Quality Care Achieved through Process Improvement

The healthcare industry has struggled to define and attain quality for the past 25 years because its focus has been on results instead of process improvement. Just as teachers that are incentivized by their class’ test scores have shifted their focus to teaching the test instead of truly educating their students, CMS’ Star Ratings have become the focus instead of the reward for many health plans.

In theory, using Star Ratings to promote preventative care, chronic condition management, and a positive customer experience should be applauded. But the program has narrowed the focus of health plans to the point where they only equate quality with stars, causing them to ignore the opportunity to create true quality in their interactions with the patient. Instead, the healthcare industry should improve efficiency and cost containment by focusing on process improvement in the following areas:

  • Customer Service
  • Product Quality
  • Service Outcomes
  • Overall Business Operations

The New Model

In moving the industry forward in a Value-Based Care model, process improvement at every level of the Patient-Provider-Plan interaction must be scrutinized for opportunities and efficiencies. In addition, more emphasis must be put on the standardization of encounter, treatment, and care processes, as well as interactions across the continuum of care.

In fact, healthcare must undertake a process improvement driven philosophy by not only looking for ways to improve quality, but that effort must also be tied to a well-defined cost-benefit model to prove real value. Because quality doesn’t grow on trees.

Example: Electronic Health Records

Electronic Health Records (EHR) were designed to improve healthcare quality by increasing access to valuable patient information, which provides a higher level of care interaction and more comprehensive, accurate, and up-to-date information. EHRs also exposed drug interactions and reduced scripting errors, thereby protecting the patient, improving safety, and creating a process to reduce critical medication errors that lead to adverse reactions.

Process Improvement

It’s critical to evaluate projects to determine where process improvement methods should (and shouldn’t) be applied. The ability to achieve significant process improvement requires time, experience, diligence, a comprehensive project plan, and the continual measurement and analysis of results.

Your Turn

Do you think that process improvement has been successfully applied in healthcare? If your organization hasn’t yet addressed quality through process improvement and justified it based on an ROI model, contact Michael Wilson at 925-265-4113, ext. 124 or mwilson@hcim.com to discuss how we can help. If you’d like help transitioning to Value-Based Care, read about HCIM’s Strategic Consulting services.

Michael Wilson

President & CEO

Dr. Bill Bysinger

Sr. Strategic Adviser

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About HCIM

Since 2000, HealthCare Information Management, Inc. (HCIM) has delivered expert consulting services and robotic automation tools for small to mid-sized healthcare payer and managed care organizations. Our concierge consulting services include everything from core claims system procurement to go live, including configuration, migration, upgrades, reporting, benefits and fee schedules, user training, and project resourcing. We also offer strategic consulting in the areas of value based payments, population health, medical management, medical loss analysis and recovery, care management, provider contract modeling, data analytics, and business process reengineering/analysis.