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To achieve real progress in reducing care variation, move beyond the 'bubble up'

November 13, 2017

    John Johnston

    Many health systems wrestle with the hardest decisions of their annual budgeting this time of year and the conversation typically turns to cost cutting. Increasingly, many health systems find, as my colleague Sean Angert recently told me, that they've "addressed the obvious places to raise productivity or cut costs long ago. The efforts that remain are tough challenges."

    Eventually, the budget conversation will rise to reduce unnecessary clinical cost. Many health systems suspect that the cost of treatments that do not improve patient outcomes can add up to millions of dollars, but aren't sure how to engage physicians effectively on making care more reliable, affordable, and accessible.

    More on care variation reduction

    For many health systems, care variation strategy has been siloed, amounting to the sum of unaligned clinical initiatives that have bubbled up across the organization. Real progress comes from moving beyond this uncoordinated collection approach to constructing a much more formal strategy that evaluates overall clinical performance to determine the biggest issues needing to be addressed.

    Earlier today, several of my colleagues shared their insights from our recent work on best practices for reducing unwarranted care variation (click here to learn more). Health systems seeking to raise their performance under value-based contracting should consider the implications of my colleagues' key takeaways on the care variation landscape and how organizations should respond.

    The highlights include:

    • The Congressional Budget Office has projected that 60% of hospitals will have negative profit margins by 2025 if they do not improve productivity or reduce costs.

    • Nationally, in the 16 years since the Institute of Medicine issued its landmark Crossing the Chasm report on care quality, 47% of effective treatment measures have shown no signs of uptake or are being followed less often. For example, inappropriate mammography use has resulted in 20% overdiagnosis of breast cancer cases (i.e., false-positive results where there is no breast cancer).

    • The foundation for success is built upon a permanent care variation reduction "engine" created by physician leadership that can improve outcomes and costs at scale.

    • The data needed to engage physicians on changing clinical behavior will probably need to come from more than one source, combining internal and external data to provide insight on patient outcomes.

    Collaborating with physicians to reduce care variation is one of the toughest challenges that health systems face for 2018. But it's worth it. To share one example, a health system that has engaged its physicians found that reducing unwarranted variation in hip and knee replacements alone could save patients more than 1,000 bed days across the system every year. Slashing variation can be powerful for your health system in improving reliability, accessibility, and affordability.

    Next, get 10 insights on reducing care variation from pioneer health systems

    Download our executive research briefing to get 10 key insights from our discussion at the Health System Performance on how health care executives can reduce care variation .

    Download Now

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