Clinical Variation is Inevitable; Physicians Must Advocate for Outcomes-Optimization, Not System-Optimization
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- On January 16, 2020
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In the inaugural issue of the NEJM Catalyst Innovations in Care Delivery, Dr. Amy Compton-Phillips shared an elegant model for leading complex change at scale. She summarized the model, stating that there are, “five essential foci: Vision (the “Why”), Trust (the “Who”), Data (the “What”), Capacity (the “How”), and Alignment (the “What’s In It For Me?”)”.
She then goes on to point out, “Large health care delivery systems exhibit the same sort of geographic variation that is evident elsewhere in medicine.” More importantly, she delivers the message that perpetuating variation, by definition, means that, “some patients are receiving suboptimal care”, and delivers a case for changing the system.
At Biome, we believe in creating transparency for physicians, as Dr. Compton-Phillips advocates for with the five essential foci for her model. We also agree that unnecessary variation must be eliminated, to ensure that best practice is delivered to every patient. We recognize, though, that not every system has the resources to dedicate physician time to task groups, and, even among those that do, changing the system is a herculean effort, akin to shifting the axis of the globe. What physicians want is not to change the system, but rather, change the outcomes: deliver better care at lower costs to more patients. Rooted in this outcomes orientation, we believe that by leveraging certain behaviors inherent in the clinical care delivery system, it is possible to achieve even more dramatic outcomes than $19 million in savings and a reduced infection rate. In fact, we are seeing multi-million dollar savings and improved patient outcomes across multiple, simultaneous initiatives at our clients. As a percentage, clients are realizing an average of 10% in annual direct cost savings.
The same system properties that lead to variation can also cure the variation problem. These system properties are outlined in the NEJM article, we repeat them for understanding here:
- “A culture in which physicians, nurses, and pharmacists learn their skills not only from books, but also from peers and mentors, perpetuating geographic trends in care patterns.
- A lack of outcomes measurement by health condition, which represents a barrier to the development of a learning culture.5
- A 20th-century fee-for-service reimbursement model in which clinicians are paid for inputs to health care (office visits, diagnoses, treatment plans, procedures), ensuring that they focus on what they do rather than what they achieve.
- An explosion of medical knowledge, with more than 2.5 million articles published each year (equivalent to roughly 285 articles each hour).6 Keeping up with the broad array of cutting-edge knowledge is simply not possible with the traditional learning model.”
This idea, that working with the system, and leading with physicians and their desire for knowledge and improvement, is at the core of Biome’s solution. The Knowledge Network accelerates peer-to-peer mentoring and learning, but develops this at a nation-wide, not the traditional, local level. Every outcome can be examined within the context of not just one, but all, of the patient’s health conditions, ensuring that physicians, as well as administrators, can learn about realistic outcomes, costs, and risks, for the patients they assume responsibility for, by using the Assessment Engine. The Performance Lifecycle Management capability gives physicians the ability to see exactly what they achieve, based on what they do, regardless of reimbursement model. Finally, the entirety of the human-enabled solution is based on bringing the most relevant insights from today’s explosion in medical knowledge to where they can affect the most change: to the practicing physician.
“Biome eliminates the individual systems-thinking bias that exists in the current healthcare system, and shifts the paradigm to a ecosystems view. Addressing one problem at a time is insufficient, given that healthcare spending is one of the leading issues of our time, and for the first time, the American lifespan is, in fact, decreasing. Focusing purely on variation is unsustainable, because each patient brings unique complexity, whereas focusing on performance allows physicians to simultaneously treat patients appropriately while achieving the all-important outcomes of reduced costs and increased quality ” says Biome SVP Kate McGinley.
“Allowing each physician to focus on their individual performance, in fact, gets you very quickly to the outcomes every system is trying to achieve. Fundamentally, healthcare will always be about the individual,—every patient is an individual, and every physician is an individual, and because of that, the process of learning and decision making by both parties will create some form of variation. If we accept that, and begin to shift from a system-optimization to an outcomes-optimization view, we can achieve real, meaningful gains for our patients, and for the practice of medicine.”
This collaborative and knowledge-based process of optimizing performance for outcomes is already transforming cardiovascular institutes at multiple organizations. To learn more about this approach, read about how Biome is used at these leading systems.