CFOs can partner with clinicians to achieve population health's Triple Aim

Shifting reimbursement models are forcing healthcare CFOs into unchartered territory. Beyond looking at key performance indicators and revenue resulting from patient volume, CFOs must understand the clinical challenges and costs associated with delivering high quality patient care.

Considering a study demonstrating that more than half of organizations that have implemented population health management (PHM) programs have seen a return-on-investment, partnerships with providers are needed now to achieve Triple Aim goals.

Connecting CFOs and clinicians involves understanding how each group’s environment influences decision-making. CFOs use analytics to identify effective care at the most affordable cost. On the other hand, clinicians are coping with limited resources, new technology, and increasing financial pressures to treat large volumes of patients in short periods of time.

An effective transition from the volume-based to value-based model depends on increased integration of clinical and financial initiatives. Along with having the right mix of internal expertise and staff resources to implement programs, here are some approaches for CFOs looking to partner with providers to create effective PHM programs.

1. Align resources with PHM strategies. Identifying and targeting the population that presents the most opportunity to deliver the highest wellness and financial impact is the first step to managing costs. For example, an Agency for Healthcare Research and Quality study showed that one percent of patients account for 22.7 percent of total expenses, and the top five percent of patients are responsible for 50 percent of spending. To meet the Centers for Medicare and Medicaid Services (CMS) goals of reduced hospital readmissions and decreased emergency department (ED) visits, target populations must be aligned with organizational resources, clinical outcomes, and benchmarks that demonstrate improved quality and reduced costs.
2. Outsource specialized patient needs to manage costs. Decreasing Medicare and Medicaid reimbursements are contributing to hospital closures and downsizing. As reimbursement becomes increasingly intertwined with performance, the question remains: what specific expertise do you need to support financial stability and growth? Corporate consolidation will result in organizations offering specialized services. One approach is to grow an organization’s existing expertise and services to meet a target population’s needs and outsource specialized services to other healthcare systems. For example, it may not make sense to build an oncology wing if a cancer center already exists in close proximity or if your health system lacks the volume of patient procedures to be viable in the market.
3. Increase transparency about healthcare costs and benefits. Raising provider awareness about actual care expenses versus expected benefits can improve clinical decision-making. For example, recent evidence-based guidelines recommend a “watchful waiting” approach for men diagnosed with prostate cancer with a life expectancy of less than ten years since they are unlikely to experience any quality of life benefits from radiation and chemotherapy. Yet research shows more than 50 percent of men that meet the criteria are still undergoing invasive, expensive treatments.
4. Coordinate care in patients’ comfort zones to increase satisfaction. Providing care in patient comfort zones — such as their community, a faith-based organization, among others — supports optimal patient functioning, satisfaction, and engagement in self-care. For example, the elderly represented 70 percent of 1.9 million hospital readmissions in 2012 and about two-thirds of those patients did not receive home healthcare visits that year, according to CMS. By using a coordinated care approach, selected elderly patients who meet certain criteria can receive reimbursed care support at home instead of being placed in a nursing facility. These efforts minimize crowding and avoid high ED costs.
5. Integrate PHM initiatives into business intelligence infrastructure to inform decision-making. Changing reimbursement models are requiring C-suite executives to look beyond key performance indicators to understand the costs associated with providing high quality care. Infrastructure — such as business intelligence competency centers (BICC) — aligns people and technology to integrate and extract real-time data from multiple systems to help clinicians avert adverse outcomes.
6. Align strategy across all Accountable Care Organization (ACO) members with defined performance benchmarks and payment incentives. With an increased focus on physician results based on defined ACO measures, CFOs can support data collection resources for affiliate physician offices to obtain high quality data that will drive performance improvement and reimbursement.

Shifting from a competitive fee-for-service to a collaborative fee-for-performance system requires a significant culture change, which involves increased transparency, organizational restructuring, and cooperation. To make this leap, CFOs can drive the culture shift to prepare for a sustainable future. Enhanced communication is needed among CFOs and providers to improve health at a reduced cost across the care continuum.

Wendy Vincent, RN, is a national practice director at Beacon Partners, and has served in executive and senior leadership positions with academic medical centers and Integrated Delivery Networks.