When I started a project in a value based care setting, I reminded my team members that while the true intent of value based care should mean, no outcome - no income, often the administration does not have ability or political will to obtain the outcome data. The easiest metrics admin will look at will be the number of patients seen...
Once there is a gradient of positive saving, the numbers (patient volume) are needed to amplify cost savings benefits. However, once again, it is easy for administration to forget there is also the concept of killing the goose that lays golden eggs (i.e. providers/team).
For me, these are best implemented when each provider/service-line leaders understand and commit to the goals and objectives - but the actual volume controller should be MA team or support team who know the patients, physician, and the work flow.
However, for administration, blind rules based on numbers are easier to implement and monitor.
So, there is the quadruple aim:
1. Increase patient satisfaction
2. Optimize outcome
3. Cut cost (through reducing unnecessary medications, procedures, testing, and referrals)
4. Enhance physician, APP or APC and staff engagement.
Often administration does not take account of #4 which is a short-sighted measure. Stanford U. calculated the wholistic cost of loss of A SINGLE PHYSICIAN to be at about 1 million dollars.
Even so, it is the current trend to talk about "acceptable loss rate" rather than to look at the root of the problem. As a surgeon shared with me - "all bleeding stops - eventually" but "what happens to the patient?"
I am reminded of the movie "Atlas Shrugged" where future dystopian society leaders who bore unfair burden due to injustices, inefficiencies, and stupidities of the system just walked off. When they left their position, they simply left a message: "Who is John Galt?"
Voting with feet should be a reminder that we are not in a normal labor market. What would happen if our best work force kept on leaving the toxic healthScare environment? I am resolved to create an alternate system based on value based care where the quadruple aim starts with #4. Here is the best part - the best work health care work force is being driven out of health care system by the toxic work environment consisting of rigid metrics and clueless leadership.