“We’ve built a successful business as a healthcare service provider. How can we break out of the growth stagnation, wasted time and money, and employee dissatisfaction imposed by manual data capture, tasks, and work hand-offs?”
Welcome to the blog, Real-World Healthcare Insights. Our second series, Maximize Value Through Process Transformation, begins here. You can read the first series, Recruiting for Your Pragmatic Clinical Study, HERE.
Our opening question illustrates a problem faced by organizations that deliver healthcare services: Improving outcomes (clinical, economic and satisfaction) while lowering cost. Healthcare organizations must deliver and seek to increase value, defined as outcomes per dollar.
Cut to the punchline: Everybody wants value—bang for the buck. Healthcare’s bang includes clinical and quality-of-life outcomes and satisfying experiences. A technology platform can maximize those outcomes while minimizing cost by eliminating costly errors, saving precious time, and reducing friction.
Maximizing the value of healthcare
For this series, we’ll focus on organizations providing healthcare services that are ancillary to those provided directly by clinicians—for example, labs, imaging, procedure scheduling or clinical trials management. We’ll look at how these organizations deliver value in healthcare, by enabling healthcare to achieve its results (2).
As we’ll explain in the next episode, achieving the most value of healthcare depends on organizing healthcare services so that they occur on time, accurately (as specified), and efficiently with minimal operational friction. These diagrams illustrate this principle: a clinical service as ordered has the potential to deliver 100 ‘value units,’ but inaccuracies, inefficiencies, or suboptimal timing in its performance take away value units along the way, so that less than 100 units are actually delivered.
The lost units may be of clinical outcomes (reduced effect of treatment or prevention) or cost (more resources expended to achieve the result). To borrow a term from economics, these inefficiencies and loss in value constitute a “deadweight loss,” one which could have been avoided. For illustration purposes, we assume ideal clinical competency and that no other factors impinge on translation of clinical competency in the (messy!) real world.
Knowing what to do, when, and how (clinical competency) are absolute prerequisites to creating value in healthcare, but to achieve the intended (maximum) value requires that the components of the process or clinical service are delivered on time, as specified and coordinated with minimal friction. When efficiency and task coordination is embedded in a technology platform, a transformation to reaping the full value of the healthcare service can occur.
In this series, we offer insights into the key role and value of process transformation and technology platform in maximizing the value of healthcare services. A technology platform acquires and manipulates data, assigns, hands off and documents tasks, manages workflow and reports on operations’ status and trends. A platform may also report on outcomes and cost (in terms of time, resources, or money).
Let’s talk about value. In healthcare, that’s outcomes per unit of cost. Generally, it is results per unit of cost. Outcomes include clinical, functional, and quality-of-life results. Products and services come with a value proposition: a (hopefully) clear statement of the kinds of results or outcomes they provide, along with a “how we do it.” So a value proposition is a what and a how. The value proposition metrics allow us to evaluate whether the product or service did what we paid for it to do, but the value proposition by itself address the cost of outcomes.
Generically, estimating value involves:
Determining the value of clinical interventions is a deep and complex subject but fortunately, our task here is more straightforward: it’s mostly about the cost of achieving a result or outcome. Improving how healthcare services are enabled can also improve clinical outcomes (for example by reducing errors or improving the patient’s experience) but for now, our focus is on how implementing a technology platform to transform healthcare services can get the desired result more quickly, smoothly, with greater ease and at a lower cost.
Are we getting the value we’re paying for? Statins are well-known to reduce the risk of heart attack, stroke, and revascularization in people with cardiovascular disease or diabetes (3). But achieving their full benefit requires consistent adherence (taking at least 80% of prescribed doses) over a long period. Full statin value, then, requires this level of adherence. Less adherence (or good adherence for too short a time) reduces the benefit (health outcome) more than it does the cost—a case of paying for more value than one actually gets.
A study published in 2005 on adherence to diabetes medication shows this nicely. (4) As adherence increased, hospitalizations decreased, and the drop in medical costs more than offsetting the increased cost of medication. Many factors figure into a patient’s adherence to treatment, but we would hope that a system that ‘knows’ how to track these factors with minimal effort would be likelier to improve adherence (and thereby increase the value of the associated healthcare) than one that relies on manual actions recorded (if at all) across several paper or electronic documentation and tracking silos.
Now apply our value question to healthcare overall: 18% of GDP in 2017 in the U.S. Did we get what we paid for? How would we know? Could we have paid less to get the same (or even better) health outcomes? We’ll tackle that in the next episode’s deeper dive into value, but for now, we can confidently say that we’re leaving money (and outcomes) on the table in large measure because of the way we think about (strategize) and implement healthcare processes.
To see this, consider this depiction of a typical healthcare process; such as ordering, performing, reporting and billing for an x-ray or lab test; scheduling operating rooms in a hospital or outpatient surgery; or recruiting patients into a clinical trial.
This process feels fragmented, as many processes in healthcare are. The links among the parts cobbled together from largely manual data entry, task assignment/hand-offs, and documentation. The system’s organization exists at a conceptual level, but it isn’t thoroughly automated with built-in efficiencies, error-checking, workflow tracking, or actionable metrics. Duplication of work and errors are inevitable. So is employee frustration.
In contrast, how does the transformed process, which achieves the same desired results, feel? It’s cleaner and uncluttered because it’s the product of an end-to-end redesign thoroughly supported by an enabling technology platform, customized to specific needs.
For healthcare to deliver its intended value, it must ensure that its service processes are carried out accurately, reliably (right person, right time, right circumstances), safely, without duplication or waste, and securely. Accomplishing this relies on thoughtfully (5) redesigning processes and enabling them with an integrated operations technology.
The operational friction imposed by manual or disjointed processes results in:
What’s in store in this series?
We’ll focus mainly on the cost part (denominator) of the value equation, and how an extensible, scalable services technology platform can help maximize the value in healthcare services by strategically leveraging electronic data capture; algorithmic decision support; task and transaction assignment, documentation, hand-offs and audit trails; workflow management; and data security to:
We’ll show you by building a use case example around each of three themes:
Next up: How can process transformation maximize value in healthcare?
We invite your participation! Join the conversation below or contact us if you want to know more.