Health care needs its moneyball moment

The health care industry has a lot to learn from baseball. Tasked with fielding a competitive team on a relative shoestring budget, Oakland Athletics general manager Billy Beane had to apply a different strategy than conventional wisdom to compete. Instead of relying on the homerun, his teams would prize players who could get on base for offense and take away runs from the other team on defense. He used new metrics to identify undervalued cost-effective players that could perform this strategy.

Now known as “moneyball,” thanks to a best-selling book by author Michael Lewis and the movie starring Brad Pitt, the approach has been a smashing success. Since becoming GM of the A’s in 1997, the team has the sixth best record in MLB despite perennially having one of the bottom five payrolls.

Of course health care is a bit different than baseball., But the idea of using rigorous analysis of metrics, benchmark data, and a fanatic focus on continuous improvement to drive operational success is pretty familiar to everyone working here at athenahealth. In fact, it drives everything we do on behalf of our clients.

At athenahealth our vision is to build the health care internet and to accomplish this we tend to focus on one metric at any given time to fuel our corporate performance. For the first ten years of our company’s existence the most important metric to optimize for our providers was Days in Accounts Receivable (DAR), a measurement of how fast we can get them paid for delivering care. DAR may sound like a basic, and boring, metric, but for many smaller medical practices the difference between being paid in 20 days versus 90 days is the difference between staying in business or not. Driving the metric were a host of operational factors that related to process integrity -- our automation rates, building faster and more reliable customer service, etc. Back then, almost everything we did as a company went to driving down client DAR.

Today, managing the revenue cycle for health care organizations is just a piece of our much larger offering, so as our services have expanded and our company strategy has evolved so too have the metrics we’ve used and outcomes that we fanatically measure ourselves against.

The current metric I obsess about is one we call “Days in Client Work,” which measures how much work providers on our network have to do. Right now our clients have an average 16 days of work to do when you factor in everything in their queue. Once we can get this down to two days, I feel like we will have moved the needle. This is the most important number in our network because everything we do is focused on freeing providers to focus on their patients. Those administrative distractions and the clogging of the provider’s mind and the sclerosis on the network is the biggest worry and biggest focus for me right now.

Removing burdensome work from the doctor, or helping staff handle work that a doctor is currently doing, or, best of all, building automation into our services so that no human has to bother with it will become the engine for a more humane health care experience.

Soon, I hope I won’t need to worry about Days in Client Work any more because we will have effectively solved this issue and moved on. Next up is likely the Patient Recycle Rate, or the percentage of times that a provider doesn’t have to ask the patient for their medical history because it is already present. We all get a medical chart when we are born, but most of the time when we show up for care at a new practice we're confronted with a fresh clipboard and need to start all over. This is unacceptable.

We’ll go full steam into solving the problem of moving patient information along from one provider organization to another with a level of fidelity that providers can trust, all centered around the patient. When every patient can show up for care and all of their health data is with the provider organization before they check in, that’s when we’ll have accomplished our vision. That’ll be health care’s moneyball moment.