Succeeding in the world of ambulatory quality is challenging. Organizations are awash in a sea of quality measures to track and report. They have multiple incentive-laden payor contracts, often with different quality-based incentives, and limited resources devoted to improving performance.
Prioritization is the key. We all know that not all quality measures are created equal. Some measures are more clinically relevant, certain metrics may be associated with large payor incentives, and other measures may drive revenue into the system.
At Upfront, we’re focused on making every visit valuable for patients and providers. This means achieving clinical, operational, and financial success while improving (not alienating) both patient and provider satisfaction.
Achieving our goal requires us to help our clients define their ambulatory quality success in the context of each patient visit. We’re aware of challenges to improve clinical quality and achieve operational excellence. Our solutions help you benchmark, prioritize, optimize, and engage patients and providers, but we also know it has to be part of a larger organizational strategy.
Here are 5 key strategies for realizing ambulatory quality in 2018:
1. Embrace the challenge
Ambulatory quality measurement is hard. It’s often difficult to retrieve accurate, actionable data. Clinicians are reluctant to accept measurement. Federal and regional regulations are confusing and ever changing since every payor has a different spin on value based payment. EMR (or CHR!) vendors struggle to keep pace with changes.
Challenges or not, quality measurement is here to stay since quality is a big part of value-based care models. Quality programs seem to be immune to politics, and it’s best to assume they will be around for foreseeable future.
However, we think ambulatory quality represents a tremendous opportunity. A thoughtful, fast-moving organization can use quality measures as a lever to provide better care, improve the bottom line, and drive growth by marketing itself as a quality leader. It’s not easy, but there are substantial rewards for being a leader in quality.
2. Don’t forget reputation
With public reporting of quality measures, it’s important to remember that quality performance is not just about assessing clinical performance and incentives. It’s now common for provider performance rates to be published by the federal government, commercial insurers, and 3rd party data products like HealthGrades or Angie’s List.
A huge percentage of patients start their search for a provider on the internet. Those quality rankings can make or break a new patient coming to your health system. It’s easy to lose sight of reputational impact among the other challenges of quality measures.
3. Make it about the patient
We’ve all heard the litany of concerns about quality measures: these metrics are not relevant to me, the data is bad, my patients are different, or “we’re only doing this for the money.” The reality is, improving quality measure performance can be very difficult and always requires special effort. Extra documentation, precious staff time, extra tasks during appointments, and adding computerized decision support are frequent necessities.
Despite objections to quality measures, nearly every clinician agrees we can do better with patient care. And we do know that improved quality measure performance = improved, safer care for patients. It’s often useful to recall that in dark moments! We have to remember that closing care gaps is helping improve someone’s health.
That said, we recognize the ideals of helping patients must balance with pragmatism. You must prioritize and target resources where you’ll get the most return, both clinical and operational.
4. Pick Your Battles
Healthcare organizations are juggling dozens of ambulatory quality measures across the enterprise. It’s common to see measures tracked for ACO programs, federal programs like MIPS, private payers, and internal strategic goals. These metrics and goal performance rates may be aligned or may be completely siloed across those programs. For example, an employed practice group may set quality priorities that barely overlap with the organization’s Clinically Integrated Network.
A key challenge is strategic alignment on metrics that matter. Organizations must use leadership and governance to manage the metrics, which must carefully manage reputation, financial risk, and clinical value. However, even with the best organizational alignment, you’re going to face more measures than you can realistically improve in a short amount of time.
So, the next challenge is to prioritize measures for intervention efforts. Metrics that matter bring the most value to patient care, reputation, and financial incentives.
5. Prioritize, Prioritize, Prioritize.
In the face of dozens of important metrics, where do you start? Do you chase dollars in certain incentive-laden contracts? Do you take a mission driven approach, with a clinical focus on certain populations? Do we care more about reputation and want to be viewed as best quality care? Do we worry about operational issues like leakage?
This “quality calculus” is complicated, but vital to achieve so you know where to best allocate resources.
We’ve found that many organizations lack a data-driven way to handle the quality calculus. It’s common for internal politics or intuition to drive decision making on improvement efforts. It’s understandable why this happens at large healthcare organizations, but not ideal. The most successful organizations will use focused, analytical approaches to develop priorities for an ambulatory quality strategy.
Upfront’s Unique Quality Measure Approach
In the context of our comprehensive benchmarking and optimization services, Upfront offers a data-driven solution to navigate this complex quality calculus. Our Visit Value Technology uses a novel analytics approach to assess each quality measure across several dimensions including clinical impact, national benchmarks, and incentive value. We estimate financial and reputational impact of improvement. This allows you to deploy improvement resources to most efficiently earn more incentives, improve public reputation, and improve quality of care.
How do we do this? We work with you to establish priorities by collecting the following information:
• Quality performance data from prior 2 years
• Contractual incentives for value based arrangements, private or public
• Strategic quality priorities, both clinical and operational
• Comparing your data to national quality benchmarks
• Assessing leakage for high value quality metrics like colonoscopy and mammography
We assemble this information and run it through our analytics. We rank potential rate of return across your portfolio of metrics. This information is used to guide how and where to deploy your or our resources to intelligently guide, prepare, recall, and schedule new and existing patients.
The results are a 4:1 ROI based on efficiency, incentives, and market share improvements.
To learn more about Upfront’s Visit Value services or our approach to quality calculus, reach out to schedule a call here.
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