In the previous blog article I wrote about the attributes of leaders, teams, and organizations that are necessary for success in navigating toward value in healthcare. To get those elements in place you need to create a compelling project that builds organizational motivation. To identify the right project, you need to know where and how to find value opportunities.
When looking for value opportunities keep in mind the fundamentals: Value increases when outcomes improve, or when outcomes remain steady but costs are reduced.
We do not measure value particularly well. Many healthcare organizations fall short of measuring the fundamentals. Value is the quotient derived from dividing the outcomes relevant to patients by the costs associated with achieving those outcomes. To begin effectively measuring value an organization must start with a true understanding of outcomes that matter to patients and then determine the costs of achieving those outcomes.
For this, you need the right data.
Dealing With the Data
Most organizations have access to volumes of data in two major forms:
1. External. This is publicly available, and can include data regarding utilization rates, patient experience, costs, reimbursements, and performance on a number of clinical and operational measures among regional competitors and top performing hospitals. These data can be helpful as a starting point for your transformation efforts, or for providing a clearer focus for them.
2. Internal data. Remember the fundamentals above. Value increases when outcomes improve, or when outcomes remain steady but costs are reduced. Also remember that the most valuable outcomes you measure will be outcomes that matter most to your patients. This data can only lie within your organization, which makes internal data critical to navigating to value.
Your organization does not need to invest in an enterprise-wide data infrastructure project if it uses the external data to identify medical conditions and care processes with the most room for improvement and cost savings. However, transformation requires more intimate knowledge of what happens within your organization and what patients care about most.
How do you know which measures are necessary for tracking and improving the value of care you deliver? How do you best collect, retrieve, organize and display your data for what you are trying to accomplish? When you think of how you are going to use the data available to you to navigate to value, you might want to take a journalist’s point of view. Before you can get to the big “How,” you need to know the “What, Where, Who and When,” aspects of your data.
What you decide to measure deserves careful thought and study. In healthcare, we often default to an existing or easily available measure that does not really get to the bottom of what we are trying to improve. Does this measure matter to patients? Have you asked them how much it matters? Measures such as A1C or FEV1 or even blood pressure provide useful information to clinicians, but they are not outcomes that matter to patients. Because there is a cost associated with tracking every measure, you need to choose thoughtfully, looking at existing literature or someone with more experience with the topic to help guide you to a pragmatic list. Try to include at least one measure that matters to patients and a way to measure the cost of achieving that outcome.
Your data points reside in many places, including in medical records, condition-specific registries, billing and appointment systems, and even in online resources that monitor physician, clinic, hospital, and regional performance. If you will be collecting your data, where do plan to store them? The complexities of retrieving data from multiple sources and linking these sources to a specific patient or group of patients may require the assistance of a data engineer. The first few efforts of a data engineer tries to pull and organize the data from your systems may be clumsy, but over time, it will become easier to automate the retrieval, organization, and display of common data points.
Who will retrieve, organize, and display your data? Will it be a single person or several? Were these people involved in planning the project implementation? Many well-intentioned projects begin by defining the what, where, and when of a measure that matters to patients and costs, but then fail because not enough thought is given to who handles the data and how much they know about the intent of the project.
When will the data be retrieved, organized, and displayed? Data that are as close to real time as possible have the most influence on processes. Displays based on data that are months or even years removed from the process have little influence, and can breed cynicism and resentment in the team.
To make your improvement and transformation to run smoothly and successfully, the retrieval, organization, and display of measures that matter to patients and drive value needs to become routine.
In the next article I will look in more detail at outcomes that matter to patients.
To learn more about my thoughts on data and value in healthcare, see Navigating to Value, where you can find the table of contents and several reviews. The book is available for pre-order now and will be in print later this month.