Merg­ing clin­i­cal and op­er­a­tional data to drive per­for­mance im­prove­ment

In this in­ter­view, Fiona McNaughton of IBM Wat­son Health dis­cusses the im­por­tance of com­bin­ing clin­i­cal and op­er­a­tional data so that providers can un­der­stand ar­eas where they can im­prove.

Modern Healthcare - - News - By Adam Ruben­fire, Mod­ern Health­care Cus­tom Me­dia


Fiona McNaughton over­sees of­fer­ing man­age­ment for IBM Wat­son Health’s Per­for­mance Man­age­ment so­lu­tions fo­cused on the cost and qual­ity of care. She has been with IBM Wat­son Health and for­merly Tru­ven Health An­a­lyt­ics for 13 years.

Why is it im­por­tant to un­der­stand the driv­ers of risk, cost, and qual­ity care?

FM: I would say that the pres­sure to de­liver high qual­ity care at an af­ford­able cost, or an af­ford­able price, is not go­ing to go away, nor should we want it to. It doesn’t mat­ter whether you’re in a fee-for-ser­vice or value-based en­vi­ron­ment, or strad­dling both, which is what we see in a lot of cases. That pres­sure be­tween cost and qual­ity is al­ways go­ing to be there. Un­der­stand­ing the driv­ers be­hind what’s con­tribut­ing to your cost, qual­ity and risk be­comes more in­tense as you’re look­ing at tak­ing on risk. If you don’t know what’s driv­ing your costs and out­comes, and you don’t un­der­stand where you have op­por­tu­ni­ties to im­prove, it be­comes dif­fi­cult to ef­fec­tively as­sess risk and whether it would be ap­pro­pri­ate to go into some­thing like an al­ter­na­tive pay­ment model or risk-bear­ing con­tract.

What com­par­isons are use­ful for ex­tract­ing the max­i­mum in­sights from these kinds of an­a­lyt­ics?

FM: When you’re mea­sur­ing how well you’re do­ing, mea­sur­ing your per­for­mance alone just tells you what you’re do­ing. It doesn’t tell you how well you’re do­ing. It’s not un­til you start com­par­ing your per­for­mance that you can re­ally un­der­stand how well you’re do­ing.

When we’re do­ing those com­par­isons, you re­ally need to do a com­par­i­son based off a level play­ing field. You should com­pare against other hos­pi­tals with sim­i­lar or­ga­ni­za­tional char­ac­ter­is­tics, or pop­u­la­tions with sim­i­lar pa­tient risk and sever­ity.

What tech­nolo­gies can help providers un­der­stand and as­sess their risk, cost and qual­ity of care?

FM: I ac­tu­ally think it’s less about what tools are avail­able, and more about how you dis­cern be­tween them. We fre­quently see hos­pi­tals and provider or­ga­ni­za­tions sup­ple­ment­ing their ex­ist­ing sys­tems with ad­di­tional tech­nolo­gies that meet very spe­cific tar­geted needs around things like per­for­mance im­prove­ment, pop­u­la­tion man­age­ment or clin­i­cal out­comes. That can get re­ally con­fus­ing if your an­a­lytic in­sights aren’t com­ing from a con­sis­tent and re­li­able source, or if you don’t have a cen­tral­ized an­a­lytic strat­egy. Providers need to bring to­gether those ac­tion­able in­sights in a con­sis­tent way, so that they have a sin­gle, re­li­able source that they can use to make de­ci­sions.

How can emerg­ing tech­nol­ogy help providers suc­ceed in both fee-for-ser­vice and value-based care?

FM: We’re re­ally see­ing that need to pull to­gether the dif­fer­ent di­men­sions of how you think about per­for­mance, and the driv­ers be­hind the per­for­mance, so that you get that more com­pre­hen­sive pic­ture, and you can see how things in­ter­act to­gether. I would say that par­tic­u­larly, in the shift to value-based care, we’re see­ing a lot more at­ten­tion be­ing paid to qual­ity out­comes by stake­hold­ers across provider or­ga­ni­za­tions than may have pre­vi­ously been seen in years in the past. With that, we’ve found a lot more re­quests for qual­ity and fi­nan­cial met­rics to be avail­able in an ac­tion­able, ac­cept­able and con­sum­able way for var­i­ous stake­hold­ers through­out an or­ga­ni­za­tion. •

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