Coordinating care and moving beyond the silos that dot the healthcare landscape are urgent necessities. As the world population ages and chronic diseases become more prevalent, it's time to act collectively. Our experience with clients in the U.S. and globally has given us insights into effective strategies and steps in developing and improving care coordination. We will focus here on three key imperatives: collaboration between payors and providers, coordination within complex healthcare systems and rigorous tactical business planning at hospitals.
1. Patient-centric coordinated care. Accountable care organizations and patient-centered medical homes can be cornerstones of the effort to provide value-driven quality in healthcare services. Our experience shows that leading organizations are succeeding by:
2. The development of common standards. Common standards could ease the task of implementing ICD-10 as well as electronic health record and health insurance exchange technologies. For example, ICD-10 co-design could help simplify payment modeling discussions and transactions processing.
3. The use of robust analytics in population health management. The focus should be on collecting, organizing and analyzing data to yield insights that lead to better patient outcomes, cost conservation and higher member satisfaction. To develop and execute a sustainable growth strategy, organizations need to apply the power of analytics.
4. The use of feedback to drive better outcomes. Pharmacy offers a useful example. Payors can provide data on claims trends and gaps in care. Practices can provide evidence-based protocols and patient preferences. The result is an optimal medication regimen with improved adherence and cost-effective formulary alternates.
1. Standardize the transfer process. Healthcare systems should develop "one-stop shops" to help streamline bed management and patient transfers. Employees could turn to these resources for policies, processes and templates as well as suggestions on staff roles and responsibilities. Systems should also standardize transfer-related processes and incorporate diagnosis-related group/utilization management information into the transfer decision process to improve patient access and reduce out-of-network costs.
2. Use dedicated resources to manage patient flow. Systems should identify a dedicated resource to manage patient flow. Examples include patient flow coordinators, "bed czars" and utilization management coordinators.
3. Optimize the use of patient flow software applications and tools. Patient flow IT tools allow beds to be efficiently and effectively monitored in the emergency department, inpatient/acute care and the operating room. Systems should ensure that data from the applications can be viewed in real time, using a “control tower” approach that allows staff to track intra-facility movement and inter-facility transfers simultaneously.
4. Develop communication forums. Systems should conduct daily multidisciplinary forums among facilities to coordinate patient needs with the plan of care.
5. Operate efficiently. Systems should use continuous process improvement methodologies, including Lean Six Sigma and queuing theory, to support inter-facility transfers. Opportunities for process improvement include:
6. Establish a performance management process. Systems need to:
To minimize volatility and maximize efficiency, hospitals should develop and deploy a comprehensive business process framework. The first step is to develop a tactical business planning process. Personnel who are central to a hospital's tactical management should take part in a biweekly process of reviewing past performance and assessing future needs. This helps align supply and demand. By increasing the visibility of well-defined patient groups over a period of one to three months across the hospital’s entire logistics network, the facility can reduce queues and waiting lists while improving financial performance.
IT solutions are central to an effective tactical planning process. Hospitals should drive improvement using sophisticated analytics involving:
Successful end-to-end implementation of the process requires an all-encompassing approach. This includes a detailed methodology for process and data analysis, deployment of the process and related software for comprehensive decision support, and change management and integration support. The potential gains include an enhanced patient experience due to a structural reduction in waiting times, increased patient flow without additional capital investment and improved resource utilization.
The views expressed herein are those of the authors and do not necessarily reflect the views of Ernst & Young LLP.
Payor and provider collaboration
Payor and provider collaboration should consist of four important areas of focus:1. Patient-centric coordinated care. Accountable care organizations and patient-centered medical homes can be cornerstones of the effort to provide value-driven quality in healthcare services. Our experience shows that leading organizations are succeeding by:
- Sharing transparent, actionable data with the right people in the right place at the right time
- Combining health plans' claims data with real-time clinical data from practices
- Providing shared services and resources
- Gaining buy-in from all stakeholders in the healthcare ecosystem, especially physicians’ groups
- Revamping payment models to include comprehensive payment for comprehensive care, enhanced reimbursement to primary care providers and a focus on outcomes and value-based reimbursement
2. The development of common standards. Common standards could ease the task of implementing ICD-10 as well as electronic health record and health insurance exchange technologies. For example, ICD-10 co-design could help simplify payment modeling discussions and transactions processing.
3. The use of robust analytics in population health management. The focus should be on collecting, organizing and analyzing data to yield insights that lead to better patient outcomes, cost conservation and higher member satisfaction. To develop and execute a sustainable growth strategy, organizations need to apply the power of analytics.
4. The use of feedback to drive better outcomes. Pharmacy offers a useful example. Payors can provide data on claims trends and gaps in care. Practices can provide evidence-based protocols and patient preferences. The result is an optimal medication regimen with improved adherence and cost-effective formulary alternates.
Coordination within complex healthcare systems
To achieve more effective care coordination, complex health care systems need to:1. Standardize the transfer process. Healthcare systems should develop "one-stop shops" to help streamline bed management and patient transfers. Employees could turn to these resources for policies, processes and templates as well as suggestions on staff roles and responsibilities. Systems should also standardize transfer-related processes and incorporate diagnosis-related group/utilization management information into the transfer decision process to improve patient access and reduce out-of-network costs.
2. Use dedicated resources to manage patient flow. Systems should identify a dedicated resource to manage patient flow. Examples include patient flow coordinators, "bed czars" and utilization management coordinators.
3. Optimize the use of patient flow software applications and tools. Patient flow IT tools allow beds to be efficiently and effectively monitored in the emergency department, inpatient/acute care and the operating room. Systems should ensure that data from the applications can be viewed in real time, using a “control tower” approach that allows staff to track intra-facility movement and inter-facility transfers simultaneously.
4. Develop communication forums. Systems should conduct daily multidisciplinary forums among facilities to coordinate patient needs with the plan of care.
5. Operate efficiently. Systems should use continuous process improvement methodologies, including Lean Six Sigma and queuing theory, to support inter-facility transfers. Opportunities for process improvement include:
- Using IT systems to gain a comprehensive view of patient flow
- Enhancing consistency in staff member titles, role descriptions and associated skill sets
- Identifying mechanisms to track patient satisfaction with the transfer process
6. Establish a performance management process. Systems need to:
- Establish and track inter-facility patient flow metrics
- Report performance metrics and progress to a governing board
- Involve senior leadership in flow-related governing processes
Rigorous tactical business planning at hospitals
Hospitals around the world tend to excel in long-term and hospital-wide strategic planning as well as short-term, day- to-day planning. This leaves a gap in patient logistics over the medium term (one to three months). The result can be a wide variation in key indicators such as bed occupancy rates, staff productivity and patient waiting times. The workload becomes volatile as lack of coordination between supply and demand leads to many peaks and valleys. Patient care and cost containment both suffer.To minimize volatility and maximize efficiency, hospitals should develop and deploy a comprehensive business process framework. The first step is to develop a tactical business planning process. Personnel who are central to a hospital's tactical management should take part in a biweekly process of reviewing past performance and assessing future needs. This helps align supply and demand. By increasing the visibility of well-defined patient groups over a period of one to three months across the hospital’s entire logistics network, the facility can reduce queues and waiting lists while improving financial performance.
IT solutions are central to an effective tactical planning process. Hospitals should drive improvement using sophisticated analytics involving:
- A simulation module supported by a data model and methodology for describing generic and specialized care paths
- A special-purpose optimizer for key bottleneck areas (for example, operating rooms, beds and ambulatory clinics)
- A rich reporting environment allowing for the monitoring of trends in key performance indicators as an integral part of the planning cycle
Successful end-to-end implementation of the process requires an all-encompassing approach. This includes a detailed methodology for process and data analysis, deployment of the process and related software for comprehensive decision support, and change management and integration support. The potential gains include an enhanced patient experience due to a structural reduction in waiting times, increased patient flow without additional capital investment and improved resource utilization.
A challenge we can meet
In today's healthcare environment, coordination of care with a patient-centric focus is essential. Change is inevitable, whether caused by regulatory action or competitive and customer pressures. For payors and providers alike, an appropriate response requires a well-thought-out plan that addresses all aspects of care. Executive commitment to that plan is imperative. By discarding old paradigms and working collaboratively, the healthcare industry can meet the challenges at its door.The views expressed herein are those of the authors and do not necessarily reflect the views of Ernst & Young LLP.
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