Value-based care’s human problem


Pictured: Able Health CEO Rachel Katz mapping the PQRS reporting journey with a partner during a design thinking workshop

HIMSS, the annual health IT conference that brings together 40,000+ health IT professionals, clinicians, executives and vendors from around the world, is around the corner, and population health will once again dominate the conversation. Population health management holds the promise of the new American healthcare system, one where we identify the sickest patients and provide them with better care before they land in the emergency room. Physician payment models are shifting rapidly to support this approach, and a myriad of ‘pop health’ vendors are emerging who will fill the HIMSS exhibit hall next week. The hype cycle is in full swing.

As a product designer I was curious: are these population health products actually improving patient outcomes? This month, Chilmark Research released an analysis of population health vendors and drew a startling conclusion. In his summary, Chilmark analyst Brian Murphy writes:

“Not a single vendor earned a full ‘A’ rating as no solution is currently meeting the user engagement and clinician workflow needs of the healthcare organizations these products are intended to serve.”

Technology vendors often ignore the fact that practicing value-based care is not just a data plumbing problem. Once you get all your data aggregated and cleaned up, you’re still left with a human problem, in the form of inaction or resistance in operations. In a high-performing physician organization, all administrators, physicians, and care managers are aligned and moving toward the same goal—delivering the right care to the right patients.

Here are some common barriers that physician organizations face when implementing population health management and associated quality improvement initiatives:

  • Physicians, care providers, and supporting administrative staff have not bought into the the organization’s quality improvement goals
  • Providers know they have to meet quality metric performance targets but lack the detailed information necessary to meet them
  • The documentation requirements of many of those quality metrics are not aligned with the how physicians have been documenting patient care for many years
  • Care teams lack transparency and performance feedback, which means they don’t find out which patients need care until it’s too late to deliver it

In an organization that has been tracking volume-based metrics for the purposes of quality improvement, value-based care requires a fundamental change in culture and behavior. How do you motivate everyone in your organization to shift their mindset and perform their best so you can actually improve quality of care and patient outcomes across a population rather than just talk about it?

I believe that a critical component is the process of design thinking. Researchers who practice design thinking embed deeply with customers and prototype with them to arrive at breakthrough ideas that people love to use. This method originated in consumer applications with the creation of early breakthrough consumer products, such as the computer mouse at Xerox PARC. But in recent years it has also worked its way into the enterprise, with companies like IBM and GE leading the charge to make large organizations high-performing by better serving the needs of employees, from sales reps to software developers. In all of these examples, products and services are thoughtfully designed based on a deep empathy for users, with an infusion of best practices from behavioral science.

Design thinking can lead to products that go beyond data aggregation—and get an ‘A’ rating for filling user engagement and workflow needs. In other words, it can lead to products that administrators and clinicians love to use. I love taking this journey together with our users.

Further reading:
A new era for measure development: Clinical Quality Language is here!
Tennessee: Preparing for MIPS with PCMH and pay for performance

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