With all the buzz about quality improvement, population health, and alternative payment models, you may be wondering how the information technology that supports these functions fits into your organization. And with many vendors saying they support these functions, it’s not easy to determine which will make the biggest impact for you.
Generally, quality improvement software is meant to help your organization manage and improve the health outcomes of your patients, with some solutions also incorporating features that manage the financial arrangements that incentivize your performance. Your goals—and the technology needed to achieve them—may depend on the nature of your payer contracts, your current performance, and your organization’s culture. The first step in evaluating quality improvement vendors is to identify your organization’s specific objectives. Then you can evaluate how well you anticipate each vendor would help you meet them.
The following seven dimensions can be used to match vendors’ solutions to your organization’s ambitions.
The first step in improving quality across an entire physician organization is to ensure you have as complete a picture as possible of each patient’s health and each provider’s activities. Since the relevant data often exists in multiple places, data aggregation is usually required. Common sources of data include administrative claims and electronic health records (EHRs), which have the benefit of providing more granular insight into clinical activities, and data can be incorporated into measures more quickly. Depending on the nature of your internal IT infrastructure, a quality improvement solution might also need to aggregate data from laboratory and pharmacy sources for accurate quality measure calculation, as well as practice management systems for improved care management.
For many organizations, quality improvement goals are dictated by the nature of their contracts, which increasingly include performance-based and risk-adjusted payment components. These contracts are nuanced, including variations in performance measures, patient populations, provider attribution methodologies, measurement periods, incentive structures, risk adjustment characteristics, and reporting methods. If your organization is interested in maximizing payments for each contract, it would not be sufficient for a solution to apply the same rules across your entire patient population. Does the software allow you to apply different patient population rules by contract? What quality measures and risk adjustment information can the vendor deliver? Payers often have unique reporting requirements as well, which can increase administrative time when it comes to collecting, aggregating, and reporting data each year. Does the solution save you administrative time by supporting reporting of aggregate and patient-level data to pay-for-performance programs?
Quality improvement solutions usually include an analytics dashboard that informs administrators on the overall performance of the organization. You may have specific indicators you care about, including quality measure performance segmented by patient population, provider, provider specialty, practice or site, and program or health plan. When viewing potential technologies in a demo or online, pay special attention to how the data is presented and organized; many solutions on the market are powered by generic analytics technologies that are not designed to meet the specific needs of pay-for-performance contracts. Solutions built from the ground up to support varying and complex payer programs present the information more clearly so administrators can quickly make decisions and take action, rather than spend time sifting through many charts and tables.
When it comes to quality improvement feedback and data, providers must be informed quickly and efficiently so they can take action on what is presented—often in front of the patient. Each organization has preferred workflows for informing providers and care managers of patients who need attention, so it is important to understand how a quality improvement solution would fit into or improve the processes your organization’s clinicians are currently using. Would a morning huddle make sense for your organization? A way for doctors to check this information throughout the day? Should this information be available via desktop, mobile device, or on paper? Pay attention to how vendors accommodate the workflows that make sense for your organization, or else you will face resistance from providers and find it difficult to improve care management in a way that meets the conditions for your organization to receive financial incentives.
Sharing information is one thing, but getting providers to take action and change their behavior to improve quality can be much more challenging. A well-designed IT solution that drives quality improvement should include feedback reports that are convincing, helpful, and motivating—for all the stakeholders in your organization. While a standard feedback report will simply display a provider’s performance results, a great feedback report will back up results with patient-level data, provide resources to help providers improve on underperforming measures, compare performance to meaningful benchmarks, and treat the presentation with the sensitivity required of such complex communication. Will a vendor’s solution create greater alignment and positive action in your organization, or will it increase tension?
Being able to trust how a vendor manages your data and calculates quality measures is critical for any quality improvement software purchase. The first thing to pay attention to is the organization’s compliance. Ensure that the solution is compliant with HIPAA regulations and follows best practices in data encryption and anomaly detection. If you are reporting for particular pay-for-performance programs, you might also ask whether the vendor has or is pursuing certifications, such as NCQA certification for HEDIS quality measures. In addition to baseline qualifications in security and reliability, the best vendors will also be able to offer the scalability, availability, and affordability that comes with cloud delivery.
Pay attention to how the vendor’s representatives handle communication with you during the sales process. Professionalism, response time, and attention to service are indicators of how that the vendor will manage implementation and customer service post-contract. Are you a priority for the company or just another drop in the bucket among much larger customers the vendor already works with? Does the company use modern product development practices to collaboratively design with its customers and deliver new features weekly, or does it use a more traditional approach of deploying updates a few times a year? Special relationships can often be formed with earlier-stage companies who are seeking customers to collaborate with and deliver custom features that better suit your needs.
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