26 Mar We’re All In This Together
I spent time recently with a roomful of behavioral health providers – non-profit and for-profit – whose highest priority is serving some of the sickest in their communities. These noble individuals and organizations have endured several years of evolving system change that affects both payment for and design of services they deliver. At the same time, they’ve been adapting to new world realities and future directions that emphasize data-driven decisions, and focus on outcomes and wellness as a basis for reimbursement and determination of “value.”
In many cases, these providers are novice adopters of electronic health records and are constrained by payment systems that continue to emphasis volume of services, rather than the clinical and social outcomes produced by all their hard work. I was struck by how valiantly these organizations are striving to do the best for the clients and families they serve, while they struggle to stay fiscally viable in a highly competitive health care market.
The policy structure at the federal and most especially at the state level needs to do more to support the true laboratories of reform. We should be grateful that these dedicated individuals go to work every day passionate about doing more and better with the tools they have. Not all of these providers will survive the turbulent transformation period we are facing, but policymakers can do more to help boost the success rate. Here are a few ideas:
Make Data Accessible – HIPAA is important, but we’re hiding from true progress by using this law as an excuse to slow down or avoid true data integration and interoperability. Facilitate sharing within community networks and with the state, force vendors to collaborate and harmonize, and help all organizations better understand their population and the opportunities to serve.
Set the Bar; Don’t Dictate the Model – The trend seems to be “finding” the best practice, model or tool, rather than articulating the goals we want to see. Does it really matter what approach is used if we are seeing a change in health behaviors, clinical outcomes and service mix? This is the promise of case rates/bundled reimbursement versus continuing our dependence on fee-for-service. But truly embracing the latter requires that we stop dictating how providers must achieve that outcome for every patient. If we embrace that each patient is unique, then the approach to his or her wellness must, by definition, also be unique.
Foster (Don’t Try to Control) Relationships – Policy entities need to prioritize inclusive stakeholder engagement and foster solutions born of dialogue and local innovation. Bring people to the table and get out of the way.
Give Policy Changes Time to Germinate…and Blossom – Perhaps no other trend is more troubling than the attention deficit that our policy and financing governance has for change. If it is well understood that culture and practice takes time to evolve, then we must extend the timetable for examining change and its impact on health. We continue to ignore that transformation may cost more in the short-term even as it delivers unexpected change that delivers good for individuals and for the system overall. Allow time for policies to really embed and use early data – whatever it shows – to drive process improvement dialogues and allow performance to create system competition organically (as opposed to penalizing organizations, for example).
Focus on outcomes that matter – Budget neutrality for Medicaid/Medicare (while important) should not be a paramount driver of patient-level care decisions. Are more patients being served able to get (and keep) a job? Are their chronic illnesses better managed (e.g. their glucose levels more constant? is their BMI improving?) These outcomes are vital indicators of improved health – maybe more than avoidance of ED use, lower readmission rates, or reduced prescription drug costs.
It’s an exciting, and yet unsettling, time in healthcare. While we spend energy and scarce resources to support patients as they engage in their healthcare, our policy establishment needs to also support those that deliver care in the community.
It’s not a call to guarantee their existence or enable continued dependence on outdated approaches. Rather, it’s an appeal to invest in and cultivate the passion and the creative possibilities of the real front line in healthcare.