Balance quality, value-based purchasing

As the healthcare industry shifts to value-based purchasing (VBP), there's "no silver bullet" to achieve better value, according to Shari M. Ling, deputy chief medical officer at the Centers for Medicare & Medicaid Services at the 9th Annual World Health Care Congress in National Harbor, Md., yesterday.

Therefore, the industry needs to find a balance for effectively measuring and scaling successful quality interventions across all domains, she said. "When we start to talk about value, that discussion is really formulated on the foundation of quality," she said.

CMS has implemented numerous quality reporting systems, along with value-based purchasing programs. However, the challenge is balancing the measurement goals across all of the programs, Ling noted. For example, clinical measures in physician quality reporting try to assess all flavors of physicians, from orthopedic surgeons to primary care providers. "But what we need is a balance between being smack on target versus what is fair and required for all providers," Ling said.

To create high levels of value and manage costs in the VBP environment, healthcare providers also must implement a modern management system, fellow panelist James Hereford, chief operating officer of the Palo Alto Medical Foundation and former executive vice president of Group Health Cooperative's group practice division, told attendees.

A better management system would enable providers effectively to bring together the physical experience of getting all the material to the right place at the right time, the cognitive experience of what goes on in the physician's head and the information management experience of moving data to the right place at the right time, Hereford noted.

With that in mind, Group Health and Palo Alto have embraced the lean model of management to improve quality and value and are seeing strong results. Palo Alto has become one of five California organizations that received four stars in pay-for-performance. Meanwhile, Group Health's lean efforts to improve care transitions led to a 25 percent drop in 30-day readmissions, more than $50 million in savings and a 20 percent jump in patient satisfaction.

Providers looking to implement lean management principles shouldn't be worried about getting physicians on board. "Physicians want to be engaged. ... They're tired of being considered the noise in the system," Hereford said. Leadership, however, can be a different story, he noted.

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