The empirical question about Value Based Care (VBC) models and pay-for-performance programs in the healthcare space is, “does any of it actually improve outcomes and effect real change to care quality for all patients”? The optimist on my shoulder considers where we came from when volume superseded value on almost every measure. Thus, my optimistic self subscribes to the perception that the various models/programs that drive providers and organizations to focus on closing care gaps have greatly improved care quality. My pessimistic shoulder, however, considers how far behind we were when we were enlightened with the concept of value over volume. This reflection reverberates when triggered by thoughts of quality managers delivering lists of open care gaps to their providers at the end of a healthcare performance year. What could possibly be done in those last few days to reduce that list and improve care? No wonder our healthcare system seems to be permanently relegated to a status of “work in progress”.
Even the best soccer teams can’t maintain a premier status by playing a single style or formation, even when played to perfection. The same is true for the pursuit to improve the quality of healthcare in this country. The plethora of government and/or private payer VBC programs have set up a few structured tactics with various requirements, which when followed can result in significant financial incentives. Those organizations not playing their part in meeting the program requirements will pay for the incentives of those that do. While these programs have established a set of foundational pathways for closing care gaps, it’s now up to the players to move the ball down the field.
Much of healthcare operates in a way that focuses on a performance year from January 1st to December 31st or a fiscal year from October 1st to September 30th. When we talk about managing quality outcomes, we are referring to the former, the performance year. There are several reasons why measuring the quality of care should be done within each performance year. One example is in understanding the true complexity of a patient population. Each year, a patient’s healthcare needs (or complexity) starts over as a blank slate. At a patient’s annual physical or annual wellness visit, the provider may go over family health histories or the patient’s historically documented chronic diseases. Each of these discussions contributes to creating that patient’s complexity story. This data is then used in various ways by various players involved with that patient’s care. Payers are more accurate in designating payments for the patient based on their complexity. The organization has a better read of each provider’s patient population make-up. Finally, the patient has a more thorough, consistent, and documented healthcare maintenance history, which no doubt means fewer traumatic, life-changing, and costly health events.
Managing outcomes consistently for each patient by closing care gaps throughout the performance year is critical if we want to move the ball further down the field. We know that managing outcomes, whether for just preventive care like BMI screening or more disease-specific action items like Diabetes management has helped. We also know that it will take more than a provider seeing their care measurement performance scores monthly to make more significant improvements in care delivery. Most providers will tell you they didn’t get into medicine to stare at a screen and have a computer specify each step of care delivery for the patient sitting next to them. Real-time data can be the happy medium between a computer practicing medicine and a patient leaving a visit without their care needs being met. Real-time data offers organizations options on how they want to use the data for more efficient communication of open care gaps in a way that works for their physicians and care givers. For example, a daily huddle report that lists only open care gaps for just the visits for that day can be viewed on a computer, emailed to the provider for viewing on their mobile device, or printed out and handed to providers by their administrative staff. The provider can avoid spending several minutes staring at multiple screens and multiple data fields to figure out what open care gaps need to be managed at the time of the visit. That is the time to be listing and delivering care to the patient. A daily huddle report for each patient provides a short list of directives that allows for more efficient use of time with the patient. The open care gaps are expressed and can be closed in the first few minutes of the visit and the rest of the time can be used by the provider to deliver care as needed for the specific patient for the specific visit.
The space between where a list of care gaps being delivered to a provider with a week left in the performance year versus a provider operating off a real-time huddle list of open care gaps at the time of a visit, is significant. Access to real-time open care gaps whether on a screen or in a provider’s hand is the “Messi-like” foot work tactics our healthcare providers need to gain more ground on providing quality care the way they should be. Real-time data is the tiki-taka method of stimulating effective change through whatever channels or styles of care delivery, that we can use to move healthcare forward.