Four Steps To System Improvement in Care Management

Jaan Sidorov

Posted 12/1/11 on the Disease Management Care Blog

The Disease Management Care Blog sympathizes with all those minimally titled and disempowered health system “directors,” “managers,” “VPs,” and “team leaders” who look up from their trenches at the folks running things from afar in their C suites and wonder: how can my bosses be so foolish? With their one-size-fits-all management, organization-wide metrics and devotion to “accreditation,” and “recognition” and “certification,” they’ve forgotten about the patient. Something is so wrong.

If you’re one of these unfortunates, you may want to send the boss a copy of this New England Journal article on the four habits of high value care organizations.  While it’s clear that some provider groups are star performers, policymakers are struggling to find the characteristics that separate the wheat from the chaff.  Author Richard Bohmer helps out by pointing to four key characteristics that drive value. They’re not what the C-suite typically wants.

Those characteristics are:

1. Specification and planning:  all patient care activities are based on explicit criteria that are tailored for patient subgroups.  As a result, any intake process, intervention, pathway, communication or discharge process is directly linked to predetermined criteria that are tailored to categories of need.  One-size-fits-all is thrown out the window.

2. Microsystem design: staff, technology, policies and procedures are also fitted to serve the patient subpopulations.  Team members have roles, supply chains are branching and information systems are tailored.  While the trick is to harmonize it all, in the end everyone knows what to do depending on predetermined and very local engineering.

3. Measurement and oversight: it’s all about internal process control and performance management based on the patient populations and the organization’s culture.  Those external accreditation metrics are important, but they’re a necessary evil that has little to do with the real work at hand.

4. Self-study: this makes use of all that internal measurement to better understand any positive or negative deviation from their own established internal benchmarks.  This may include conducting ad-hoc prospective research-lite protocols.  In addition, understanding what the measurement is saying becomes part of the organizations’ culture.

While C-suite types may be aghast over these recommendations, the DMCB has seen them work in day-to-day care management programs.  It believes a good tide of risk segmentation, tailored care planning, ongoing measurement and a virtuous cycle of quality improvement will be a tide that not only improves HEDIS® scores, it will also reduce costs and improve quality.

Bravo says the DMCB.  It’s mentioned many of these characteristics in prior posts, but this article does a nice job of pulling it all together.  Best of all, it’s open access.  Whether you’re a small physician owned practice or a large ACO wannabe, this article deserves to be in your library.

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