I am not the first and will most certainly not be the last to discuss the shift from the fee-for-service model to the value-based model. Additionally, I do not claim to have any answers on where we will end up on the continuum between the two. What is obvious, however, is the fact that we need to begin looking at how we measure success today and how it will be measured tomorrow.
Most articles and studies today focus on large, complex health systems because they are at the forefront of the changes. Given the rocky start to programs like the 2-year-old CMS Pioneer ACO program—where 75% of participants failed to earn bonuses—the buzz on the shift to value is less than positive. So the question remains, how do we get ready for the shift and avoid the pitfalls seen by the health systems?
Change your KPI (Key Performance Indicator) perspective!
Practices today are very focused on cost reduction. As with any business, if you reduce unneeded costs, and maintain revenue, you increase profitability. Well, what if we translated that in the value-based world to Cost of Care? Imagine that you start this now and can soon prove that by reducing unneeded tests, prescribing generic drugs, and adding a rigorous pre- and post-surgery education program, your total Cost of Care is lower. This information could be used to gain bundled payment bonuses, not to mention the added benefits of cost reduction itself.
Other KPIs that should change are around patient access and engagement. Most practices have adopted the meaningful use benchmarks as their high-water mark for portal usage. However, we should change the conversation to true Patient Engagement. Rather than X% of providers sending a message to a patient or completing a VDT task (patients viewing, downloading or transmitting their clinical record), track the value added by your portal. Ask yourself if patients with a portal are more loyal? Do they add on more ancillary services that you provide? Do they refer more new patients to your practice? Do they have a better pre- and post-surgery experience? Aside from these more qualitative measure that can increase value, you can track cycle times for clinical and non-clinical processes, which directly impact costs to you in terms of staff time.
Last but not least is something that health systems already track but that can be adapted to the specialty ambulatory setting, Capture Rate. This is the portion of the patient’s total care that is captured by your practice. This means driving adoption of “other” services or simply grabbing market share. This KPI can be driven up by providing advanced access. This may mean having a percentage of the schedule open for on-demand access, or adding e-visits, or expanding hours. You can dovetail this with a portal to provide a more self-serve model. The concept here is that if you can provide more of the touch points in your practices, you can reduce costs along the continuum of care.
Experiment, Adjust, and Communicate.
Defining your KPIs is the first step towards creating a measurable improvement. While the ones above are some suggestions, your team may come up with more targeted KPIs based on your practice goals. A few quick tips as you go forward.
- Keep it simple – KPIs are not about data for the sake of data. Pick 1 or 2 and experiment.
- Be ready to pivot – We learn the most from mistakes and there is nothing wrong with changing course when you have more data.
- Consider both short- and long-term goals – Don’t try to jump to 100% value-based KPIs in 1 step.
- Communicate! – The biggest mistake you can make is not involving your entire organization. The full team must understand the end goal and then progress toward it. Nothing kills an initiative like the lack of a sense of ownership.
What are your teams doing to get ready for the shift to the value-based model? Do you have KPIs that you’d like to share?
Lester earned a BS Finance and Management from Montclair State University and an MBA in Marketing Management from Rutgers. In addition, he is a certified PMP (Project Management Professional), CSM (Certified Scrum Master) and CSPO (Certified Scrum Product Owner).
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