The following is an abbreviated version of ourwhite paper with the same title. For the full white paper, which offers additional insights on each characteristic or attribute, please click on the button at the bottom of this page.
Prompted by the Affordable Care Act (ACA) and numerous other environmental factors, many healthcare organizations, physicians, employers, and newcomers to the industry have been simultaneously focusing on multiple objectives to decrease an unsustainable cost of care growth while improving the quality of care and access for millions of patients. A question for healthcare organizations to consider is how to remain relevant to patients and financially viable in an industry that has been in and will likely continue to be in a constantly developing landscape?
We have observed consistent and common characteristics or attributes among the leaders and many of the employees who work in the highest performing organizations. Here are 10 of these characteristics to consider as you journey through this sometimes uncertain and sometimes turbulent, but always challenging and many times rewarding industry we call healthcare. Some of the characteristics below are basic, but well worth mentioning again because of their foundational importance.
1. Continuously Learning, Well-informed, and Insightful. These organizations understand the current environment with an eye toward the future change trajectory. It is only by keeping a constant pulse on the numerous environmental factors that have multi-faceted impacts such as political (government), economic (market segment), social (population), and technology (information, devices, web) that high-performing organizations can begin to make meaning of the trends and organizational changes required. In turn, they can set their course and pursue imperatives that best position them to be successful in this dynamic environment of healthcare.
2. “Change-Forward” with Bold, Inspiring Vision. High-performing organizations are not satisfied with incremental change, but desirous of “breakthrough, transformative change.” They are not just “change ready,” but embrace change management as a competitive advantage. The type of change underway in healthcare is clearly significant, and the pathway to the transition from fee-for-service to value-based care is not a clear one. It is being discovered through pilots, trial and course correction, and some failed attempts.
3. Agile and Adaptable. High-performing organizations continue to pursue strategy and find value through staying agile and adaptable. Because the world is accelerating the time frame, the strategy needs to be more flexible and “opportunistic” and is rarely beyond one to three years with an emphasis of planning the specific goals of the most immediate year. Prioritizing the change underway for the organization according to strategic pillars and related value proposition is important to manage the diverse portfolio of imperatives. These pillars translate into multiple project efforts that are more synergistic with similar goals (and measures to impact). For example, improving OR throughput, while addressing readmission issues, and while creating new care models of evidence-based care, are not an unusual portfolio of programs with different timelines and needs of an organization.
4. Actionable Information-Oriented. These organizations understand how to translate data into data analytics, into information, into transparent, actionable-information and ultimately, into “predictive analytics.” Many organizations are challenged by the following: overall analytics framework that does not outline and prioritize information or reporting needs; overlapping reporting efforts across various analytics silos; limited transparency and understanding of reporting capabilities and queues of each silo; and limited or no understanding of alignment of analytics efforts against strategic and operational goals. Unfortunately, much of this disarray and uncertainty stymies action or creates “analysis paralysis.” Many high-performing organizations have analytic strategies to ensure they are leveraging data and actionable information to gain a strategic market position and incorporate that into their value-based payer strategies. When successful in addressing the challenge of “actionable information,” these high-performing organizations can, for instance: Improve access to care across the network; create information architecture in support of population health initiatives; continually improve provider network’s performance while decreasing spend; evaluate clinical programs and initiatives and understand the effect of the interventions and return on investment; and reduce out-migration of patients and better understand referral patterns across the network.
5. Financially Disciplined. High-performing organizations have financial discipline as a priority. This is to meet the vision and mission of the organization while achieving a financial balance between the capital needs and financial capabilities. This translates to clarity on the level of strategic investment the organization can make relative to an overall operating profit and loss portfolio and credit rating objective. A well-integrated, strategic, financial, and capital planning process is paramount to achieving the balance. Defining the financial goals forecasted out 5 years and annually, along with clear objectives designed to meet the expected well-defined capital needs is a key goal.
6. Respectful and Optimized Staffing. One of the greatest “wastes” in healthcare is not deploying staff at their “highest and best” use. With labor typically comprising more than 50 percent of any hospital or health systems expenses – salaries, wages, and benefits are typically a common “target” for cost savings. Unfortunately, an “across the board” cut or an even more focused reduction in force, tends to never get to the “root cause” of underlying disjointed, ambiguous, and sometimes even broken processes, and certainly the savings are never sustained.
High-performing organizations engage their staff from the “ground up” or by the “diagonal slice” in helping to resolve the long-standing challenges of more efficient and effective care. These organizations will assess the entire “human capital value chain,” ensuring best practices in strategy and talent management (workforce planning, employee engagement, learning and development), workforce management (scheduling, staffing and assignment, span of control, productivity, coaching and mentoring) and human capital operating model (reporting and analysis, improve and control, training, benchmarking).
7. Accountable and Execution-Focused. Many organizations, if not most, struggle with implementation and effective execution. The reasons are numerous: inability to effectively prioritize; multitude of initiatives dilutes effectiveness; “analysis paralysis”; “no one is accountable”; and overwhelmed staff already busy doing their “day jobs.” Effective transitions from direction setting and strategic planning by the leadership of the organization to execution by the middle management and frontline levels of the organization are done best by high-performing organizations. High-performing organizations have found a nuance to increase accountability – creating venues to ensure bi-directional input between owner and sponsor for the imperative, project, or task – at the organization level and the local level at which the individual contributes. And what to do when the accountability goes beyond the four walls of the hospital? At a time when leadership extends to new groups and partners, some of which are not inside the four walls of the hospital this bi-directional exchange and development of local plans to deliver are critical to best create ownership.
8. Patient-Centric and Operationally Proficient. These organizations are focused on standardizing care processes, embracing clinical protocols, and effecting seamless, patient access. Efficient and effective operations discipline in the way care is delivered and supported, as well as, broad and deep ongoing improvement efforts, are key attributes of high-performing organizations. Maximized operational efficiency with top-decile clinical quality is the priority, with emphasis on areas that impact patient access, patient flow through the system, and effective discharge to the right post-acute care entity (“right care, right place, right time”). As well, standards set relative to evidence based care and effective standard care plans for treatment types are important to providing reliable care with reproducible patient experience and quality outcomes. Process improvement work is a key enabler to achieving these goals through practices, tools, and methods addressing waste elimination, improving inefficient operations, redesigning care processes, and standardizing work delivery. Additionally, many high-performing organizations are utilizing real-time decision-making driven by predictive analytics, enabling ability to accommodate capacity demand, complex transfers, ED boarding, and PACU holds while driving seamless patient access and maximizing resource utilization.
9. Creative Collaborators. A key attribute is partnerships and joint ventures with other providers, payers, employers, clinical technology companies, and other key stakeholders, all intended to create and increase value for patients and communities. Many organizations are challenged in determining the right value-based payment arrangement programs and investments to set up over a multi-year window (3-5 years) to realize the organization’s strategic vision and achieve financial strength. For high-performing organizations, it starts with addressing the basics of creating reliable quality care highlighted in patient centric and operational proficiency. Along with this, high-performing healthcare organizations expand this focus to connect and align the fragmented system of care delivery to improve patient experience, cost, access, and quality outcomes vertically and horizontally across the care continuum. This effort is incentivized by CMS’ continued transition to value-based payment reimbursement. New partnerships are expected, aligning physicians, payers, employers, providers, and consumers helping healthcare payments transition more quickly from pure fee-for-service to alternative payment models. Identifying the clinical programs, care models, and care interventions coupled with aligning and coordinating the physicians in the care continuum around common goals of value-based care, is a priority. Population health models and clinical and financial integration vehicles will continue regardless of administrative or legislative action as employers, providers, and patients are expecting and even demanding greater value.
10. Realizing the Value of System Integration. Many healthcare organizations, in pursuit of economies of scale and scope, have acquired a collection of overlapping units that have failed to achieve the intended goal of system integration and transformation. High-performing organizations create value through economies of scale and scope with system integration and optimizing synergies. They enact a unifying vision, strategy, processes, technology, and especially culture to achieve improved performance expected as an integrated system. With a deep understanding of financial operations and clinical care as well as the related decision-making structures and processes, high-performing organizations tend to work a customized problem-back approach to system integration, understanding the “precious few” areas to focus on that will be prioritized and sequenced in a way that creates the most value for the organization.
This top 10 is an abbreviated version of our white paper with the same title. For the full white paper, please click the button, below.
Mr. Green is a senior vice president and the practice lead for the financial operations and transaction advisory practice at GE Healthcare Camden Group. He has more than 26 years of healthcare experience with 13 years of healthcare consulting experience and 13 years of provider-based financial, operational, and strategic experience among health systems, hospitals, medical groups, management services organizations (“MSOs”), and physician hospital organizations (“PHOs”). Mr. Green has significant expertise in building high-performing teams and leading and executing transformational change. He may be reached at email@example.com.
Mr. Greene is a vice president for the strategy and leadership practice at GE Healthcare Camden Group. He has more than 18 years of strategy to execution consulting experience, including 11 years in healthcare. He has significant expertise in strategic planning, business management systems implementation, talent management, performance improvement, leadership, and leading and executing transformational and culture change. He may be reached at firstname.lastname@example.org.
The list below, compiled from CMS' Medicare Shared Savings Program ACO Performance Year 1 dataset, shows the top 10 ACOs ranked by earned payments. Each ACO started its program agreement in 2012 and earned its performance payments by providing complete and accurate reporting for all quality measures. Earned shared savings equal 50% of the ACO's generated savings (minus an adjustment for sequestration). The information reflects totals as of October 2014.
1. Memorial Hermann Accountable Care Organization
Earned Shared Savings payments: $28,338,705
Assigned beneficiaries: 34,430
Generated savings: $57,834,092
Savings as percent of benchmark: 11.5%
2. Palm Beach Accountable Care Organization
Earned Shared Savings payments: $19,388,729
Assigned beneficiaries: 36, 268
Generated savings: $39,568,835
Savings as percent of benchmark: 6.5%
3. Catholic Medical Partners - Accountable Care IPA
State: New York
Earned Shared Savings payments: $13,682,060
Assigned beneficiaries: 33, 253
Generated savings: $27,922,572
Savings as percent of benchmark: 7.0%
Earned Shared Savings payments: $12,094,617
Assigned beneficiaries: 17,303
Generated savings: $24,682,891
Savings as percent of benchmark: 9.1%
5. RGV ACO Health Providers
Earned Shared Savings payments: $11,900,756
Assigned beneficiaries: 7,089
Generated savings: $20,239,381
Savings as percent of benchmark: 14.4%
6. ProHEALTH Accountable Care Medical Group
State: New York
Earned Shared Savings payments: $10,737,854
Assigned beneficiaries: 28,651
Generated savings: $21,913,987
Savings as percent of benchmark: 6.1%
7. Triad HealthCare Network
State: North Carolina
Earned Shared Savings payments: $10,537,755
Assigned beneficiaries: 40,944
Generated savings: $21,505,622
Savings as percent of benchmark: 4.6%
8. WellStar Health Network
Earned Shared Savings payments: 9,738,884
Assigned beneficiaries: 45,732
Generated savings: $19,875,274
Savings as percent of benchmark: 3.7%
9. MaineHealth Accountable Care Organization
Earned Shared Savings payments: $9,406,443
Assigned beneficiaries: 48,273
Generated savings: $19,196,711
Savings as percent of benchmark: 3.3%
10: Accountable Care Coalition of Texas
Earned Shared Savings payments: $9,357,388
Assigned beneficiaries: 33,739
Generated savings: 19,096,711
Savings as percent of benchmark: 3.5%
A proposed rule issued by CMS this past Monday, December 1, aims to encourage additional participation in the MSSP by reducing provider risk. The proposal, which is open to public comment until Feb. 6, states: "As shown in our impact analysis, we expect the proposed changes to result in a significant increase in total shared savings, while shared losses would decrease."