Journal of Healthcare Management - March/April 2014 - (Page 109)

c osts and B enefits of PRAC TITIONER t ransfor Ming p riMary c are p ractices A P P L I C AT I ON Anthony V. King, chief executive officer and executive director, The Wellness Plan, Detroit, Michigan R eading the article on practice transformation caused me to reflect on the various transformation processes that I have witnessed or participated in over my 20-plus years in healthcare. All seemed to have similar goals of improving quality and patient outcomes while managing costs. In the article, the authors present the case for practice transformation as a response to achieving the Institute for Healthcare Improvement's Triple Aim of improving health, improving healthcare outcomes, and reducing the costs of care. These are indeed challenging aims, but, as the study suggests, introducing a transformation process moves practices closer to achieving some degree of success. In today's environment we have many forces pushing us toward improving outcomes. Meaningful use and patient-centered medical home (PCMH) designation are two examples of programs encouraging practices to collect and use information more effectively in the treatment of the patient. In addition, insurance companies are looking at patient outcomes and attaching incentives to primary care offices' success against specific HEDIS (Healthcare Effectiveness Data and Information Set) measures. As the authors suggest, opportunity costs accompany transformation activities, as has been historically the case. When my organization began its meaningful use journey, the practice-level personnel and nonpersonnel costs associated with the implementation were consistent with those mentioned in the article, but as the practice incorporated the transformation into its everyday work, we experienced a reduction in these costs. It has been my experience that regardless of the tools used, whether continuous quality improvement, Six Sigma, Lean, or others, there are significant financial implications. For primary care practices, many benefits may be realized by going through the transformation process. As mentioned in the article, PCMH status can derive direct financial benefits. But several other financial benefits can be gained as well. For states with significant managed care populations, improving health outcomes brings direct financial benefits as practices improve their HEDIS scores. Managed care companies offer direct incentives to practices for these improvements that more than offset the cost of the transformation. My organization, for example, realized a bonus by improving the hemoglobin A1C levels of diabetes patients to within acceptable parameters. We were able to achieve this success because we underwent a transformation process that provided us with the tools to evaluate and correct our performance. Using both internal and external resources, we were able to develop the reports necessary 109

Table of Contents for the Digital Edition of Journal of Healthcare Management - March/April 2014

Journal of Healthcare Management - March/April 2014
Contents
Interview With Marna P. Borgstrom, FACHE, President and Chief Executive Officer, Yale New Haven Health System, and Chief Executive Officer, Yale-New Haven Hospital, Connecticut
Specialties: Missing in Our Healthcare Reform Strategies?
Costs and Benefits of Transforming Primary Care Practices: A Qualitative Study of North Carolina’s Improving Performance in Practice
Governing Board, C-suite, and Clinical Management Perceptions of Quality and Safety Structures, Processes, and Priorities in U.S. Hospitals
Use of Electronic Health Record Documentation by Healthcare Workers in an Acute Care Hospital System
Why Hospital Improvement Efforts Fail: A View From the Front Line

Journal of Healthcare Management - March/April 2014