Change Principles for Health Care Transformation

HealthInsight has worked with providers and patients for more than 40 years to improve health and health care. We feel both proud of and humbled by this experience. Proud, because our services have improved health outcomes and helped transform the care delivered to millions of people. And humbled because experience has taught us that real transformation takes time and sustained commitment—and it is hard. We also know our efforts often fall short of the vision of what is possible. So, in quality improvement terms, we seek to design better models.

In support of our core business of improving health and health care, we seek to be a thought leader, shaping the future of our communities and nationally. We are continually considering and reconsidering the best ways to help our system work better. In that spirit, we’d like to share some of our ideas.

Broadly, we believe that sustainable improvement will happen only when patients, providers, payers and purchasers come together at the community level to promote, demand and support transformation based on the following change principles.

1. Aligned payment system reform. Decades of unsustainable cost increases threaten the financial security of workers, families and businesses across the country. Overspending in health care has resulted in significant underspending in other areas, such as social services and infrastructure. We’ve learned that more care does not mean better care and that quality and cost are not opposing forces but are two sides of the same coin. Achieving greater value in health care depends on fundamental changes in the way we pay for care, the way providers are organized, and the way consumer benefits are structured. With widespread tests of value-based purchasing reforms underway, we see promising signs. But providers need for payers to work together to ensure a successful, sustainable transition to new payment systems. And we all need to expect more fundamental change, moving well beyond the weak, primitive and sometimes confusing signals of pay for performance as a substitute for meaningful payment system redesign.
2. Collaboration and coordination across settings and systems of care. Hospitals, health systems and health plans have worked for decades to improve quality and reduce costs. Too often, the results have been less than optimal because of limited coordination across settings and systems of care. We need to better align transformation initiatives via multistakeholder collaboration to ensure that all participants are working to achieve common cost and quality goals.
3. Credible, transparent information about system performance. An axiom of business is that you can’t manage what you can’t measure. That sounds simple, but it isn’t. Measuring what matters is hard, and doing so without adding unnecessary burdens is even harder. But communities must be able to identify opportunities to reduce costs and improve quality and to assess whether those opportunities are leading over time to change in their region. To do so, we all need actionable data about service costs and quality, population health, patient experience and the extent to which innovative methods of delivery, payment and health promotion are being used locally. Community ownership of the data promotes credibility and actionability. Transparency of the data provides healthy tension for change, supports payment reform efforts, enables better care management and is essential for engaging patients, purchasers and the public.
4. Empowering patients and their families. Even the best-intentioned and highest-performing providers are limited in their ability to improve quality and reduce costs without strong participation from patients and their families. We must engage community members in activities that will maintain and improve their health, and support them in choosing providers and services based on cost and quality and based on their values. When patients own their own care and engage with their providers as partners, we can begin to narrow the gap between the care people want and the care they receive.

Over our history, we’ve seen many changes in the approaches to health care quality improvement. And we expect the models will continue to evolve. The question is not whether, but how and when these changes will come. In part two of this blog, I’ll share a few of our recommendations for how the Medicare Quality Improvement Organization program should evolve in the upcoming five-year contract cycle.