Second in a series on Business Strategies for Payment Reform. Read part one.
Whatever your political viewpoint or agenda, the evidence is clear that healthcare in the U.S. is changing. As maternity providers, we understand transition and all of its drama. If you can think of healthcare reform as a birth, then perhaps the flutters of anxiety you may be feeling about your current business practices and their dependencies on things like out-of-network authorizations and balance billing can be put in context. Think of Clinical Episodic Payment (CEP) as the second child. You already know the basics of the work you do, and now you’re going to learn to juggle what you know with some new stuff that you will totally believe worth the reward once it’s here. In addition, if what you are doing today is resulting in good outcomes, then you are well suited to adapt to this new addition.
As I outlined in our last post, there are three primary themes to CEP models:
This article will focus on the first (and most fun!) component: engagement.
If engagement is the prescription for good maternal health outcomes, what is the right dosage and delivery route?
Engagement is a healthcare reform buzzword that everyone likes to throw around; providers like to say they do some form of it, but no one’s really sure exactly what the standard is supposed to be to actually produce positive results. I think of engagement as the single most important element of healthcare services — the relationship. Just think about your own healthcare experiences. When you feel fine, you don’t necessarily need to tell anyone (unless you’re one of those overly happy people that like to shout from the rooftops, “I feel great today!”). However, most of the time, the best thing we can do when we are either sick or experiencing a health event that seems challenging to do alone (like a pregnancy) is to tell someone else. We engage with other people based on trust, knowledge and access.
Getting the right balance of those elements will often determine almost every element of our experiences of care, or lack of care. When the people or systems we engage with provide us clinical, education or support services, we describe those people or systems as providers. In most cases, payment is the basis of the relationship but with engagement, we’re talking about something more qualitative and harder to define than a transaction for services rendered.
According to the Health Care Payment Learning and Action Network (LAN) white paper titled Accelerating and Aligning Clinical Episode Payment Models, engagement means supporting patients and families to be partners in their care. At the system level, it also means engaging consumers in meaningful participation in the design, implementation, governance, evaluation and quality improvement of new models of care delivery and payment. The LAN envisions a set of tools and information that can support this high-quality engagement. As you look at the graphic from the paper, you may see why we’re so excited here at Maternity Neighborhood about this well-articulated vision for a technology-enabled service model that includes so much of our vision and long-held goals.
How valuable is engagement?
Most of us may believe engagement is just common sense. But in the world of data-driven, evidence-based care, engagement must be measured and quantified in order for the magic word to come into play: reimbursement. When we look at certain models and components of care that are centered around patient engagement and have been shown to improve outcomes, the list is impressive. Strong evidence suggests that delivery models that include birth centers, home birth , midwifery, group prenatal care, doulas/continuous labor support, patient feedback, sharing of the health record, education and shared decision-making all have positive impact on outcomes for women and and their babies.
The challenge for each of these innovative delivery models is scale. Incorporating high-quality engagement into your practice — plus measuring and reporting it — all takes time and resources. Also, when you start to expand caring support services beyond the small moments of your clinical encounters, you may find it difficult to satisfy the needs of your clients. Many women don’t have necessary support systems during their pregnancies and these gaps can have negative impact on health, as well as burning out overwhelmed support workers who are not resourced to manage the level of need. This is why team based care is so important. Collaboration and communication amongst many members of an inter-professional team of providers are the key elements to delivering “enough” services to women without overwhelming any one provider/practice.
One step at a time: let’s measure what we already do.
One way we can improve measurement of engagement without sacrificing efficiency is to integrate data capture with our everyday workflow. Technology serves us best when our tools are so compelling and so well designed that we can’t imagine doing our jobs without them. Good design is the key, and that comes from listening to the community of users and developing supportive tools that not only support what you do today, but set the stage for even more benefit as the system births this new payment model.
As we highlighted in our post about the MN Care Guide and our enhanced engagement tools, our platform is shifting to make room for new and better ideas on efficient and effective maternity care delivery for everyone in the system. Think of the Care Guide as the new addition we’ve built on to the house to make room for the expanding family. Some improvements that our customers have asked for have been shifted in order for us to develop this new tool, but now that it’s here we’re pretty convinced that once you try it you won’t want to imagine life without it. And now that our Scheduling system is live, we hope that our loyal customers who have been sending us valuable feedback will see that we have been listening and are bringing you what you need to make EVERYTHING work better. We’re so convinced that this tool will become a critical component to your care delivery system that effective September 1, 2016, we are now offering the Care Guide for FREE with our basic Electronic Health Record package. Contact firstname.lastname@example.org to learn more!
Midwife, CEO and Founder of Maternity Neighborhood
PS: See you in Pittsburg! September 22-25
We’d love to keep the conversation going. Join our Founder, Brynne Potter, and Director of Client Experience, Tara Faust, at the AABC Institute for Birth Centers in Pittsburg this September. Contact us at email@example.com to schedule a demo, tutorial or conversation about Maternity Neighborhood or stop by our booth to just say hi!