Show Me the Money
In early February, we posted, “Show Me the Outcomes.” I have to come clean and tell you, that’s not enough. You need to show me the money. Showing us the outcomes is only one-third of the job before us.
Let me explain.
Everyone has heard the phrase, “we have to move from paying for volume, to paying for value,” but what the heck does that mean? What is value and how do we measure it?
We are learning that high value services have three characteristics:
- Outcome-Based Care: The services you provide must be effective in achieving individual outcomes or system-wide outcomes – what I discussed in the February post. In most cases, these outcomes will result in lower costs somewhere in the ecosystem, either in the short or long term. If you can’t demonstrate with data that your organization makes a measurable difference in people’s lives and achieves excellent outcomes and high success rates, don’t even bother proceeding to the second or third characteristic.
- More Cost Effective: The services you provide must be more cost-effective than alternatives that may have been selected. This is new for many behavioral health organizations. It’s not enough to deliver a successful intervention. If a center across town gets the same outcomes for similar clients using different approaches that require less duration and/or service intensity – and people start to figure this out – you might be toast. This sounds like a big lift, and it is.
- Lean: The services you provide must be are “lean”, meaning that waste (excess costs) have been removed through process improvement activities. I’ve been working with more and more behavioral health centers that have adopted the model of Rapid Cycle Improvement, which is the predominant method for achieving lean. These folks have been trained by the Institute for Healthcare Improvement, NIATx, the National Council and David Lloyd’s group, or through other resources. Remember, lean is more than a cut of beef.
An organization that can demonstrate these three characteristics will have a strong, competitive advantage in any market. As long as you still implement the other elements of a behavioral health center of excellence – easy access, world class customer service, and comprehensive care.
Being able to show them the money requires a high-performance leadership team that has achieved clinical, financial and administrative integration. Clinical leaders must understand the financial implications of their work. Financial leaders must be able to compute the utilization and costs of a center’s programs. And both much be grounded in a data-driven reality that includes number with dollar signs as well as other quantitative measures (e.g. PHQ-9 scores) that can be collected and synthesized by an effective information system.
Tell us what you think.
- Are we asking too much by demanding that you tackle all three components of high value care?
- When have you consciously considered the cost-effectiveness of a program or service in relation to other alternatives? If the answer is “never”, let me know that too.
- Where else can your colleagues turn to learn about lean?
- Do you have any tips for how others can achieve clinical, financial and administrative integration within their organization and leadership team?
If you haven’t seen the behavioral health center of excellence draft concept paper, you can download it here. If you haven’t downloaded the behavioral health center of excellence study guide, get it here.
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