Variation is alive and well in hos­pi­tal per­for­mance. Grow­ing vol­ume of data holds key to change.

Modern Healthcare - - MODERN HEALTHCARE -

Variation in hos­pi­tal per­for­mance is alive and well, as shown by Tru­ven Health An­a­lyt­ics’ stud­ies con­ducted ex­clu­sively for Mod­ern Health­care. Variation con­tin­ues to be a prob­lem, de­spite pro­duc­tive ef­forts of hun­dreds of or­ga­ni­za­tions and hun­dreds of thou­sands of health­care pro­fes­sion­als ded­i­cated to per­for­mance im­prove­ment.

The per­sis­tence of wide dis­par­i­ties in hos­pi­tal per­for­mance is a red flag for all health­care net­works, whether led by a health sys­tem, an in­surer, a physi­cian group prac­tice or a self­in­sured em­ployer. With health­care re­form now un­der­way, re­li­able out­comes and costs across the en­tire net­work are “musts” for suc­cess in man­ag­ing the health of a given pop­u­la­tion.

Anal­y­sis of the align­ment of hos­pi­tal per­for­mance within health sys­tems in Tru­ven’s 15 Top Health Sys­tems study showed that nar­row­ing sys­temwide variation is a much more dif­fi­cult chal­lenge than re­duc­ing variation within a sin­gle hos­pi­tal. Our re­sults demon­strate that even the high­est-per­form­ing health sys­tems show wide in­ter-hos­pi­tal variation on in­di­vid­ual mea­sures in both achieve­ment and im­prove­ment. Even wider variation was iden­ti­fied in a sep­a­rate Tru­ven Health anal­y­sis of self­in­sured em­ployer and health plan net­works. Em­ploy­ers and pay­ers of­ten se­lect hos­pi­tals based on ge­o­graphic lo­ca­tion and price be­cause qual­ity in­for­ma­tion is of­ten not avail­able. The prac­tice re­sults in sub­stan­tial variation in per­for­mance across the net­work. Cur­rently, we are ini­ti­at­ing work with a self-in­sured em­ployer and providers to col­lab­o­rate on find­ing meth­ods to re­duce avoid­able costs and in­creas­ing qual­ity while driv­ing higher re­li­a­bil­ity.

A new wrin­kle in prov­ing value is the advent of health in­sur­ance ex­changes. State gov­ern­ments, ex­em­pli­fied by Min­nesota, are al­ready ed­u­cat­ing cit­i­zens about se­lect­ing in­sur­ance through the ex­changes. Con­sumers are learn­ing that for the first time, they should have ac­cess to com­par­a­tive price, qual­ity and pa­tient-sat­is­fac­tion in­for­ma­tion when they choose a health plan. In the past, con­sumers have had to as­sume sim­i­lar qual­ity of care when they se­lected their health in­sur­ance for the year. As con­sumers be­come ac­cus­tomed to us­ing data to make their choices, the re­li­a­bil­ity of qual­ity, cost, and sat­is­fac­tion of the health­care net­work is likely to be­come crit­i­cally im­por­tant.

The new par­a­digm of man­ag­ing pop­u­la­tion health, cou­pled with point-of-sale per­for­mance in­for­ma­tion, will sig­nif­i­cantly in­crease in­cen­tives to re­duce variation. Net­works with­out high re­li­a­bil­ity of qual­ity and cost will be at a ma­jor dis­ad­van­tage in the fu­ture mar­ket­place as con­sumers are able to make more in­tel­li­gent choices. Un­der th­ese cir­cum­stances, variation should drop sig­nif­i­cantly over the next few years. We look for­ward to mea­sur­ing that progress.

Jean Chenoweth Se­nior vice pres­i­dent of per­for­mance im­prove­ment and 100 Top Hos­pi­tals, Tru­ven Health An­a­lyt­ics

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