Are healthcare cost increases inevitable?


“Healthcare costs will continue to rise until the entire system collapses under its own weight”.

This doomsday scenario is certainly one possibility, but it is a “do-nothing” option.

How about an approach that reduces costs at the same time as it increases the quality of services to patients?

Win-win solutions are not easy to come by. They require out-of-the-box thinking that often meets with resistance.

Here below are six (6) steps YOU can take to reduce the cost of healthcare services delivery at your clinic/hospital and improve patient care.

Implement these and you can look to potential savings in the order of 30-50%.

  1. Rationalize scheduling.

Traditional calendar scheduling works for casual interventions (e.g. annual checkups) and poses few problems.

On the other hand, inpatient scheduling requires coordination of care across time, across staff and across facilities, with realization that there is one dimension of scheduling that deals with the allocation, leveling and balancing of scarce resources across patient populations then another dimension that deals with coordination of care at the individual patient level.

Scheduling, in the case of the latter, requires subscribing to two management methodologies called BPM (Business Process Management) and ACM (Adaptive Case Management).

See how you can use ACM/BPM in the next step . . . .

2.       Promote Consistent Use of Best Practice Protocols.  

There are two types of “best practices”. One, industry best practices which are usually mandated, then, organizational best practices that give organizations competitive advantage.

Consistent use of best practices sets the stage for improved outcomes. You won’t get any arguments re the merits of consistent use of best practices. No one would want to make consistent use of worst practices.

BPM is of the methodology of choice for documenting best practices. BPMs (Business Process Management Software) is needed for putting best practices in line to set up guidelines for the execution of tasks.

ACM augments BPM by accommodating deviations from best practices.  ACM provides guardrails for the execution of ad hoc tasks.

ACM/BPM accommodates any mix of structured and unstructured work.  Don’t leave home without ACM/BPM.

Do not cave in to the use of other groups’ best practices.

The ACM/BPM environment you use to populate your EMR should allow functional units within your agency to build, own and manage their own best practices.

Go in this direction and you will eliminate ALL complaints re the collection of “unnecessary/ redundant” information – the only information you will end up collecting is information that is needed by your agency, information needed to provide quality care to individual patients and information mandated by regulatory agencies.

See what is needed for implementation of ACM/BPM in the next step . . . .

3.       Give your Case Managers a Case Management System.

ACM and BPM are methodologies – subscribing to these does not make things happen.

“Case” is the place where everything comes together.

ACM/BPM background software posts tasks to users at User InTrays. Users post ad hoc tasks to InTrays.

The run-time environment provides orchestration and governance and automatically posts data/documents to the Case.

4.       Reach Out To Your Patients

ACM accommodates reach-out to patients at any point along a patient care pathway or at any ad hoc Case intervention.

Consider patient encounters where a face-to-face encounter results in requisitioning of various tests followed by a 2nd encounter at which time test results are reviewed.

In some cases (e.g. “everything is normal”), the 2nd encounter can be replaced with a personal video prepared by the physician at the time he/she reviews the results.

A video is the next best alternative to a face-to-face encounter where the communication is one-way (physician to patient) and yields important cost / time savings.  It takes much less time/cost to prepare a personal video than it does to organize a face-to-face encounter.

Videos are a big step up from a voice call out, an e-mail message or a private posting to a patient portal.

Reserve tele-health encounters for situations where two-way communication is necessary.

5.       Add Interoperability

Healthcare service rendering is fast moving.

Rule One is “if it’s not in the e-chart it does not exist’ – any deviation from this rule can lead to clinical errors.

Make sure everything IS in the chart by incorporating ECM (Enterprise Content Management) IN your Case/EMR such that all manner of digital data plus “documents” find their way to the e-chart (PDF files, DOC files, spreadsheets, images, even videos/voice recordings).

Above and beyond ECM, you need generic data exchange by and between multiple internal and external data sources (other clinics, hospital encounters, hospital admissions/discharges, lab test results).

Building your own e-hub is an initiative you should not take on.

Contract instead with HMO networks you may be a member of or  pressure State EHRs to set up e-hubs that allow you to see the complete EMR for each patient.

6.       Make the EMR the focal point for all Patient Interventions

Now we get to the hard part.

No point having all of the moving parts working seamlessly if your staff members do not get into the habit of consulting patient EMRs PRIOR to each encounter/ patient communication.

The Case or EMR provides a reverse chronological history of all provided services to a Patient. It provides at-a-glance overviews to all interventions. Once you have interoperability, there is longer any reason to requisition duplicative and redundant tests – you will have the results of ALL performed tests in each patient EMR.

SUMMARY

OK, how much money will all of this save.  Difficult to say, and it will vary from agency to agency.

A good starting point is an expectation of a 30-50% cost saving.

How can you quantify this in an ROI that reasonably turns positive within 18-24 months?

The answer is to bring in an experienced consultant who can, within 2-3 days, (assuming homework is done in advance of going on site) reach agreement with stakeholders on a plan of action that is capable of yielding savings of 30-50%.

Don’t make the mistake of preparing the ROI and then failing to monitor progress against the ROI, otherwise the entire initiative will be a waste of effort.

Sounds easy, but in practice many organizations fail to stay the course and never get to see the returns they spent their hard-earned money on.

About kwkeirstead@civerex.com

Management consultant and process control engineer (MSc EE) with a focus on bridging the gap between operations and strategy in the areas of critical infrastructure protection, connect-the-dots law enforcement investigations, healthcare services delivery, job shop manufacturing and b2b/b2c/b2d transactions. (C) 2010-2017 Karl Walter Keirstead, P. Eng. All rights reserved. The opinions expressed here are those of the author, and are not connected with Jay-Kell Technologies Inc, Civerex Systems Inc. (Canada), Civerex Systems Inc. (USA) or CvX Productions.
This entry was posted in Adaptive Case Management, Business Process Improvement, Business Process Management, Case Management, Compliance Control, Customer Centricity, Data Interoperability, Decision Making, Enterprise Content Management, FIXING HEALTHCARE, Interoperability, Operational Planning, Operations Management, Process auditing, Process Management, Process Mapping, Productivity Improvement, Strategic Planning, Telehealth and tagged , , , , , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink.

4 Responses to Are healthcare cost increases inevitable?

  1. I am in agreement if we do not talk about the US healthcare arena.
    A key problem of healthcare costs in the US is malpractice insurance and legal expenses. That is true for pharamzeuticals, hospitals and doctors and therefore multiplying the effect. This cannot be recitfied by reducing the costs of treatment or optimizing patient care. It needs a solution by congress that limits the legal options and expenses that people (really lawyers) can chose for malpractice suits. Even as a software vendor you have to be careful that an overzealous lawyer (which means any lawyer) might include the software vendor of a healthcare package into a suit just to blackmail settlements.

    Like

    • Good point.

      Another factor that contributes to high costs in the USA is the isolation of the patient in the selection of services rendered.
      The patient obviously wants the best possible and most comprehensive range of services. If the amount of the co-pay were to vary, the patient would become an active participant in the process but this would result in needed services being unavailable to a significant segment of the population.

      The physician, should be the main gatekeeper, assuming a way could be found to prevent them from getting distracted by monetary issues.

      Insurance is a gatekeeper that often views the patient as a number and the physician as an adversary.

      We could easily conclude that the healthcare system in the USA is not working because of the longevity statistics. But, we all know the reason for the poor numbers is lack of a focus on wellness. Fixing problems after the fact does not work well in any industry sector.

      Like

  2. Trio says:

    Thanks for sharing these points.

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s