It’s safe to assume that overachievers typically set very specific goals – and then do everything in their power to bask in the glory.
For instance, it’s likely that when Michael Phelps gets in the pool to swim the 100 meter butterfly, his goal is not to simply swim fast. His goal is to swim the race in 49.81 seconds – and set a new world record. Why? “Swimming fast” doesn’t really mean much. To solidify his position as the premier swimmer in the world, Phelps needs a specific measurable goal, not some vague idea of what he wants to do.
Healthcare providers now need to swim in the same fast lane. Why? Over-achieving is becoming a prerequisite for mere survival in the healthcare industry. Certainly, with the economy still struggling and healthcare reform a reality, providers need to bring their “A game” – treating more people, doing so with decreasing levels of reimbursement and providing better care.
More specifically, under the auspices of healthcare reform, providers will need to treat a growing number of Medicare patients. By 2016, some 30 million people who are currently uninsured will have coverage and will be seeking services. Although providers will welcome the increased volume, the challenge will be to more cost effectively treat this growing population, the majority of whom will be covered by government payers. In other words, providers will no longer be able to balance their Medicare reimbursement with more robust payments from commercial payers.
At the same time, reform ups the ante regarding quality of care. The legislation emphasizes prevention and wellness, and is expected to result in fewer, less-expensive acute episodes. Performance-based payments, reduced payments for readmissions, Medicare penalties for poor outcomes and hospital-based purchasing programs that reward quality outcomes are just a few of the reform elements that will prompt healthcare organizations to improve clinical care.
As a result, providers across the country are hustling to meet the healthcare industry’s ever-present superlative of “providing quality care while cutting costs.” To do so, leaders need to adopt a performance improvement model that produces results by keenly focusing on key performance metrics.
Such goal setting is especially important when trying to improve financial results. A broad project – where the goal is simply to improve financial health – often results in nothing more than a whole lot of inertia.
A metrics-driven performance improvement approach requires that providers:
Set specific, measurable goals. If a provider wants to improve the quality of patient access, leaders need to key in on specific metrics that can make the goal a reality. Instead of broadly aiming to improve point-of-service cash collections, the system should be set up to zero in on key performance indicators – such as collecting $75 cash per eligible encounter, for example.
Measure the progress toward reaching their goals. Unfortunately, healthcare leaders often only have a very vague idea of whether or not they are achieving goals because they simply don’t measure performance or the measurement of certain metrics requires pulling data from a number of disparate sources. Under such circumstances, providers infrequently examine data or make decisions based on limited data. Instead, healthcare leaders need a performance analytics scorecard that specifically tracks how the organization is progressing toward key metrics. The revenue management system also should pull data from multiple systems into one database – thereby enabling users to take action and ultimately meet their goals.
Tweak technology to facilitate the movement toward the goals. Healthcare organizations need to continuously fine-tune performance in an effort to more expeditiously achieve defined goals. Think of it like this: Michael Phelps’ coach constructs his workouts so that the swimmer can meet specific goals. For example, if setting a world record in the 100 meter butterfly is the objective, the workouts probably would emphasize butterfly training, not breaststroke technique.
Healthcare organizations need to fine-tune performance in a similar manner. If a provider is trying to reduce the number of insurance denials, they might discover the need to go beyond simply checking eligibility when the patient presents for treatment. A rule could be created in the revenue management system that says “if the patient’s condition changes, then eligibility must be verified in the system again.” Customizing systems with rules engines that automatically alert users when certain metrics are falling outside of desired parameters accelerates the movement toward measurable goals.
By taking this metrics-based performance improvement approach, healthcare organizations optimize their use of technology. Defining and agreeing upon metrics early on in the process brings about the necessary buy-in from leaders and enables organizations to achieve the business process change required for success. Instead of simply installing software, the solution is leveraged to enhance performance and push organizations to exceed expectations. The end result: Healthcare providers realize a return on their investment in technology – and then some – by meeting the specific goals that are vital to the organization’s unique definition of success.
Jim Morrison is Vice President and General Manager, Revenue Cycle, McKesson Provider Technologies.