Donatelli is a former Association of Healthcare Value Analysis Professionals (AHVAP) president and recipient of the organization’s Lifetime Achievement Award.
Value is perhaps the most highly sought achievement in health systems today. On the spend side of the house, supply chain and procurement professionals use value analysis methods and tools to align strategic and clinical priorities. On the reimbursement side, providers, medical staff, and quality professionals are adapting to payer models that distribute value-based payments instead of traditional payment for services. From tighter supply chain management to higher-quality provider performance that delivers better outcomes, value is both the pursuit and the payoff.
We explore how healthcare operations software is helping to find and recover value in the distinct areas of value analysis and value-based care and payments.
Where healthcare operations technology creates value in spending
Value analysis in the supply chain requires transparency, evidence
Evidence, safety, and regulatory compliance factor heavily into supply chain decisions, but so does the recovery of fast, measurable return on investment (ROI). Healthy systems grapple to provide equal weight to the competing forces, but must do so to ultimately improve outcomes.
As a result, forward-thinking health systems are applying value analysis methodologies that use evidence and data-driven decisions to achieve high-functioning revenue and regulatory results in the healthcare supply chain. For value analysis methods to be successful, however, data must be easily accessible to stakeholders and integrated system wide. That’s where value analysis software comes in. It combines clinical evidence and operational data to serve as a foundation for clinical alignment. In other words, it involves the right people, at the right time, and in the right capacity to approach evidence-based decision making within a digital framework.
From a practical standpoint, value analysis means having a systematic, standardized decision support process to help make evidence-based, financially conscious, and outcome-centered decisions—and using it every time.
To deliver cost-efficient, quality-driven, and outcomes-focused performance with every decision, health systems must build a rigorous value analysis infrastructure. And while every healthcare organization strives to make well-informed, value-based decisions, COVID-19 exposed two key insights for value analysis teams and hospital leaders:
- Evidence-based decisions can’t be made, and value-based care can’t be achieved, without high levels of engagement from physicians.
- Most existing decision-making processes in healthcare enterprises today are unable to handle critical tasks such as compliance adherence, exposing the system to unnecessary risk.
Further, because many hospitals still make decisions at the facility level they’re unable to realize the largest benefits of value analysis. Simply put, many fail to collect and use integrated data for strategic decision making. Today, we can tap into a wealth of resources to support product decision making—from clinical evidence to regulatory and safety information. Using all of the data available at our fingertips empowers decision makers to make the right choices for their healthcare organizations the first time around. Rather than relying on individual, manual information gathering, leveraging integrated data through APIs and technology partners allows for system wide improvements that save and recover scarce dollars and resources.
Learn how symplr Spend supports data-driven decision making though our Clinical Evidence database, which includes aggregated clinical evidence and summaries on thousands of products, alongside powerful analytics on safety and financial impact.
Where healthcare operations technology creates value in reimbursement
Value-based care depends on improved provider performance—and patient satisfaction
Value-based healthcare models are designed to improve outcomes while reducing costs. The associated value-based payments, or reimbursement, for participation in the models reward healthcare organizations and providers for meeting or exceeding outcomes measures. The outcomes are wide ranging and include measures such as:
- Patient mortality and complications
- Healthcare-associated infections
- Patient safety
- Patient satisfaction and patient experience
- Efficiency and cost reduction
According to Mark McClellan, MD, PhD, Robert J. Margolis Professor of Business, Medicine, and Policy at Duke University, U.S. healthcare will continue shifting toward care and reimbursement models paid on a basis other than fee for service. “[The models] shift the focus of care away from downstream facility-based procedures and complication management into upstream, more personalized, digitally based, home-based care and extend the boundaries of how we think about healthcare,” he said.
In this sense, value refers to the measured improvement in a patient’s health outcomes for the cost of achieving that improvement. Improving patients’ health outcomes relative to the cost of care ideally benefits all participants—patients, providers, employers, and private payers and government organizations such as CMS. But if you can’t measure it, you can’t manage it.
As a result, health systems are using healthcare compliance, quality, and safety software to achieve desired quality and reimbursement outcomes. The software aids in maintaining strict control over the metrics that affect reimbursement using powerful insights into provider performance and performance improvement.
Coordinating care, evaluating and demonstrating quality, identifying risks, and monitoring compliance all require data from multiple sources and systems, yet the data must be integrated. Using the combined data for all of the aforementioned factors is key to improving the patient and provider experience—and increasingly, to secure higher reimbursement under value-based care and value-based payment models.
Perhaps the most important aspect of value on the minds of providers and patients alike is patient experience, which is growing in importance in value-based care and payment models. Although the terms patient experience and patient satisfaction are often used interchangeably, they aren’t the same. Both measure patients’ view of healthcare quality, access, safety, and more, but patient experience better measures patients’ range of interactions with multiple touch points of the healthcare system.
Increasingly, your organization will be paid and rewarded with risk pool incentives and through shared risk models that consider patient-reported experience. The weight that patient experience carries in the distribution of payments varies, but the takeaway is that improving overall patient experience is associated with good processes and outcomes—and showcasing that form of value in delivering quality care makes good business sense.
Where value analysis and value-based care meet
It may seem that value analysis and value-based care operate in parallel tracks in healthcare systems, but together they create the fabric that is healthcare. For example, whether for product (value analysis) or performance (value-based care), if done well both can:
- Reduce variation through standardization of processes
- Improve efficiency
- Decreases the likelihood for error
- Result in reduced cost/improved outcomes
- Increase clinician/staff satisfaction
But the similarities don’t end there. Both take product and service evaluation from subjective to objective and foster a collaborative approach among interdisciplinary teams to reduce and manage expenses while improving outcomes.
Last but not least, all of the goals encapsulated by the Institute for Healthcare Improvement’s Quadruple Aim are represented in the tenets of both value analysis and value-based care: improve population health, reduce per capita healthcare costs, and enhance patients’ and providers’ experience.
These objectives cannot be met absent rigorous, mature, value analysis and value-based care structures that use integrated data from across a healthcare enterprise. And that requires healthcare-specific software solutions that enhance your ability to achieve truly connected, integrated, enterprise-wide operational efficiencies.
By implementing value analysis and value-based healthcare, you can improve care quality and the patient experience while reducing costs.