As a competitive (albeit relatively slow) athlete, I can tell you there comes a point in every long, grueling race where you must dig deep to overcome physical, mental and emotional exhaustion. My career in healthcare sometimes feels the same.
We’re nearly a decade into the transition to value-based care and I can see the fatigue settling in. It’s understandable. Transforming healthcare is most definitely an ultra-endurance event and nowhere is the work more challenging than for physicians, nurses, care teams and their supporting staff.
The success of any healthcare system rests upon physician efforts as they are responsible for the vast majority of decisions that determine utilization, quality and patient outcomes.
In a way, the title of this blog is misleading because I believe physicians, nurses and care teams are the most engaged group in healthcare. Period. They hit the ground running every morning, prepping their offices for the steady stream of people flowing through their doors, caring for those people the best they can, and then remaining until after the last patient has been seen and all the boxes are ticked in their EHRs. That’s engagement.
But there’s another side of care delivery – process. Value-base care brings significant change to the processes supporting care delivery and everyone, every day, must actively engage to make it work.
Transition means straddling fee-for-service and value-based worlds for a time. Right now, between patient visits and endless phone calls, physicians and their staff must squeeze in the busy work of showing value along with the traditional red-tape processes of healthcare. This is, undoubtedly, the heartbreak hill of our transition marathon.
It’s where some will push through and others will fall to the side. For organizations failing to engage physicians, the cost is high. Two Gallup studies reveal just how much is at stake:
- At one hospital system, engaged physicians were 26 percent more productive than physicians who were not engaged or who were actively disengaged. The added productivity equaled an increase in patient revenue of $460,000 per physician per year. Gallup concluded this hospital system could increase annual revenues by nearly half a million dollars for each physician who moved from not engaged to engaged.
- At another hospital system, Gallup studied the difference in referral volume for engaged and disengaged community physicians. Again, engaged physicians outshone disengaged counterparts by sending 3 percent more outpatient referrals to the hospital and 51 percent more impatient referrals.
Additional research reveals a direct correlation between the busy work of supporting care delivery and physician burnout – 86 percent of respondents in the 2018 Physician Misery Index cite data reporting a key driver of diminishing their joy in practicing medicine.
It isn’t enough to simply point out a problem. We must develop strategies to overcome and share resulting best practices.
To truly change the way physicians process their work, they must have four key elements:
1. Leadership. I agree whole-heartedly with the words of Andrew Dreyfus, CEO of BlueCross BlueShield of Massachusetts, as he looks back at the landmark success of one of the country’s oldest and largest value-based systems, “When we launched the AQC a decade ago, there was a common misconception that a value-based care model would work only for large physician groups with advanced electronic medical record systems and relatively healthy patient populations. That isn’t the case. What matters most is physician leadership. Success has been achieved by groups with inspirational leaders and physicians who are willing to change, stay passionately involved, and make a sustained commitment to the shared goal of better care and lower costs. More than 80% of Massachusetts physicians and hospitals currently take part in the AQC model.”
2. The right data and tools. To ease the busy work of identifying care gaps, patient outreach and reporting of quality metrics, physicians and their care teams need direct line-of-sight into claims-level data and the resulting analytics. They need systems that work with, not against, their natural workflows to improve outcomes for patients, while helping to restore the joy of medicine in physician practice. In fact, the lack of access to claims-level data is one of the top reasons why physicians won’t enter into value-based reimbursement arrangements in the first place.
3. Education. Without a doubt, physicians and care teams must be educated and inspired on the concepts driving the transition to value-based care. But on a highly practical level, leadership must understand that change is hard and fee-for-service care is deeply entrenched. To shift physicians and their support staff toward value-based care, healthcare organizations must provide hands-on training and education to support daily routines and processes required for value-based care success.
4. Ongoing resources. It’s human nature to resist change and to stick with familiar processes, even if they don’t work well. It’s my experience in athletics and in business that ongoing mentoring and scheduled, regular check-ins are key to developing and maintaining stamina and ongoing improvement. For value-based success, I recommend a collaboration between physician leadership and proven population health experts – people who can review clinical insights with physician and clinical teams, develop concrete action plans, evaluate results and adjust plans going forward.
To cross the finish line, healthcare organizations must continuously engage physicians in the process of transition. Leadership must address points of frustration with reform and help physicians achieve a sense of equity and ownership in the organization, process and outcomes.