Shift to value-based care requires cultural transformation

Healthcare's need to transition from volume- to value-based care models is a constant refrain in the industry, but the shift has hit a rough patch that demonstrates organizations can't achieve true reform until they change their cultures, according to a Health Affairs blog post.

Major studies on medical homes and readmission prevention last year often produced negative or disappointing results, writes Stuart Pollack, M.D., medical director at Brigham and Women's Advanced Primary Care Associations, South Huntington in Jamaica Plain, Massachusetts. In addition, many accountable care organizations (ACOs) continue to leave the Pioneer ACO program. 

Moreover, he writes, only 53 of the original 220 ACOs participating in the Medicare Shared Savings program kept spending at levels that qualified them for performance payments. This doesn't mean it's impossible to deliver higher quality care at lower cost, Pollack says. But organizations that try to replicate the results of successful Triple Aim initiatives often have the wrong focus, emphasizing raw process over shifts in culture and principles, according to the post.

To make these necessary changes, he recommends the principle of Adaptive Reserve, or maintaining a consistent vision, learning culture, interpersonal relationships and communication and shared leadership: "[n]ot differences in functional processes, but differences in cultures."

To create such a culture, he suggests healthcare leaders implement processes that address:

  • Hiring practices
  • Individual/team development
  • Meeting strategies, with specific emphasis on huddles
  • General leadership strategies
  • Team, inter-team and team-leader communication
  • Vision and mission

It's not enough to implement these practices; intent matters as well, he says. Successful organizations will view these practices as the ongoing backbone of their processes, not as items on a checklist that they must complete.

"Culture can be designed, engineered, and executed," Pollack writes. "Organizational leadership can invest in building incredibly tight processes around hiring; individual, team and leadership development; communication, huddles and meetings; and most importantly, a strategy for communicating and living a shared set of principles."

To learn more:
- read the post