Practicing healthcare is challenging, especially for those in patient-facing roles. Clinicians understandably prefer to focus more on delivering patient care and less on the administrative work that can come at the expense of face time with their patients. If you ask me, the root of the burnout in our healthcare system isn’t the large daily volume of patients—it’s the administrative tasks required for every patient. Even when organizations do a great job of streamlining internal workflows, each patient still has unique requirements: everything from prior authorizations and drug formulary considerations to home health certifications, identifying insurance-aligned specialists, navigating various portals, and much more. Expecting clinical teams to be the jack of all trades is unrealistic.
1. Leadership teams without front-line clinical staff
So how can we get our clinical teams off the relentless hamster wheel of administrative work? A critical first step is ensuring that practicing clinicians are part of leadership teams. Leadership who fully understands the front-line realities can make informed decisions that significantly impact what actually happens in the clinic. Some of the best-managed organizations have physician champions who split their time between clinical and managerial duties. Most provider leaders understand the pain points better than anyone sitting wholly on the managerial side of the fence.
These unicorn physician champion leaders are also best positioned to negotiate realistic contracts (especially for value-based care), design practical internal workflows, and secure buy-in from their peers for organizational changes. This is crucial for groups navigating both fee-for-service and value-based models.
Oftentimes I see new providers getting involved in VBC contracts without fully understanding the amount of resources that are needed to properly execute. By closely examining the goals and current resources of the organization, champion leaders can help define its North Star. For example, if you are focusing on a specific cohort of patients and trying to work towards a defined outcome, then you likely already have or plan on having those resources to support this initiative. If you can align already existing programs into your contracts, you will reduce the learning curve that is needed to ramp these initiatives up. It will also give your team small wins that encourage them to keep moving toward other goals.
2. Overlooking vital patient data
Another challenge facing clinical teams is the overwhelming amount of disorganized patient data which often remains underutilized. Patients show up to visits with extensive paper records, lab results, and external consult notes. Vital information can be found in electronic health record (EHR) data, health information exchange (HIE) feeds, claims data, payer reports, and population health system reports. The information overload is real.
For this scattered data to improve patient outcomes, it must be readily accessible to care teams. Without a clear view of patient data, it is very difficult to accurately assess patient complexity, track external care, and ensure the completion of preventative services–all crucial to delivering value-based care. It is exciting to see new innovative solutions emerge to solve these problems by automating administrative tasks and helping providers quickly find the clinical insights they need.
3. Staffing shortcomings
Of course, technology is not a replacement for real-life experts. Staffing remains a significant challenge for healthcare organizations nationwide. In value-based arrangements, the provider acts as the gatekeeper for all patient-related activities but is supported by a robust team that includes case managers, pharmacists, coding and quality staff, social workers, specialists, nutritionists, and community health workers, among others.
I recommend working with your local colleges and universities and see if there is a workforce development program that can be established for new grads. Some programs have started adopting value-based care education, making it a win-win for the organization, the students and the school.
Take a look at your community of healthcare professionals. You likely already know who those people are. You should be working with people who understand the goals of value-based care, and how everyone can work together to deliver more coordinated care with better outcomes. Organizations can also leverage claims data to help them identify which providers in the community patients are seeing, and deploy resources that support clinicians throughout service locations.
I cannot overstate the fact that value-based care is a team sport. Everyone—from the front office staff to the call center team—has an important role in the care team. Such teamwork leads to unparalleled care delivery, better care coordination, and improved patient outcomes—all key objectives for organizations committed to delivering value-based care.
About Dana McCalley
Dana McCalley is the VP of Value Based Care at Navina. She has 15+ years in healthcare with a focus on Quality Improvement and Risk Adjustment. She led one of the nation’s top performing ACOs for 9 years and was responsible for helping 700+ clinicians provide care to 230k value-based patients. Dana received her Bachelors of Psychology from the University of South Florida and her Masters of Business Administration from Liberty University.
