The trend toward value based healthcare delivery is clear. The re-election of Barack Obama as President of the United States and the continued implementation of the Affordable Care Act all but ensure that scores of new performance metrics will be established beyond those associated with the HITECH program that provides incentive payments for the demonstrated proficiency in using electronic health records and related technologies to improve patient care. Initiatives including NCQA patient centered medical home (PCMH) and the Bridges to Excellence diabetes recognition (BTE DRP) program focus one level deeper, and arguably, more pointed toward realizing the potential of the triple aim goals of better care for individuals, better health for populations, and lower per capital costs.
Beyond these broadly known and recognized programs though, lies a bevy of opportunity in the space of healthcare intelligence including (but not limited to) patient risk profiling and segmentation, population health management and provider benchmarking. In a grossly simplified model, the idea is to:
1) Identify those patients with greatest need for clinical intervention
2) Engage them in an effective and efficient population-targeted program specifically designed to improve their condition
3) Measure how effective the program and individual providers’ care has contributed to success. In addition to measuring clinical outcomes, data capable organizations will measure financial outcomes as well. After all, the ultimate scenario of value-based healthcare lies in the ability to measure the intersection of financial and clinical outcomes.
A learning loop or process where organizations follow evidence-based care as a means to achieve triple aim goals under this simple, straight forward model will help to optimize the process whereby continued improvements can be achieved.
So the next time anyone tries to paint a picture that our healthcare system is either too complex or complicated to make real gains, challenge them to this practical, lean approach to improving healthcare for our most needy, and costly patients.
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