I had the pleasure of connecting with physician executives from across the country at Advisory Board's recent Chief Clinical Executive Summit. The conference was abuzz with discussions about strategies—and challenges—for reducing unnecessary care variation. And one of the main focal points of the conversations was engaging physicians in reducing clinical variation, which also happened to be the number one concern among C-suite hospital executives according to a 2016 Health Care Advisory Board poll.
Coming out of the Summit, two themes struck me as being top of mind for most of the physician executives I spoke with.
First, clinical executives are feeling a lot of pressure to make progress on their quality and clinical efficiency initiatives—and fast. Second, they're concerned about their ability to engage physicians in these initiatives. As I've said before—aligning with physicians requires appealing to their hearts, minds, watches, and wallets. So let me tell you what I've seen work effectively to do just that.
Uniting specialties in improvement efforts
Over the last few years, I've been working with health systems to align their physicians with inpatient care variation efforts by setting up hospital efficiency improvement programs (HEIP). HEIP is a contractual arrangement between a health system and its Clinically Integrated Network (CIN) to engage physicians in inpatient performance improvement initiatives. If there isn't a local CIN, health systems can contract with physicians directly.
You may already be familiar with co-management agreements that focus on a single service line or specialty. But HEIP is different; HEIP is designed to be cross-specialty. So rather than having multiple co-management agreements, an organization can create a single contract that aligns physicians in different specialties.
For example, a sepsis reduction initiative requires input from intensive care, hospitalists, and emergency medicine to define and execute appropriate care. HEIP brings all of these specialties together and aligns them behind a common vision to improve care quality and clinical efficiency for sepsis.
The HEIP contract is written to incentivize physicians in the CIN on key outcomes within high-variation areas. And we assemble governance and cross-specialty teams to lead the performance improvement work. When physicians are both financially incentivized and engaged in tackling the hospital's areas of greatest costs variability, it makes a big impact. I've seen remarkable inpatient cost avoidance and quality improvements in the space of just months, not years.
A fine line between the winners and losers
Of course, hospitals can improve quality and efficiency outcomes through other arrangements. But it takes a lot longer to see results when trying to tackle the long list of quality measures by engaging one specialty at a time—through separate contracts.
Last year Modern Healthcare reported that more than half of the hospitals penalized for hospital acquired conditions were on that list for the second year in a row. These are not "bad" hospitals, it's just incredibly hard to tackle inappropriate clinical variation in a way that is timely, effective, and will show meaningful impact for both your patients and your bottom line.
But good news, successfully reducing care variation is attainable. I recently worked with one large health system that identified 12 priority initiatives to improve transitions of care, condition management, and clinical utilization. Based on an opportunity analysis, we set a target of $58 million in savings over the next three years, and by the end of year one had already achieved $11 million.
Moving the dial on quality and clinical efficiency improvements isn't easy, but with the right strategy in place those financial gains could be closer than you think.