Increasing value in health care is a top priority for health systems, payers, and policy makers across the globe, as health care costs continue to escalate and consume an ever-greater proportion of national expenditures. Toward that end, policymakers have introduced value-based payment models that reward quality and efficiency, in contrast with the traditional fee-for-service model, which incentivizes volume. The U.S. Centers for Medicare and Medicaid Services (CMS) has said that by 2018 it wants 90 percent of its payments tied to value. From bundled payments to accountable care organizations, value-based payment models incentivize providers to deliver high-quality care—efficiently.
To reorient themselves around value, health systems must rethink how they deliver care. Creating greater value requires a multi-pronged approach. Improving access to care, increasing workforce productivity, optimizing clinical operations, and managing population health are important—and interrelated steps. Four key outcomes to transforming healthcare:
- Lower entry barriers and increase geographic reach to improve access to care
- Increase workforce productivity by optimizing the skill set of your workforce while shifting routine work away
- Reduce waste and unwarranted variations with automated and standardized workflows to optimize clinical pathways
- Identify and stratify patients by disease severity to manage population health
New research conducted by Harvard Business Review Analytic Services and sponsored by Siemens Healthineers examined the methods used by various health care providers such as Cleveland Clinic, Geisinger Health System, the Martini Klinik, Mercy Virtual, and Johns Hopkins Medicine.
Many of the organizations that were included in the study employ three distinct methods: 1) The Lean methodology— a set of operating philosophies that help create maximum value for patients by reducing waste and wait times 2) High-reliability organization (HRO) principles and 3) Systems engineering, aided by technology and data analytics to improve outcomes and efficiency. Whatever their approach, the providers shared a common goal of excellence and efficiency in patient care—and a willingness to innovate to get there.
Sustaining Results Achieved Through the Lean Methodology
Brandon Carrus, a senior partner at McKinsey & Co. who specializes in Lean, notes that only about 30% of Lean quality-improvement projects see results sustained beyond three years. What distinguishes the percentage that succeed, he says, is that they focus on enterprise-wide transformation, take account of interdependencies, and strive to improve the entire continuum of care from the patient’s perspective. He points to the approach taken by a large, not-for-profit, integrated health care delivery system in the U.S. that manages a population of over 1 million unique patients including several hundred thousand members in their health plan.
Under a renewed mandate from its CEO, the organization implemented a Lean transformation across the enterprise, with the goal of improving care outcomes, the patient experience, and access. There was a heavy focus on cross-functional collaboration in engineering solutions focused on delivering value to the patient, which ran counter to the traditional management approach organized around functional units and clinical departments. Access increased on the level of 10,000 specialty visits per year, wait times dropped 20-40%, quality outcomes increased across most clinical categories, and total economic value created totaled over $60 million per year.
HRO Principles and Patient Safety
Several healthcare organizations interviewed emphasized their reliance on practices that define high-reliability organizations (HROs), especially as related to patient safety. HROs are high-risk organizations that manage to be safe and reliable, such as nuclear power plants and naval aircraft carriers. With medical error accounting for as many as 250,000 deaths yearly in the U.S. alone, improving the safety and reliability of health care delivery is critical. “HROs are agile, adaptable learning systems that respond well to the unexpected,” says Kathleen Sutcliffe, Bloomberg Distinguished Professor at Johns Hopkins University, whose work studying wildland fire fighting is foundational to the field. Their high levels of safety and reliability are based on five practices:
A preoccupation with failure. HROs are alert to any failure, however small, because deviations can result in tragedy—and always aware of what could go wrong.
A reluctance to simplify. Complexity is a given in HROs, and they do not go for easy answers when a problem arises.
Sensitivity to operations. Front-line workers are in a better position to recognize problems than executive leadership, and HROs welcome their input on how to improve.
Commitment to resilience. In an ever-changing environment, HROs continually look for potential problems and innovative solutions.
Deference to expertise. Expertise matters more than authority for HROs, which recognize that on-the-ground workers may well know more than their leaders.
Managing Population Health for Value With Technology and Data
Managing population health relies on data and analytics to identify patients in need of care and predict disease progression, prognosis, the likelihood of hospital admission or an emergency department visit, and more, allowing earlier intervention.
Geisinger Health System, a large integrated health system with 500,000 subscribers to its health plan, is applying robust analytics to its patient data. “We look at care protocols for a certain disease, say coronary artery disease, then identify care gaps. Same with diabetes. Close those gaps, keep them as healthy as possible,” says John Kravitz, its chief information officer. More and more, predictive analytics are used to identify patients likely to visit an emergency department or have a hospital admission, so that health care providers can take steps to deliver appropriate care and prevent escalation or inappropriate utilization. “We have more data than at any other time, and data is the means to improving the health and well-being of populations,” says Jonathan Weiner, professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.
Predictive tools model and forecast individuals’ health over time using data from medical claims, electronic medical records, and demographics like age and gender, stratifying by risk— for instance, likelihood of a hospital admission in the next six months—and identifying patients who would benefit from focused care management.
“Like a lot of health systems, we were taking a largely reactive approach to health care. By focusing on population management, we are proactively identifying patients who need services and reaching out to them,” says Dr. Nirav Vakharia, associate chief quality officer for population management at Cleveland Clinic. Predictive analytics allows Cleveland Clinic to match resources to need and has produced overall improvements in outcomes, including a reduced number of emergency department visits and hospital admissions.
Without a doubt, health care is getting more complex—and expensive—and those trends won’t end. An increasing disease burden among the population, a predicted shortfall of physicians, and ever-growing costs invite forward thinking health care organizations to look for ways to deliver greater value as they deliver care. And that requires optimizing for quality and efficiency both at every step of the way, for value is a function of both.
Lean process improvement, predictive analysis and HRO principles have guided many of the efforts described here, allowing healthcare providers of all ranks to fully contribute to and deliver safe, reliable health care. But the real game-changers are technology and a treasure trove of data to drive continuous improvement, with the patient as the ultimate beneficiary.
Healthcare transformation calls for less expensive and excellent care. That is why it is our mission at Siemens Healthineers to enable healthcare providers to achieve better outcomes at lower cost by expanding precision medicine, transforming care delivery, improving patient experience, and digitalizing healthcare.
To learn more about what organizations are doing to transform the healthcare process read the full report by clicking here.