AI for outcomes-based compensation in healthcare
What is outcomes-based compensation in healthcare? Compensation plans in the healthcare industry have undergone a paradigm shift, with more providers moving away from volume-based to outcome-based compensation for their employees. This is partly attributable to the rising healthcare costs and enhanced patient empowerment, with a growing need for better quality of service delivery (Zigrang, 2022). Volume-based models compensate providers for the quantity of care delivered rather than the impact on the health status of patients (Tai et al, 2014). The vision for outcomes-based compensation in healthcare revolves around incentivizing and rewarding healthcare providers based on the outcomes they achieve in patient care rather than just on the volume of services delivered. This approach aims to improve the overall quality of care, enhance patient outcomes, and reduce healthcare costs. However, existing literature on outcomes-based compensation models shows mixed results in terms of impacts on quality of care and costs, with some reporting significant cost savings and others reporting increased costs of care, as expounded later on in this chapter. In an outcomes-based compensation model in healthcare, providers are encouraged to focus on delivering measurable results and positive patient experiences. This may involve achieving specific health outcomes, such as reducing hospital readmission rates, improving patient satisfaction scores, or effectively managing chronic conditions. By aligning compensation with outcomes, healthcare organizations aim to drive better patient outcomes, ensure patient safety, and enhance healthcare delivery. Healthcare outcomes reflect the quality of care offered by practice and remain stable over time compared to process measures, which keep changing over time. For instance, the target outcomes in a diabetic care clinic include reduced blindness, reduced amputation rates, improved self-management and confidence, and reduced heart attacks. These target outcomes that matter to patients the most tend to remain stable over time regardless of where you practice. On the other hand, process measures such as fundoscopic examination, blood glucose assessment, foot care, and medication review may vary over time. This forms one of the basis for outcomes-based compensation models (Dunbar-Rees, 2018). The outcomes-based compensation model offers several benefits to different players in the healthcare field. Patients get to enjoy quality care over volume, with the potential to address health inequalities. This is so because the model emphasizes outcomes that matter to patients, which tend to remain constant regardless of the geographical location. For instance, the target outcomes for a diabetic care clinic in Kisumu, Kenya, Africa, would be more or less the same as for a clinic in Atlanta, Georgia, USA. For the providers, outcomes-based compensation helps reduce the wastage of resources and unnecessary interventions by enabling efficient resource allocation. It also reduces fragmentation of care by encouraging collaboration and coordination across clinicians and specialties. The payers benefit through reduced wasted healthcare spend as well as focusing on buying healthcare that is based on outcomes that matter most to their beneficiaries (World Economic Forum, 2023). The outcomes-based model has been implemented across different healthcare facilities worldwide in a bid to improve the quality of care and reduce costs. There are several studies showing the impact of outcomes-based models on the quality of care, resource utilization, and healthcare costs. These studies show varied outcomes, with some reporting positive impacts and others reporting negative impacts or no significant impacts. For instance, the Pioneer Accountable Care Organizations (ACO) implemented by the Center for Medicare and Medicaid Services in the USA as an outcome-based compensation model reported a reduction in healthcare costs by approximately $385M in two years compared to the previous volume-based compensation model, with no difference in quality of care (McCarthy, 2015). The Medicare Shared Savings Program, which was also designed to incentivize cost reduction, reported similar cost savings of $385M dollars over one year of implementation (Eijkenaar & Schut, 2015). However, some studies suggest that outcomes-based models were associated with additional healthcare costs, mainly in the form of bonuses and incentives paid out to healthcare workers. For instance, the Quality and Outcomes Framework (QOF) implemented in the UK as a pay-for-performance program was reported to have spent about US $9 billion on incentive payments over a period of just seven years (Ryan et al, 2016). Outcomes-based compensation models impact on the quality of care delivered to patients, albeit to varying extents from the available literature. In one study, the Quality and Outcomes Framework model operationalized in the UK to incentivize family practitioners for target patient outcomes resulted in an increase in the median practices achieving the target HbA1C levels for diabetic patients from 59% to 66.7% in two years. (Vaghela et al, 2009). However, another study evaluating the impacts of the same Quality and Outcomes Framework in the UK on hypertension reported no significant change in blood pressure monitoring rates and treatment intensity attributable to the program. There was no significant difference in the cumulative incidence of stroke, renal failure, and heart failure as well (Serumaga et al, 2011). With such mixed data on the impacts of pay-for-performance on costs and outcomes, it is evident that this alone may not be sufficient to improve the quality of patient care, and more factors need to be accounted for in order to achieve optimal patient care quality. Another study in rural Kenya evaluated the utility of outcomes-based compensation models in improving the management of suspected malarial fevers. The program rewarded measures of process quality of care, including the proportion of patients correctly given antimalarial drugs based on test results. Incentives were provided to facilities with increased rates of treatment for confirmed malaria cases, as well as those with reduced treatment rates without any confirmatory tests. From the study, the odds of receiving treatment following a negative malaria test in the intervention arm was 0.15 relative to baseline, compared to 0.42 in the comparison facilities that were not enrolled in the program. This translated to a 2.75 times greater reduction of inappropriate prescription of antimalarial drugs in the incentivized groups compared to the comparison groups (Menya et al, 2015). Another instance in which the outcomes-based model has been utilized is through Humana’s
What Does it Mean to be ONC Certified and Why Does It Matter?
In today’s digital age, technology has become a cornerstone of our daily lives, and this is particularly evident in the healthcare sector. Medical practices now require robust and secure methods for data management. Advanced Electronic Health Record (EHR) systems are pivotal in this regard, enabling the efficient exchange and management of patient information, as well as streamlining administrative tasks. The healthcare sector’s growth has prompted the Office of the National Coordinator for Health Information Technology (ONC) to define specific criteria for EHR systems. These criteria ensure that such systems are structured effectively to gain certification. EHR providers, including Genesis, have the option to submit their products for ONC’s evaluation and certification. Understanding ONC Certification The ONC’s Health IT Certification Program was initiated under the Public Health Service Act. This program aims to establish benchmarks within the rapidly evolving domain of health information technology. EHR systems undergo rigorous testing by independent third parties, focusing on their ability to record, secure, and share information. Certification is granted only to those systems that adhere to the ONC’s stringent standards. For medical practitioners, using an ONC-certified EHR system is essential to qualify for Medicaid and Medicare incentive payments. This certification also instills confidence in both healthcare providers and patients regarding the secure and efficient handling of health information. ONC’s Trusted Partners Accreditation Laboratories and Certification Bodies The ONC collaborates with a select group of laboratories for the certification process. Currently, these include: Drummond Group ICSA Labs InfoGard Laboratories, Inc. SLI Compliance, a Division of Gaming Laboratories International, LLC These labs, with their diverse expertise, including in healthcare, are responsible for the thorough testing and certification of EHR systems. For instance, Drummond Group, has successfully tested and certified Genesis under the 2015 Edition Health IT Module. Impact on Healthcare Professionals and Patients The involvement of independent laboratories in testing EHR software ensures that medical professionals are not solely reliant on the claims of service providers. Only EHR systems that meet the high standards of security, reliability, and functionality achieve ONC certification. This assures healthcare staff and physicians that their chosen software adheres to the highest Health IT standards. Adopting an ONC-certified EHR system also has financial benefits for medical practices. It enables them to avoid Medicare payment penalties and secure Medicaid incentive payments, while simplifying processes for both staff and patients. Patients, too, stand to gain from the widespread adoption of these certified systems. EHRs simplify healthcare management and enhance the security of personal health information, ensuring privacy and peace of mind.
Are You Someone’s Hero?
In the last chapter we talked about hunger and the drive that must exist between all members of a patient community, including the patients themselves, but what about the patient’s need for a mentor? Remember in previous chapters we talked about how Joseph and Bonnie’s dispositions not only affected their ability to treat effectively but also resulted in lost patients? Patients, because they are people, respond and react to the emotions they receive. We don’t always react in the expected way, but that has more to do with the person interpreting than the person reacting. So how do we set ourselves up so that when we aren’t having the best day ever and performing at our peak state, our patients still receive the best care possible? The answer is heroism. And no, I’m not talking about superhero heroism like we see in the movies today. I’m talking about the heroism of someone behaving in a consistent and positive way that inspires others. When people see someone working harder than everyone else (and I don’t mean slightly harder, I mean orders of magnitude harder), they naturally want to help that person. Following success is a tremendous motivator for many because it means that they don’t have to expect 100% effort from themselves to achieve a goal. In other words, the responsibility isn’t 100% on them, and so they feel compelled to work as hard as possible, if not harder. We all know the power of heroes in fiction and how they inspire their comrades and even enemies, in many cases, to follow the path of good and righteousness. Take the most famous superhero of them all. Superman. As we prepare for the dawn of the Superman movies in cinema, these films raise powerful questions about what is meant by a leader. Many would say that Superman is an example of a great hero, but I would disagree. Superman is a great character and, in fiction, does amazing things for many. However, because his power is so great and far removed from our own, we don’t feel like what he does is ever enough (hence people never truly appreciate Superman except when their lives are on the line). As practice owners and clinicians, we’re often seen this way. We hold in our minds and hands, the ability to create massive change in a patient’s life, change that that patient would otherwise be unable to experience. This truly defines us as Superheroes, but it also presents a major problem. It means we are too far removed from our patients resulting in this kind of detached relegation. We feel compelled as patients to receive care and do so reluctantly, hoping we never need to return (think about it, how many patients truly want to be thinking about their illness?). Now take the example of the practice owner and how we react when we feel like superheroes. Sure, at the beginning, it’s an incredible ego booster, it makes us feel like we are kings and invincible. But then what? The feeling goes away, and we’re left with a patient roster that, quite frankly, is embarrassing by superhero standards. Naturally, this gives way to the feeling of inadequacy and negativity we discussed earlier. So what do we need to do? Simple (but not easy), we need to get closer to our patients. In other words, we need to close as much of the rift between a patient and their physician as possible. Since this is a natural phenomenon with man-made side effects, it is especially difficult to resolve. It means that we, as practice owners, have to first overcome our confidence needs to see ourselves as our patients see each other, powerful and capable. Above is a diagram that describes what I’m talking about. Nature develops these build-in separations as we grow in expertise and capability, but it also creates a lack of empathy and connection with our patients. The real question is, who is responsible for bridging this gap? Heroism lies in effective communication with patients and addressing their concerns holistically. As a practitioner, you should be able to listen to, understand, and share in people’s feelings, beliefs and experiences in order to take care of their real needs and offer individualized care rather than just focusing on the science of the illness. This is part of the spectrum of empathetic communication (Moudatsou et al, 2020). Several strategies can be used to effectively communicate with patients. These include active listening, using plain language while avoiding technical jargon, using relatable examples and illustrations, using appropriate language, keeping the interaction confidential and letting patients explain concepts in their own words to demonstrate understanding. (Tulane University School of Public Health and Tropical Medicine. Strategies for Effective Communication in Health Care. Sept 2021; Float Care 2023 ) Here’s a great personal example. In graduate school, I was a teacher’s assistant (professor lackeys or TAs as we were widely known) teaching the recitation for a course on statistics for Psychology undergraduate majors. These were first-year students who, for the most part, had no idea what they were doing, but also knew exactly what they were doing. As with most young people, there was a split, and although they needed guidance, they weren’t ready to admit it yet. This was clear in the first month as I clearly entered the room as an authority figure. I was confident in my knowledge of the material and ability to convey it in a manner that would instruct students (sounds engaging, doesn’t it?). Obviously, you can imagine what happened next: I inspired exactly zero students to actually be interested in the material and as a result, many did not pass the first exam. There was an uproar from the professor and from the students, apparently thinking that the recitations were the source of the problem. The professor sat me down for an hour over coffee and tea (I was the difficult one who didn’t and still doesn’t drink coffee), explaining the difference between
Are You Hungry?
Great, now Reuven wants to know if I’m hungry. Don’t worry, we’re not talking about hunger pains or anything like that. I’m talking about drive, the hunger to stop at nothing to succeed. But I’m also not talking about it in the most general sense. In other words, we’re not talking about all those Youtube videos dealing with motivation, drive, and hunger. I’m talking about the hunger unique to healthcare that is required to create a thriving practice. I’m talking about community hunger. When you want to put together a thriving patient community, regardless of specialty, of course, it’s critical that both you, your staff, and your patients feel a certain hunger. Gone are the days of thriving practices where patients simply receive care. Today, a thriving practice depends on the teamwork built between a patient and the staff in the office. However, anytime you have a team, you need teamwork based on a voracious hunger. A driving force that unites the team and propels them forward. Clearing objectives, roles, and expectations; providing training and support; promoting diversity and representation; providing incentives and feedback; and securing institutional support and sponsorship are all examples of effective patient engagement tactics, according to a systematic review on the topic published in Bombard et al. (2018). One of the biggest misconceptions about hunger and drive is that you must be an extrovert or high-energy person to derive strength from hunger truly. In fact, I’ve quite often experienced the opposite. In Joseph and Bonnie’s case, these two had opposing personalities, but Bonnie, who was more of an introvert than Joseph’s incredible extroversion, was clearly overcome by a stronger hunger. She was more consistent in her behavior and suffered from less burnout than Joseph. She was also more adaptable. She was able to empathize with both high-energy patients and low-energy ones. Experience really is the best teacher, and more often, it’s easier to understand high-energy people from a low-energy perspective than to understand low-energy people from a high-energy perspective. According to research, personality factors have been linked to job satisfaction and burnout among healthcare professionals. For instance, higher neuroticism levels have been associated with lower job satisfaction, increased emotional exhaustion, and depersonalization. Contrarily, agreeability and scrupulosity are positively connected with job satisfaction and adversely associated with depersonalization (Kang & Malvaso, 2023). These findings imply that managing burnout and enhancing worker well-being in healthcare settings can be facilitated by understanding various personality types. I’ll give you a personal example. I am a high-energy person who loves to be loud, talk fast, and get from A to B with as little in between as possible. I was always the quintessential type A personality who never enjoyed the journey because he was too caught up in achieving the destination. In school, that can often do well for you, as I always achieved top scores on exams and papers. However, my personal relationships suffered greatly. For example, I could never maintain quality friendships (although I had many friends), and forget about romantic relationships where you truly need to be present to be successful. Imagine being so caught up in the result of effort and bringing that to a romantic situation. Strong leadership is crucial in community-based healthcare practices. Effective community involvement projects have been shown to involve communities in planning, designing, implementing, and evaluating primary health care services. Community leaders are essential in promoting teamwork and driving the group toward shared objectives (Erku et al., 2023). Ultimately, I had to recognize the drawbacks of my personality and the opportunities that presented. In other words, what were the challenges I had to overcome, and how would those help me to become a better and more contributing individual? At the same time, I struggled because some of my friends had great connections, and I often felt that they were lazy because they spoke slower, didn’t engage at a super high level of energy, and often stayed home instead of constantly going out. It’s important to consider the varied personality types’ needs for recharge time (Grailey et al., 2023). Now we understand the difference in recharge time required for different personality types. For example, if you are more introverted, you can definitely be the life of the party, but afterward, you’ll need some time to recharge the batteries. There’s nothing wrong with this; in retrospect, I think this is more beneficial than constantly being out. The literature also emphasizes the importance of reflection and self-awareness in identifying one’s fundamental limitations and comprehending the advantages associated with various personality characteristics. Extroverts may thrive in social situations and get their energy from continual engagement, but introverts have a special ability to use deep thought and reflection to advance both personally and professionally. This implies that accepting and comprehending one’s innate characteristics might result in personal growth and achievement in a variety of areas of life (Grailey et al., 2023). It challenges us to search for that hunger within instead of constantly being hungry for what’s outside of us. In my personal struggle to expand beyond my core limitations, I recognized the incredible power of introverted people and how I could leverage that to grow personally and professionally. However, one of the biggest mistakes people make is thinking they can grow this way independently. In other words, they think there is a way for them to simply absorb this information without help. Nothing could be further from the truth. Studies have underlined the value of mentoring for improving patient outcomes, career growth, and skills in healthcare settings (Nandwani, 2023). The analogy of hunger shows how, similar to the body’s requirement for nutrition from outside sources, people may need coaching to comprehend and successfully realize their inner desires. Without the right direction, they could make detrimental decisions repeatedly, just like when they consume “junk” without understanding their genuine needs. Mentorship serves as a compass, assisting people in discovering their true desires and fostering both personal and professional development. Think about your body, your purest form of
