The Role of Performance Excellence in Pay For Performance Health Care

"Position the organization to compete on value: it is the new reality."

– National Committee for Quality Healthcare, Pay for Performance PPT Primer (2006)

Most health care professionals would say that providing value – high quality care, timely delivery and patient satisfaction – is their mission. Yet, positioning a health care organization to compete based on the value of its services is a relatively new idea, and one whose time has come – that is, depending on whom you ask.

Many payers are in favor of linking some portion of provider payments to quality and efficiency metrics. As of 2006, more than half the HMOs in the United States offered such "Pay for Performance" provider contracts. Given that in excess of 15 percent of the nation's gross domestic product is now spent on health care insurers are hoping that Pay For Performance (P4P) plans will make patients healthier and ultimately reduce the cost of health care.

Health care consumers also appreciate being able to compare physicians and facilities when making decisions about where to seek care. Unfortunately, P4P measurements of hospitals and health care providers have yet to be standardized, which can be confusing to someone trying to compare reviews from different sources.

Despite these challenges, health care appears to be moving in the direction of consumer-driven selection. As a result, the industry is increasing its measurement of results and its adherence to guidelines. However, in order to compete in this new market, physicians, hospitals, laboratories and other health care organizations must do more than simply measure their processes and report on results. They must demonstrate improvement in these areas over time.

For healthcare organizations, viable and sustainable improvement requires three things:

1. An established system that can be applied to any process, clinical or administrative, to positively impact outcomes and metrics.

2. A methodology that is easily transferable, so health care professionals can learn to apply it to their own processes as they help patients.

3. A common language that drives the process of improvement but is flexible enough to be adapted to the specific culture of each organization.

While P4P provides a venerable stick to grow by, it remains to be seen whether it provides the means to grow. In contrast, a well-designed Performance Excellence program, based on a proven methodology such as Lean Six Sigma, can help health care providers realize dramatic and long-lasting improvements in the areas measured measured by P4P metrics: safety, efficacy, timeliness, efficiency , equality and consumer focus.

Most importantly, Performance Excellence and Pay for Performance share the same goal: to provide high quality patient care with the best possible outcome at the lowest cost. Whether this objective is labeled a value proposition, a mission statement, or just the way health care should be, it's a goal that providers, payers and patients can all support.



Source by Debra Jennings

Granado Jane

Back to top