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The Three Best Drivers for Supporting Quality Mandates

A recent study in Health Affairs suggested that physician performance is impacted by publicly reported quality measurements. In a five-year study in Wisconsin, most quality measurements improved after they were publicly reported. Additionally, the quality measures performance exceeded results for surrounding communities, regional areas and even national comparisons. But is public reporting the only way to realize improvements? And do those improvements indicate better communication among the clinical team, resulting in improved provider and patient satisfaction?

Health Insurance Exchanges: Role of Qualified Analytics in Qualified Health Plans webinar slides

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New Predictive Analytics Solutions that Speak the Providers’ Language

Perhaps it is my arrogance as a surgeon, but when “healthcare reform” and “clinical integration” began to dominate the political lexicon, I remained skeptical.  In the bureaucrats’ messaging, one very critical factor was missing.  Truly successful reform requires significant change at the patient bedside.  That is, to realize meaningful quality improvement and cost savings on a national scale, the “providers” actually driving care management decisions and personally engaging with patients and their families, must buy into the reform concept, goals, and processes.  True success in reform, clinical integration, shared savings, P4P, bundling requires ownership and active participation by providers in both the ambulatory and inpatient settings.  My skepticism was only furthered when I served as a physician executive in a large, multi-state hospital system.  Panic permeated the C-suite as the executives began to appreciate that without true provider buy in and participation; there would be no way to avoid the draconian reimbursement penalties meted out by CMS for suboptimal quality care delivery.

It’s not that physicians don’t want to improve quality and reduce costs of care.  In fact, physicians believe that we have been and remain the true champions of quality improvement, that we are the truest patient advocates.  This belief is at the core of the physician culture.  However, the yang to this yin is our belief that non-physician stakeholders (payers, including at the federal level) and non-clinical data (such as claims data) is solely targeting cost reduction and to the exclusion (and even detriment) of quality.

Thus, the major challenge to engaging providers in true clinical integration and healthcare reform is not technological, as predictive analytics solutions have guided payers in identifying cost efficiency opportunities for decades.  Rather, the greatest obstacle to realizing successful reform is cultural.  Predictive analytics solutions and other historically payer-utilized reform tools must be modified to “speak to” providers and provide clear clinical value.  In addition, providers must be educated to appreciate that cost efficiency goals are not inherently anti-patient, and, in fact, that higher quality care delivery should cost less (that is, that cost efficiency and quality improvement are two sides of the same coin).

Today, predictive analytics are beginning to bridge this cultural gap.  New predictive analytics solutions that speak the providers’ language are offering opportunities to both improve quality and reduce cost at the bedside in real or near-real time.  Such solutions offer a “win” for payers, providers, and patients.  This is only the beginning of the provider empowerment revolution.  Today’s tools will evolve rapidly, allowing real time intervention, education, and communication with patients to drive health care towards higher value, preventative, ambulatory care.

Learn how the use of common language that is meaningful to both payers and providers allows users to perceive the same information as relevant, understandable and impactful.   If you are attending HIMSS, I invite you to see a demonstration of the new MEDai Navigator Physician Portal, visit Booth #6129 during exhibit hours or click here to schedule a meeting and product demonstration. Each participant who schedules and attends a product demonstration meeting will be entered to win a new iPad mini.

You can also find me at the Clinical & Business Knowledge Center at 2:00 PM on March 4, 2013.  I will be speaking on “Predictive Analytics for the Bedside Provider” – Booth 869 Kiosk #4.  See more

I look forward to meeting you.

Dr. Peter Edelstein