tactics you employ, you don’t have to run out and hire a care team just yet.
“Start small. Have your medical assistants make calls intermittently or maybe just devote one assistant with the task of contacting patients,” said Taylor. “Once you starting receiving reimbursements from your initial efforts, then you can start to think about hiring a care manager for other quality programs. At that point, you will need the staff in place to consistently align those clinical and administrative workflows with your outreach efforts.”
The process is pretty clear- cut; however, physician enthusiasm may be harder to rally during the development of your transitions of care. After all, physicians are used to making all the decisions about their patients from prescription renewals to discussing treatment options and test results. It’s not easy, but Taylor says your physicians are going to have to learn to let go a little if you want to make the most of improvement efforts.
“As a physician, I can tell you that it does take some adjustment,” Taylor said. “However, just like there isn’t one technical solution to this process there isn’t one human solution either. These new care delivery models were designed to be effective and efficient, so that you still have a touch point with your patients, but you don’t have to oversee every detail regarding their care. That’s where your care management team will come into play. At that point, you will need them— and your patients will come to rely on them, too.”
If your physicians still aren’t thrilled, don’t forget the importance of performance measurement and benchmarking. “There are lots of ways to apply positive pressure to change,” said Taylor. “Once hesitant providers recognize the success that other providers are having with the same programs, they may very well be motivated to become more open minded and engaged.”
4. Performing Closed-Loop Analysis
Once you’ve put all those components in place, the final piece to becoming a Coordinated network is to keep at it. Continual assessment and measurement of your progress will allow you to keep your organization aligned with your objectives. Once again, allowing those clinical quality improvement programs to be your anchor will help you stay on top of what needs to be addressed, and in what order, as you continue forward.
“It’s important to remember that this is an iterative and ongoing process,” said Taylor. “It’s not about reaching an endgoal; it’s about creating a progressive means of assessment, reassessment, and ongoing evolution. The quality programs will always be changing, so will your clinical quality improvement programs, and so will your focus. Once you recognize that, what it takes to become a high-performing network will also be well within sight.”
Wondering what’s next? Stay tuned for Taylor’s take on what it means to achieve and maintain a High-Performing network in our final edition of this three-article series on network maturity.
