The ABCs of healthcare performance management
By Yasthelle “Yasty” Puig, CPC, CRC, CPMA, CDEO, ISTQB certified
As the healthcare system continues to expand value-based care delivery, giving an effective and high-quality patient experience has taken on greater importance, particularly for providers. Under value-based care models, provider payment is linked to performance rather than services rendered.
Managed service organizations and payers play a crucial role in helping providers enhance their performance to meet agreed-upon contractual terms. However, the path to achieving these goals can be a complex and winding journey. Here, we’ll discuss the ABCs of performance improvement in the context of valued-based care.
Analyze
To provide improved performance, a comprehensive analysis is vital. One must recognize that every medical practice is unique, and what works for one may not work for another. Begin by looking over the practice’s composition, workflows, and patient demographics and reviewing data to pinpoint areas where the practice excels and areas that pose challenges. Demographics, culture, and location can introduce unique hurdles but understanding the practice inside and out can help identify the areas where intervention is most needed.
Build relationships, break down barriers
Providers and their staff may perceive consultants as disruptions to their daily routines rather than a helping force. Building relationships breaks down these barriers and earns trust and confidence, so your ideas will be heard and accepted. Start by asking questions and actively listening to their challenges and obstacles. Schedule a casual lunch with the office manager, providers, or staff to create a personal connection. Share their victories and setbacks and be memorable by introducing something fun, like a snack or activity. Building these relationships is the foundation for success.
Create and communicate a plan
Once you’ve established a relationship, it’s time to create and communicate a plan that addresses identified barriers and opportunities. It’s extremely helpful to include yourself in the plan when possible. Don’t try to fix what’s not broken; instead, offer your assistance where it’s needed. Explore avenues for support, such as making phone calls, connecting patients with qualifying programs, or partnering with local providers to close care gaps. Your involvement demonstrates commitment and increases buy-in from the practice.
Document the plan and the progress
Effective documentation is essential. Keep a record of all communicated plans and progress, and make sure to keep it in a place where they can refer to it. For face-to-face meetings, provide the practice with a dedicated binder or follow-up emails that summarize the conversation and next steps. This documentation serves as a reference point, reminding them how their efforts are paying off.
Educate and engage
Education and engagement are key components of performance improvement. Sometimes a provider group may fall short of metrics due to complex requirements they don’t fully grasp. Offering education and accessible documentation can be immensely helpful to providers and staff. Maintain continuous engagement with the practice, reach out to the practice in between visits to show genuine interest in their progress, and ensure that next steps are reinforced and resurfaced.
Follow up and follow through
It’s essential to consistently follow-up and follow-through on your promises for maintaining trust and accountability. If you promise something, ensure you deliver. Remember that trust is hard to gain but easy to lose, and reliability builds confidence in your guidance.
Gain buy-in
Presenting information effectively is just as important as the content itself, and accuracy in data is just as crucial as breaking it down into actionable items. Gain buy-in by demonstrating how their actions can lead to easy wins. For example, if by scheduling a few more patients this month, they can significantly improve their patient visit percentage. Ask, “Do you think you can schedule five more patients by next Tuesday?”
Hold accountable and provide positive feedback
If the staff agreed to scheduling five additional patients, next time you follow up with them hold them accountable by asking about it. If they succeed, praise them and provide positive feedback. If they encounter challenges, ask how you can help. Recognize the stress and workload in medical practices today is higher than ever before. Staff shortages and increased demand from patients and payers have added to an already overloaded system, so your positive feedback and encouragement will make your visits not something to dread but rather something to expect.
Inspire with incentives for increased performance
Continuous positive feedback, along with financial incentives, will ultimately result in increased performance. Providers and their staff will be inspired to excel, knowing their hard work is both recognized and rewarded.
Achieving performance improvements is indeed a challenging journey in value-based care. By following the ABCs of performance improvement management, providers, MSOs, and payers can navigate this path with clarity, precision, and a shared commitment to delivering better care to patients while improving their financial outcomes.