On Day 2 Themes Were Echoed, but With Greater Transparency #LeadingVBHC

The patient was the emphasis of the second day of #LeadingVBHC. It wasn’t intentional, but rather a side effect of people with immense passion for what they do sharing stories about their wins and lessons learned in value-based health care.

Maybe best summed up by David Janiec of The Rothman Institute:

“At end of the day - doing the right thing for the patient is how we all succeed.”

The theme of building an interdisciplinary team echoed again today.

James Capozzi, MD focused one (he had two today) of his entire presentations on the importance of team education in patient-centered, value-based care models; especially from those who frequently interact with patients. His session was shared in case study format from his own experiences as chair of Orthopedic Surgery at Winthrop University Hospital.

First, identify everyone involved in the patient journey

The first step is to map out every person who interacts with a patient and their patient encounter from their first touch point through at least 90 days post-op. This is an important step to gain buy-in from all involved and level set everyone’s understanding of the goals and approach to the opportunity.

A kickoff meeting is recommended involving the entire staff to set the goals and rationale for the effort. This first meeting should be devoted to outlining every step of the patients’ pathways in minute detail and should involve everyone touching the patient throughout the process. This is helpful in many ways, one of which allowing everyone to understand other’s responsibilities and activities. Once the current process is detailed, attention can be turned to ways of improving the program. The most expeditious way to begin is to look for what can be fixed most easily, is least costly to adjust and brings the most return on investment.

Continue to Meet to Maintain Momentum

Following this, weekly meetings should be held involving representatives from all disciplines (MDs, nursing, secretaries, etc.) to review progress and outcomes and maintain momentum for change. At these subsequent meetings a broader view can be taken where the patient’s pathway can be designed from the “perfect world” perspective. With a view of the ideal program, organizations can compare their current approach to evaluate how close they can come to best practices considering physical plant, programmatic, financial and administrative constraints. It is helpful to have a team member who is not involved in a set of processes walk through and map out the process from an independent perspective. This may well identify opportunities for change that are not readily apparent to those very close to the processes and settings.

Get Everyone’s Input to Assure Buy-in

An important ingredient for success is to actively engage everyone involved so they feel a part of the solution and believe that their ideas are being heard. The continual quest for “how do we get to the ‘ideal’” should be followed. Having everyone on the team convey the same messages to patients is imperative for efficient management of patient expectations and behavior.

Something Jonathan Pearce said in an earlier session really tied into Dr. Capozzi’s case study and that was:

“Medical providers need to advise on the importance, clinical relevance and reason for activity or outcome to obtain the interpretation needed.” - Jonathan Pearce

Simply put, when you tell your staff why you do things, they tend to jump on board.

A Broad Range of Data is Needed to Create and Manage Value-Based Care Programs

While the need for data was ever present, today there was a deeper sense of transparency and comradery about of exactly what metrics should be analyzed. Sonia Szlyk shared the incredible results her organization, INOVA Fair Oaks, achieved by simply tracking the correct metrics and making data-driven decisions. INOVA reports a 91% recommended rate and has decreased LOS, resulting in TJR savings of more than $630,000.

Here’s the slide she shared depicting just how INOVA got there.

Another great example of data sharing is this slide shared by David Janiec, in reference to how the Rothman Institute presents data to their team. He noted the importance of consistent use of color and organizing the data by lowest to highest, instead of chronologically to make the data more meaningful.

Jonathan Pearce, CPA and cost data guru, really brought the two themes together by discussing the importance of Data Analysts. Data analysts are an increasingly important member of the care team. They provide information and insights that characterize the activities and consequences of various treatment pathways.

He said the data analyst’s role is to inform and support decisions about changes in process and resource, to those involved.

Good Data Has Broad Appeal

In the same vein, analysts data about cost and payments is useful to care managers, physicians, finance, and strategy executives. Bundled payment claims data is somewhat unique in that it contains all Medicare paid services (except part D drugs) throughout the episode, is highly granular in that it contains details down to the claim level, is identifiable with specific patients and is delayed by several months after the services are performed. While this data is useful in understanding the service landscape and designing bundled payment strategies it is inadequate for real-time care management due to the time lag. 

This is where high patient touch team members can come in and bring the most immediate value. Regardless, when the focus is around the patient, everyone wins.