Changing Behaviors to Adapt to Collapsing Reimbursements

Updated on January 16, 2022
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By Bob Lokken

The impending transition to value-based care presents many challenges to healthcare providers. The zero-sum nature of payment models (similar to The Hunger Games) being enforced by the Centers for Medicaid and Medicare Services (CMS) means high-performing health systems will be rewarded for quality and cost savings to the detriment of sub-par performers. The scale and scope of each health system will dictate strategic plans to mitigate risk and those that survive and thrive will be the ones that can adapt more rapidly than peers.

The execution of value-based care strategies is largely dependent on highly autonomous and distributed care providers – the true change agents of healthcare reform. They must fundamentally change behaviors and processes to ensure that the highest quality care is delivered at the lowest cost. Doing this successfully requires comprehensive physician engagement and effective change management, two significant barriers in healthcare.

Comprehensive Physician Engagement

To get physicians engaged in value-based care transformation, they must be aligned to overall health system goals and personally motivated to drive improvement. In value-based care, clinical procedures must not only be re-engineered, but they also are now deeply intertwined with the financial models. Thus, physician engagement – especially to the performance standards demanded by the value-based payment system – is absolutely critical. However, most health systems have struggled with physician engagement largely due to the way we traditionally organized, regulated and paid for healthcare in the United States. The transition to value-based care flips this paradigm with mandates that are simply unattainable without wholesale physician engagement, alignment and clinician-led change.

Change Management

An efficient and effective change management process is difficult given the siloed nature of healthcare. Performance improvement initiatives are predominantly departmental or service-line oriented, with best practices and evidence-based medicine being distributed in literature and conferences on an ad hoc or annual basis. Contrast this reality with the performance mandate of value-based care delivery in which “value” is a dynamic yardstick – it is not just improvement, but the rate of improvement that matters. This means performance transparency and physician collaboration must rapidly increase to accelerate effective change within the health system.

The demands of value-based care require new technologies that address these challenges. Data warehouses, EMRs and business analytics are adequate at collecting data and reporting information, but ineffective at driving system-wide change. Simply “knowing” information does not equate to “doing” things differently to drive improvement. 

WhiteCloud Analytics has identified several ‘performance management’ capabilities that address this “knowing-doing gap” to engage physicians in transformative change. The purpose of this new generation of software is to move beyond reporting the numbers, into the realm of improving performance.

Historically, people have assumed that technology’s job was to simply report on performance via scorecards and dashboards. While this is certainly valuable, the issues of physician engagement and change management require much more to motivate action. Historically, this next step of “what to do with the data” has been a manual matter, typically staffed with analysts, consultants and teams of people. The new value-based performance management technologies breaks new ground, bringing advances in technology to facilitate, accelerate and scale the engagement and change processes. 

Effective value-based performance management solutions provide technology capabilities to help shift behaviors and influence results that improve organizational performance. With physicians engaged in value-based care strategies and change management processes accelerated across the continuum of care, health systems are able to improve outcomes and adapt to collapsing reimbursements. Value-based performance analytics offers a new light for health systems mired in ineffective improvement processes driven by individual meetings, interventions and reports.

Bob Lokken is the CEO for WhiteCloud Analytics, an innovator in the Value-Based Performance Management Analytics industry.

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The Editorial Team at Healthcare Business Today is made up of skilled healthcare writers and experts, led by our managing editor, Daniel Casciato, who has over 25 years of experience in healthcare writing. Since 1998, we have produced compelling and informative content for numerous publications, establishing ourselves as a trusted resource for health and wellness information. We offer readers access to fresh health, medicine, science, and technology developments and the latest in patient news, emphasizing how these developments affect our lives.