Value-based care as a way of holding down costs while enhancing overall health outcomes is continuing to gain momentum.
New reimbursement models—The Bundled Payments for Care Improvement (BPCI) initiatives and the mandatory oncology care model—and increasing MIPS rewards and penalties are gaining traction in the market.
But, according to the report Engaged Physicians: How to Align Performance Management for High-value Healthcare, provider groups and health systems are underprepared to excel under the latest models. The report compiles and analyzes research from Sage Growth Partners, MGMA and AMGA, and ArborMetrix case studies.
“These organizations need to develop performance management strategies that impact all these initiatives across the board,” says Kurt Skifstad, PhD, CEO of ArborMetrix. “Providing high-value care is the ultimate key to success under any reimbursement model.”
“By putting performance management practices in place and elevating clinical and financial performance to deliver high-value care, managed care executives can equip their organizations to make informed decisions about what type of reimbursement risk to take on and how to manage it successfully,” Skifstad says.
The significant planned increase in participation in true risk-based payment models calls for greater transparency and greater focus on physician performance management, according to Skifstad.
“Healthcare executives must first define what changes need to be made at an organizational and at a network level, then ensure the data sources, data, reports, and insights that are needed to enable those changes are all in alignment,” he says. “The fidelity of this performance management information flow and how it’s managed lays the foundation for organizations to drive higher margins, optimize patient outcomes, enhance patient and provider satisfaction and strengthen negotiating positions with payers.”
Three ways to improve health outcomes
According to Skifstad, improving health outcomes “calls for a performance management approach rooted in transparency and data science so that physicians trust the reports and engages in the improvement process.” He says there are three ways healthcare execs can work with their network on improving health outcomes:
- To build trust, ensure that data is clinically meaningful and timely. “Organizations can make the mistake of starting with whatever data is available and building reports based on that,” Skifstad says. “Instead, organizations should ask themselves what their objectives are, what insights will enable those objectives, what reports will inform those insights, what data is needed to create those reports, and what are the sources of that data.”
- Ensure their reports are transparent, timely, and clinically meaningful. “Physicians won’t trust reports if they don’t have visibility into how metrics were developed, or if they don’t align with the clinical workflow,” Skifstad says. “Leaders should also ensure open communication with physicians about what defines quality.”
- Align physicians’ performance with financial incentives and peer comparison. “This is the best approach to ensure physicians are motivated and drive each other to be agents of change,” Skifstad says.