As the U.S. healthcare system shifts emphasis away from volume-driven to value-centered care, the way that quality is defined, delivered and measured will characterize the essential elements powering the collective performance of every stakeholder.
In this new paradigm, providers that demonstrate positive clinical outcomes across episodes of care—while simultaneously lowering expenditures—will survive and thrive. Similarly, data analytics that help organizations to monitor, manage and report errors and adverse events will play a central role in realizing the delivery of safer, higher quality care.
Those who develop useful and usable solutions for this purpose will best position themselves to effectively meet the expectations of both providers and payers if they can provide a unique blend of functionality that centers on three fundamental areas—safety risk management and surveillance; pay-for-value reporting; and performance analytics.
As part of this offering, the combination of SaaS-based solutions and information services should be made available, either on a standalone or fully integrated basis, to more effectively monitor and measure clinical and financial performance with precision and conviction. The combination of all of these elements will likely prove formulaic in helping our healthcare system to deliver value-driven care and to be compensated for it, while paving the way for true improvements in patient safety and clinical quality.
The new healthcare reform environment places emphasis on outcomes achieved relative to costs. As payments become increasingly and explicitly linked to a complex myriad of performance measurements, non-performing providers will face greater financial risk.
Accountable Care Organizations (ACOs) and other alternative payment models that aim to deliver better care at lower cost must pay substantial attention to and optimize, their day-to-day operations. To unlock value in healthcare and see improvements in quality and safety, there must also be a commitment to standardizing their approach to the treatment of major medical conditions and measuring their outcomes.
Information technology vendors must take the lead in embedding standardized order sets and clinical processes into electronic medical records and in creating software solutions that automate and aggregate outcomes data collection. A data platform that enables provider benchmarking based on resource utilization and condition-by-condition clinical outcomes should be included as a critical component.
In the absence of a consensus on measurement—yet with finances truly at stake—the adoption of a continuous quality improvement process that measures what matters and holds providers accountable is also more critical than ever.
Toward that end, as more employers, health plans and government purchasers implement value-based payment models, quality and safety risk management solutions will play an integral role in helping to align physician and hospital incentives for measured outcomes. Healthcare organizations that spend the time to develop their capabilities and adopt robust processes that support and continually improve them will gain early-adopter advantages as they strive for higher quality care and increased market share.
With the widespread use of healthcare information technology (HIT), data that providers need to track patient care is now readily available. This is notable, considering that episode of care analysis, where the complexity of measurement is most evident, requires a sophisticated system for tracking and measuring data.
Fortunately, episode evaluation systems exist that can span the entire continuum of patient care. Unlike traditional encounter-based systems, these have the capacity to capture all clinically related encounters and assign them to a single episode of illness regardless of care setting, enabling providers and purchasers to accurately compare the total cost and utilization of medical services against local peer groups, national norms and generally accepted best practices. This gives providers the power to measure what matters using meaningful and reliable information for assessing the integrated delivery of cost-effective care.
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