Suppose for a moment that you are an administrator in an organization that provides health care and your job is on the line for delivering both savings and improved care. Because you want to be part of the solution to the health-care-cost problem, you have signed contracts with payers that reward your institution or system for reducing the costs of care. These same contracts require you to pay a penalty if the costs of care go up more than inflation. What would be your first, second, and third move?
This is not a hypothetical question. More than 300 hundred administrators of accountable care organizations (ACOs) across the United States are facing it.
My team at Partners HealthCare in Boston is faced with this exciting (and daunting) challenge. Having signed shared-savings contracts with both commercial payers and Medicare, our CEO, Gary Gottlieb, established a Population Health Management unit. A major focus of our work is to achieve shared savings in our contracts. That means controlling costs for the populations cared for by our primary care physicians. Since doctors and hospitals within Partners bill for a majority of the care these patients receive, you could say our success depends on reducing the income of our colleagues. Harvard Business School’s Clayton Christensen has taught us this is not possible — that an organization will not cannibalize itself.
So when we go knocking on the doors of our department chairmen and senior administrators, you might expect the conversations to be difficult. Surprising as this sounds, most of those conversations are truly exciting. You see, the people who spend their lives delivering health care are passionate about the patients they serve, know more than anyone else about care delivery, and have lots of ideas about how to make health care better. What makes the conversations exciting is the richness of the innovative ideas and the prospect that they might actually get to try them. These are the kinds of ideas you’ll see in the “From the Frontlines” articles in the Leading Health Care Innovation insight center that HBR and the New England Journal of Medicine are hosting.
These innovations include some easily recognized themes, but their interest lies in the specifics. For example, giving more decision-making authority to non-physicians is a well-recognized path to more efficient care, but lots of real world obstacles can obstruct implementation. So the specifics matter — specifics like the protocols used at Cleveland Clinic that allow respiratory therapists to manage patients’ respiratory conditions.
Another theme — matching patient problems with the most knowledgeable clinicians — can be seen in Montefiore’s home wound-care program. Still another theme – putting information in the right place at the right time (with or without some enabling information technology) can be found in several articles, including “Stat! A Rapid Communication App for High-Acuity Care,” “A Tool to Improve Mobility in Hospitalized Patients,” and “An Electronic Modified Early Warning System Can Reduce Mortality.”
And some problems require a multifaceted approach like the program that Intermountain instituted to reduce injuries that patients and staff suffer while the former are being moved. (The Intermountain program also highlights the importance of analyzing data to uncover hidden sources of problems.)
The innovations highlighted in the From the Frontlines articles include some unavoidable implementation challenges. In implementing their innovations, clinicians struggle with ensuring that any change benefits as many patients as possible and no patient is shortchanged. Achieving this goal can be tricky and usually ends up making the new process much more complicated than when it was first conceived. So one of the challenges we face is balancing the requirement for greater efficiency with the very real complexity of the many faces of human suffering.
Nonetheless, in our experience, anyone taking up this challenge is handsomely rewarded. As the late Michael Crichton, the best-selling novelist who held an MD from Harvard Medical School, pointed out in his 1970 book Five Patients, for health care to change, it is the physicians, nurses, technicians, and even the administrators of health care organizations who will need to make the changes. It is their ideas that will incorporate a deep understanding of the biology of human disease with a fiduciary’s eye toward cost containment and a “how I would like my mother to be treated” approach to care delivery. So the men and women who have devoted their lives to patient care can get pretty excited when the response to their innovative ideas is: Let’s try it.
Date: September 25, 2013