As the shift to value-based payment models picks up steam, a new piece in Harvard Business Review states that this factor alone isn't enough to fundamentally change the way care is delivered.
Duncan Maru, M.D., Ph.D., is the co-founder and chief operating officer of Possible, an organization that works with the government in Nepal to run a hospital, several health clinics and a community health worker network. He says the organization faces many of the same challenges that U.S. providers experience in the effort to reform the fee-for-service paradigm.
"As in many other healthcare systems, providers are conditioned to treat patients with authoritarianism, focus on acute systems rather than chronic or preventive care, and to use inept vitamins and antibiotics to treat almost all conditions," he writes.
And the shift to value-based payment models doesn't necessarily mean this mindset will change, Maru argues. Instead, his organization has turned its focus to promoting managerial discipline and worker behavior change to lower costs and boost outcomes in the Nepali healthcare system. Here are some of the best practices that Possible has uncovered in this quest:
Standardize protocols. There likely will be an abrupt shift from a fee-for-service model that values customized care, Maru writes, which can be both expensive and ineffective. Instead, his organization standardizes medical interventions, particularly in the realm of how providers prescribe medicines.
Clearly define roles. While U.S. healthcare leaders have increasingly focused on engaging physicians, it's also important to maintain a healthy degree of separation between administrators and clinicians, according to Maru. He argues that allowing managers to manage and clinicians to focus on clinical outcomes plays to each group's individual strengths in a way that leads to better job performance.
Embrace technology. Despite its role as a rural provider, Possible has increased its efficiency with a computer-based project management system, an electronic stocking system and electronic medical records. "In 21st century healthcare, these are basic tools for effective care delivery, yet are frequently missing, even in less impoverished settings than rural Nepal," Maru writes.
Hold staff accountable. Organizations that ensure that even seemingly small tasks such as cleaning bathrooms and fixing beds are completed can make a big difference in terms of patient experience, according to Maru. His organization also tracks patient-centered outcomes to measure the effectiveness of providers and their managers, a strategy that has already enveloped the U.S. healthcare industry through entities like accountable care organizations.
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