This report is based on a 2019 Healthcare Analytics Summit presentation given by Holly Burke, Executive Director, at Clinical Innovation and Quality, Pulse Heart Institute, MultiCare Health System, and Needham Ward, MD, Chief Medical Officer, at Pulse Heart Institute, MultiCare Health System, titled, “Physician Alignment and Data-Informed Decisions Increase Contribution Margins and Market Share.”
Finding reliable data and analytics to improve market share remains a challenge for healthcare organizations. While health systems have to balance myriad priorities at the same time—such as patient access, provider recruitment and productivity, and quality outcomes—they cannot forget to prioritize building a cohesive network of services to win the market share battle.
Organizations can increase market share by more closely aligning providers, administrators, and the data they rely on to make decisions. A health system’s leadership team must be committed to improving the quality of healthcare delivery, employee engagement, provider recruiting, and financial gains while also finding a way to scale the process, apply it to other clinical domains, remonetize the platform, and ensure sustainability.
In order to balance all the moving parts, it is critical that health systems have a clear objective, strong leadership dyads (composed of one administrator and one clinician) supporting the objectives, and easy access to keep team members on track.
Health systems—large or small—often find team members pursuing different goals, proving that alignment at every level is crucial. Realistic, long-lasting changes start with practicing providers who still care for patients and work with front-line staff. With providers at the helm of new alignment changes, other providers and clinicians are more likely to support the changes and ensure that they are realistic and sustainable.
Another piece of the alignment strategy is to create some type of provider contract, a simple, yet clear, document that defines the mission, vision, and guiding principles that will drive the provider-led, patient-centric culture. It is crucial that both providers and administrators commit to live the principles and to be champions of the mission and vision. After the provider contract is created and agreed upon by leadership, team members should review the document regularly to promote its value and reiterate the health system’s goals.
After the foundation for alignment is laid, it is time to clarify expectations and responsibilities. The first step is to create and then define centers of excellence (COE). Leadership teams can define a COE (like a heart or vascular institute) as a patient-centric program focusing on financial and clinical outcomes and the role of process improvement and care coordination within care settings and across teams/organizations. The COE is also responsible for surrounding the patient with resources that lead to the best clinical outcomes for the patient and financial outcomes for the institution.
As improvement teams consider different leadership strategies, they discover that leadership dyads composed of both a clinical and operational team member drive better results, making it easier for the COE to improve operational, financial, and clinical performance.
With patient-centric processes in place and input from administrators and providers, a COE is better equipped to provide a patient with the right resources he/she needs along the continuum of care throughout his/her life, instead of providing a singular episode of care.
In order to make improvements, the COE needs a baseline to help the leadership team identify improvement opportunities and then prioritize which areas to focus on first. The best place to start is to perform a readiness assessment to gauge the organization’s current standing in regard to data access and utilization. The readiness assessment is an essential tool in order for an organization to build an outcomes improvement-focused culture. After completion, the readiness assessment can reveal opportunities for improvement:
Tool 1: Access to data. With overwhelming amounts of data, healthcare leaders often feel unsure where to start. With the help of data analysts and research about what data strategies other health systems use, leaders need to understand that giving providers access to consumable, specific data about each provider’s performance is a must-do. It can be time-consuming for the data analysts to manually build the application, but one of the most effective ways for providers to improve performance is to see their individualized numbers benchmarked against their peers.
Tool 2: Data acumen. Because providers play a crucial role in adopting new processes, it is just as crucial to get providers more involved/familiar with data on a regular basis. Health systems should provide data to its leadership dyads on a regular basis, in an easy-to-understand interface. When providers and administrators have quick, easy access to consumable data through simple applications, data transparency increases throughout the health system. Through increasing data transparency, all team members understand that data matters and plays an important role in measuring progress.
For example, a health system could post each provider’s monthly performance time for something like door-to-balloon time—a publicly reported metric that measures the time it takes a patient suffering from a heart attack to get from the emergency department to the cardiac catheter lab—on the walls of the catheter lab so all team members can see providers’ door-to-balloon times compared to their peers. Increased transparency results in increased engagement and reinstates the important role that data plays in measuring performance.
Tool 3: Finance. Accurate data improves a health system’s ability to survive on narrow CMS margins. Data reveals which procedures have the greatest per case margin change, an example of one way to increase revenue. So, it is valuable for health systems to review data variation by provider. For example, Dr. Smith is performing at X dollar amount more than Dr. Jones for the same procedure. When the doctors performing at higher costs ask the improvement team why, they can explain—with data—specific actions the doctors are doing that is causing increased cost e.g., ordering more CT scans or labs or keeping patients in the hospital longer than other doctors.
The reasons behind the cost variation are an opportunity to prompt thoughtful discussion between the providers and administrators that can lead to increased awareness about the cost of ordering unnecessary labs/tests, keeping patients too long, etc.
Tool 4: Vision to Execution. Data helps leaders understand how to operationalize the vision into measurable, specific steps. On the road to execution, it is vital for leaders to ensure that each patient is on the right pathway to recovery. In order to move forward without feeling overwhelmed, improvement teams should advise COEs to choose one procedure they want to improve, e.g., LVAD, CRTs, etc., and then define clinical indicators for the procedure they selected. After defining clinical indicators, the team can run the numbers against the system’s enterprise data warehouse to see how many patients are clinically indicated for a certain care pathway, compared to how many patients were actually on that care pathway. This will reveal if the patients who meet the criteria for certain care processes are actually receiving that care. If not, it presents many opportunities for improvement, such as increasing referrals.
Tool 5: Prioritizing outcomes. With so many opportunities for improvement, health systems must rely on data to prioritize what to execute first. Health systems should measure progress with any preferred tool (like scorecards or run charts). One opportunity to improve alignment is to use the same scorecard for administrators and providers, to ensure they are working toward the same goal. Even though the scorecard measures are the same, leaders can still tailor goals within the scorecard based on subspecialty, e.g., a CT surgeon’s goals are different than an administrator’s goals.
The customization piece cannot be overlooked because it sets performance expectations, instills a sense of accountability within each individual team member, and allows each team member to see how they play a role in the bigger picture.
The five improvement opportunities can only be successful if a health organization’s team members have the appropriate analytics support. With a strong data analyst team in place providing proper support to team members, providers and administrators feel more comfortable referencing data before making decisions and more confident in their ability to make decisions and then accurately measure progress.
To effect long-lasting change, healthcare leaders can’t rely solely on either administrators or providers.. Rather, improvement teams achieve the highest value when they involve both providers and administrators in the decision-making processes that affect all team members in the health system.
To keep the leadership dyads on track, leadership teams should implement regular trainings, with information specific to the administrators and providers in leadership positions. Improvement leaders will see better outcomes if they implement trainings on a regular basis because it is an opportunity to continuously remind leaders of the objective—quality improvement, leadership, and finance. It is also an opportunity to garner clinical support by having providers present trainings.
With committed leadership dyads and consistent training in place, the providers and the administrators have an opportunity to learn more about the value the other brings to the health system. This increase in understanding can improve relationships and increase trust between groups, fostering an environment that values the diversity of thinking that results from combining clinical and operational viewpoints.
For example, Pulse Heart Institute (PHI) realized it could increase healthcare market share by more closely aligning providers, administrators, and the data they used to make decisions. With a clear objective to become a destination center for heart and vascular health in the northwest, new leadership dyads combined with easy access to data empowered PHI to increase its revenue by more than $48M, surpassing the year-three market share goals in year two.
As health systems continue their journey to become data driven, leadership teams must realize that perfect data doesn’t exist. Leadership teams should identify an accuracy threshold e.g., 80 percent accuracy, at which the data can be used to drive decision making and will effect positive change. Defining the data accuracy threshold will allow team members to move forward instead of delaying action based on the elusive idea of perfect data.
Providers and administrators are key players in leading change, but easy, constant access to data is equally important in order to target the right changes. Clinical and operational dyads drive more comprehensive results than a provider or administrator working alone and emphasize the importance of teamwork. The combination of leadership, data, and a team mindset are a triple threat to cut costs, align leadership/team members, and increase healthcare market share without compromising quality care.
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