How can outcome data help you collaborate with other healthcare providers?

It has taken decades to understand that the drivers of outcomes are predominantly not clinical interventions. It is hard to understand how misguided our designers have been for 40 years of cost cutting while avoiding the big health entities draining the treasury or the 30 years of quality improvement that cannot touch the disparities increasingly dividing our nation. In addition, the combined cost cutting and micromanagement has MELTED basic health access across primary care, mental health, and women's health/ MELTED is my term for more to do of higher complexity in less time with fewer and lesser delivery team members. How can anyone reverse decades of previous life shaping experiences in the few minutes remaining for them to interact?

#1 should be “help you avoid establishing relationships with those who have bad outcomes”. The most important thing is to ONLY refer your patients (family and friends) to practitioners who have good outcomes. YOU THINK YOU KNOW, BUT YOU DO NOT KNOT KNOW. That “nice guy (or gal)” you have beers with, or met in the gym locker room, or golf with - might be a nice buddy to have but doesn’t mean he’s/she’s not a Dr Death when it comes to outcomes.

Value is the measure of outcomes per unit cost. Right now most academics and policy wonks are using those Garbage-CMS measures of quality vs real life outcomes. Those that measure value using CMS metrics are misleading the public by cherry picking those garbage CMS metrics and claiming valid conclusions -nonsense. Use of real life outcome metrics is the only way to measure real life value.

The gaps are huge for 40% of the US with 45% of complexity and just 25% of the primary care, womens, and mental health workforces. This comes with < 20% of spending for specialty shaping deficits in team members. How do you integrate, coordinate, or outreach where workforce, social supports, and team members are half enough and overwhelmed? Did anyone consider that 3% taken from Medicaid for waivers will translate through practice budgets to shrink delivery team members more. Why ignore the insider perspective when toxic practice environments are rampant? Why does Medicare 2011 data reveal payments less as levels of workforce decline, 15% less for office services in the 2621 counties most behind? Is CMS accountable? What about do no harm?

Progress is considered to involve performance based designs. But what does micromanagement do to our nurses caught between DRG, profit focus, short staffing, and forced multitasking. Is it progress to focus on overutilization where most Americans suffer from deficits of workforce, underutilization, and inappropriate utilization? In these places volume is called access or survival, given the discriminatory financial design. There is no value if access is missing and worsening. What is the point of quality and cost studies if they cannot explain away the alternative hypothesis that the differences in the study are really about differences in the populations being compared? Bandwagons roll on, and too often over those who deliver the care.

Community impact of healthcare providers requires all the above elements to be linked in collaborative provider efforts. Individual provider roles and impact on care, STEMI for instance, can vary from primary, to acute, to tertiary care and improvement of outcomes requires collaborative efforts across the community and provider groups. This is true for less acute care, as well. Smaller hospitals have been successful in driving performance improvement by forming collaborative quality networks that demonstrate the collective impact of care even for low volume providers.