Do you want to deliver outstanding results for your patients, your clients? Do you want to deliver the triple aim of healthcare-patient-centered care at a lower price with better population level outputs? If the answer is 'Yes', then you need to continuously improve the quality of the care that you deliver, the service that you supply. I believe that this is the goal of most providers.
If you have been adopting the steps of Business Process Management that have appeared in previous newsletters, then you are ready to move on the last step-managing and improving your processes. As you may recall, the previous steps were:
1. Identifying top priority, critical processes.
2. Validating customer (patient) requirements.
3. Documenting the processes.
4. Developing process measurements.
Many organizations after implementing these four steps move on to actively manage their processes, their services. I do know some that do not. Such a waste of effort, I believe. Armed with the information collected and developed in the first four steps action must be taken to address the findings. Energy must be sent to manage the most important processes so that the quality of care does not suffer. From my experience, this is what most provider and service organizations do. They collect data on their most important processes and identify patient requirements and then keep performing the same processes over and over. They are not interested in actively addressing changes that lead to better outcomes.
Consider a group of primary care providers who have been engaged in patient care for many years. The majority of their income comes from fee-for-service activities. They have many patients who have Medicare. They do work to meet government mandates such as EHR meaningful use requirements. However, their focus is primarily on fee-for-service activities. In the next few years their returns for these activities will steadily erode as CMS switches over to the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) requirements. They may excel in managing the fee-for-service processes at their site, but still their income will erode.
Healthcare providers who not only seek to manage their processes and meet patient requirements but also seek to improve the quality of their care and will most likely see increases in revenue at their site. If they work on the triple aim-work continuously to improve their outcomes-then they will be rewarded by private payers and CMS.
What are some examples of continuous improvement projects that lead to hitting the triple aim? Houston Methodist Hospital works hard to improve patient health by concentrating on population level health management supported by data collection. Houston Methodist owns seven hospitals, a long-term care facility and contracted specialty and primary care physicians. They have stratified their patients into groups including a high-risk pool. Methodist Hospital provides case management services to this group. Over a six-month period recently they moved 50% of the high risk patients to a low-risk pool, so hitting the triple aim. You can find out more about this accomplishment in an article from HealthLeaders Media online .
Patient-centered medical homes are another example of primary care providers working to improve patient outcomes by focusing on the patient. Mercy Health Physician Partners of West Michigan is certified as a patient-centered medical home by the NCQA. They focus on patients with care plans tailor to the patient. Included in access to care is a well designed patient portal.
Another avenue to hitting the triple aim is through Accountable Care Organizations. Recently CMS added another contract model for ACO's-the Next Generation ACO Model. This model provides several ways to manage risk in a restricted environment. The hope is that more organizations will sign contracts with CMS to provide care in this model.
There are many tools that can be used to improve the quality of care at a lower cost. Healthcare quality improvement managers use programs such as Lean 6 Sigma, Plan-Do-Check-Act cycle and Total Quality Management. Each has a different focus but all are built upon collecting data as a part of business process management and looking at patient and customer requirements. The American Society of Quality and the Institute for Healthcare Reform has many resources that address these quality improvement programs.
The culmination of any business process management program is to continue to improve the service or care offered. In healthcare, this is known as the triple aim-lowering costs while focusing on the patient with population level management programs. There are many approaches to achieving the triple aim. Any program hoping to continue improve should adopt strategies and methodologies that resonate with their staff and leadership wherever it is Lean Six Sigma, Total Quality Management or Plan-Do-Check-Act cycle. Using these or similar tools will lead to ever better outcomes for all involved.