Does your data know something you don’t? Why you should be focused on understanding physician variation

The need to create more efficient and coordinated models of care has never been greater.

Healthcare providers are already challenged with managing costs and utilization in the wake of declining reimbursement rates, a payment evolution and new competitive entrants pecking away at their patients. At the same time, providers continue to struggle with limited resources, operational complexity, sub optimized technologies, physician burnout, transparency and consumerism. These multifaceted dynamics are contributing to significant variation in patient care and operations management, especially for physician practices.

This article was written in collaboration with Premier. 

In fact, an analysis from healthcare improvement company Premier Inc. found wide variation in primary care staffing model composition, provider performance and costs of care. The report concluded that an evidence-based approach to addressing medical group staffing and practice variation is needed to further reduce costs and improve overall provider and patient satisfaction.

"Premier’s report underscores the need for a data-driven, intentional approach to medical group staffing model design to reduce unnecessary variation in practice expenditures and care delivery," said David Olson, vice president of physician enterprise analytics at Premier®. "In the same vein, it’s critical that providers have access to this information so that they can begin to understand their practice infrastructure and ways by which they may be contributing to the over or underutilization of services."

Managing clinical utilization is key to provider profitability

This is especially true in the transition to value-based payment models where proper management of clinical utilization is key to provider profitability. For example, there are a range of medical conditions with more than one treatment option, deemed "preference-sensitive conditions," of which care is often dependent on variable factors such as patient clinical status, practitioner discretion and institutional policies.

"These are conditions where provider preference can drastically impact overall healthcare spending. It’s critical that medical groups begin to understand their internal variation with respect to care delivery as government and commercial payers will continue to make this an area of focus," said Chris Smedley, vice president of physician enterprise solutions at Premier.

CMS bills physicians for services delivered to patients with preference-sensitive conditions. Moreover, evolving valuebased payment models are beginning to limit annual services for or create a set amount of dollars to treat patients for preference-sensitive conditions.

In the shift toward value, there is a risk for overtreating and undertreating, but providers also need to focus on the patient experience. Unnecessary procedures and tests that aren’t needed can have both short and longterm effects on patients. Reducing variation goes a long way in improving the patient experience — a key factor in successful population health management.

Using data to understand physician performance

A common challenge in medical groups is that evidencebased care practices have not been well documented or understood. Access to timely, actionable and accurate insights is essential for providers to understand how to respond to external forces, as well as effectively standardize and optimize medical group performance.

Physician practices need analytic reporting systems that show how individual clinicians stack up against their peers, but they often rely on surveys based on outdated information with limited sample sizes. Providers that rely on surveys are challenged with the accuracy of the information received as responses can be skewed based on the interpretation of individuals completing the survey, among other things.

Having access to meaningful insights is also becoming increasingly important as health system and physician practice leaders work together to navigate the complexities of the healthcare landscape.

"It’s really not about the need for more information. Medical groups have this data. But they often don’t know what questions to ask and lack the right technology to properly manipulate it," Mr. Smedley said. "We need to find ways to use the data medical groups already have to highlight the variation that exists and understand how and why physicians are treating patients differently. Once physicians validate the data and agree there are opportunities, they are often naturally motivated to figure out what’s driving variation."

Medical groups, as well as the employers and health systems working with them, are searching for ways to provide more coordinated, higher-quality care at a better price point, and position themselves as the choice provider in their markets.

"Data analytics that can pinpoint variation in care for preference-sensitive conditions, for instance, is needed to help providers prepare for the shift to value and make informed decisions," Mr. Olson said. "At Premier, we’re collectively analyzing preference-sensitive conditions to identify opportunities. We’re working with physician practices and health systems to track this data and focus on potential revenue enhancement opportunities, optimizing the patient experience and mitigating risk as it relates to value-based payment models."

More collaboration to share data and insights is needed

Increasingly, health system and medical group leaders are also realizing the value in leveraging technology and information sharing to better understand physician practice performance and variation. Networking and collaborating with peers is critical to more effectively spread knowledge and develop solutions to address the core issues facing physician practices while managing the required pace for change. When medical group leaders come together to share data, insights and best practices, they can accelerate the discovery of solutions to evolving provider needs.

Thousands of providers from medical groups and health systems across the nation that are participating in Premier’s Physician Enterprise Collaborative are currently working together to share data on practice patterns. Participants are specifically focused on five of the preference-sensitive conditions CMS is weaving into its payment models, which they have identified as driving the most fluctuation in clinical utilization and costs.

The five preference-sensitive conditions Premier members are prioritizing to delve into physician variation include:

  • Maternity (cesarean rates)
  • Low back pain, herniated disc and spinal stenosis
  • Cardiology (stable ischemic heart disease)
  • Oncology (localized prostate cancer)
  • Hip/knee osteoarthritis

Premier and its members are seeking to identify variation in clinical practice to create awareness around which practices are most effective. "By sharing their data, experiences and best practices, Premier Collaborative members are also having more meaningful conversations around specific practice patterns for these conditions," Mr. Smedley said.

Real-time interventions are the next frontier

Once they understand where variation lies and have identified the practices that are most effective, it is time to put them into action. The next frontier in costeffective, high-quality care is using advanced clinical decision support technology as a mechanism to drive transformation.

"With valid information in hand, providers can then cycle back learnings within their organizations to create change in practice and address utilization," Mr. Smedley said. "Proactive, evidence-based processes can be integrated into the physician workflow with clinical decision support solutions to more easily and effectively standardize practices."

For example, bolt-on clinical decision support technologies that can alert physicians with the best next steps to take based on highly-reputable, real-time information can produce meaningful insights at the point of care. This allows organizations to address physician variation more proactively through enabling technology and real-time interactive decision-making practices.

"As long as the information is clean, prompt and accurate, organizations can be confident that their physicians are making the right decisions," Mr. Smedley said.

Zeroing in and tackling variation at every level

Drawing a line in the sand and aiming to zero in on variation at every level of clinical utilization is essential for medical groups as they transition to value. With the right analytics, peer network and technologies, healthcare leaders can simplify the conversation and allow decisions to be based on evidence. As health systems increase their partnerships and collaboration with physician practices, it is critical they employ solutions that physicians will embrace to move the needle on performance.

"The key is to have solutions in place to enable a clear understanding of quality and cost goal status, how variation in patient care is leading to less predictable outcomes and excessive versus appropriate testing," Mr. Smedley said. "These insights can help feed peer discussions around the creation of successful practices and allow for the standardization of evidence-based guidelines."

While some organizations have the capabilities in place to address variation effectively, they may not have the mechanisms to tell them where it is, talk to others about it and drive change. Premier’s physician practice intelligence and enabling solutions, along with its network of medical groups and health systems, are helping providers figure out what the data is trying to tell them to reduce clinical variation and cost-effectively optimize the patient experience.

models of care has never been greater.
Healthcare providers are already challenged with
managing costs and utilization in the wake of declining
reimbursement rates, a payment evolution and new
competitive entrants pecking away at their patients.
At the same time, providers continue to struggle
with limited resources, operational complexity, sub
optimized technologies, physician burnout, transparency
and consumerism. These multifaceted dynamics are
contributing to significant variation in patient care
and operations management, especially for physician
practices.
In fact, an analysis from healthcare improvement company
Premier Inc. found wide variation in primary care staffing
model composition, provider performance and costs
of care. The report concluded that an evidence-based
approach to addressing medical group staffing and
practice variation is needed to further reduce costs and
improve overall provider and patient satisfaction.
“Premier’s report underscores the need for a data-driven,
intentional approach to medical group staffing model
design to reduce unnecessary variation in practice
expenditures and care delivery,” said David Olson, vice
president of physician enterprise analytics at Premier®.
“In the same vein, it’s critical that providers have access to
this information so that they can begin to understand their
practice infrastructure and ways by which they may be
contributing to the over or underutilization of services.”
Managing clinical utilization is key to provider
profitability
This is especially true in the transition to value-based
payment models where proper management of clinical
utilization is key to provider profitability. For example,
there are a range of medical conditions with more than
one treatment option, deemed “preference-sensitive
conditions,” of which care is often dependent on variable
factors such as patient clinical status, practitioner
discretion and institutional policies.
“These are conditions where provider preference can
drastically impact overall healthcare spending. It’s critical
that medical groups begin to understand their internal
variation with respect to care delivery as government and
commercial payers will continue to make this an area of
focus,” said Chris Smedley, vice president of physician
enterprise solutions at Premier.
CMS bills physicians for services delivered to patients with
preference-sensitive conditions. Moreover, evolving valuebased payment models are beginning to limit annual
services for or create a set amount of dollars to treat
patients for preference-sensitive conditions.
In the shift toward value, there is a risk for overtreating
and undertreating, but providers also need to focus on
the patient experience. Unnecessary procedures and
tests that aren’t needed can have both short and longterm effects on patients. Reducing variation goes a long
way in improving the patient experience — a key factor in
successful population health management.
Using data to understand physician performance
A common challenge in medical groups is that evidencebased care practices have not been well documented or
understood. Access to timely, actionable and accurate
insights is essential for providers to understand how
to respond to external forces, as well as effectively
standardize and optimize medical group performance.
Physician practices need analytic reporting systems that
show how individual clinicians stack up against their
peers, but they often rely on surveys based on outdated
information with limited sample sizes. Providers that
rely on surveys are challenged with the accuracy of the
information received as responses can be skewed based
on the interpretation of individuals completing the survey,
among other things.
Having access to meaningful insights is also becoming
increasingly important as health system and physician
practice leaders work together to navigate the
complexities of the healthcare landscape.
“It’s really not about the need for more information.
Medical groups have this data. But they often don’t know
what questions to ask and lack the right technology to
properly manipulate it,” Mr. Smedley said. “We need to
find ways to use the data medical groups already have
to highlight the variation that exists and understand
how and why physicians are treating patients differently.
Once physicians validate the data and agree there are
opportunities, they are often naturally motivated to figure
out what’s driving variation.”
Medical groups, as well as the employers and health
systems working with them, are searching for ways to
provide more coordinated, higher-quality care at a
better price point, and position themselves as the choice
provider in their markets.

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