Two Canoes … and Four ‘I’s

Change: No two healthcare provider organizations experience it the same way. Some actively pursue development of clinically integrated networks and accountable care organizations, others double down on traditional healthcare practices. Many are paralyzed, not knowing what to do or how. The transition from volume to value has been described as “stepping from one canoe to another midstream.” Although the analogy clearly depicts the challenge, it doesn’t instruct healthcare executives how to successfully execute the step without falling in. The American Hospital Association has tackled this task by publishing a series of white papers describing the journey as moving from “first curve” to “second curve” healthcare. The most recent, Your Hospital’s Path to the Second Curve: Integration and Transformation (January 2014), provides 10 strategies, necessary organizational capabilities and potential paths for hospitals. It depicts a number of case study organizations that are actively “living in the gap” between volume and value, and describes various integrated delivery programs to improve care coordination, physician alignment, performance measures and patient outcomes. While most volume to value publications rarely address healthcare information technology, except to say “implement EHRs” as part of clinically integrated care, this white paper takes it a step further. It encourages health systems to “conduct information exchange” and use information systems to:

  • Implement electronic health records
  • Enhance health information system interoperability across sites of care
  • Use existing data to facilitate analysis and reporting for process improvement and behavioral change
  • Use predictive modeling for population health management
  • Use data analytics for care management and operational management

Yet, many health systems and providers are challenged to successfully execute these recommendations. In fact, we find the operational, clinical, financial, technological and legal unintended consequences of HITECH often undermine the potential benefit. Many clinicians still ask “why” and have not incorporated needed workflow changes.   Healthcare executives question what value they have received for their multimillion-dollar investments. To a certain degree, the focus on Meaningful Use and its incentives has been the “technology tail wagging the dog.” Rather than leading with the business strategy we wanted these systems to enable, the healthcare industry focused on the technology. So while healthcare strategists are actively living in the gap and planning the next step on the journey to value, clinicians and other users of information technology are struggling with the day-to-day impact these systems have left on care delivery. Rather than rushing to select health information exchange applications, layer on business intelligence systems and purchase care management systems, we suggest an alternative approach focused on value creation and realization. It starts with one letter – “i.” My friend Praveen Chopra, Executive Vice President and Chief Information Officer at Thomas Jefferson University and the TJU Hospital System, started his career outside healthcare in retail and supply chain. “Rather than focusing on technology, the healthcare industry should focus on three “i’s” – information, integration and innovation,” Chopra says. At Maestro Strategies, we also want to focus on one more “i” – insight. We believe that a focus on these four words will help drive more value as we take the next steps on our joint transformation journey. Our “i-men” characters help us tell the “why,” and with this new website, we plan to bring our clients and friends specific strategies and tactics to help execute on the change and close the gap between the two canoes.

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