Comment / Driving value

It seems a long time since my visit to the HFMA US conference in June. But a presentation by Maureen Bisognano, the chief executive of the Institute of Healthcare Improvement, has stuck with me. 

Unsurprisingly, income collection made up a big proportion of the conference agenda, but there was also a notable shift in emphasis from payment based on volume to payment based on value. 

Ms Bisognano’s presentation in particular could have been delivered word for word to a UK audience.  She highlighted case studies from around the world including a renal dialysis unit in Norway, where patients’ involvement in defining the delivery of the service had resulted in a move to self-dialysis. The patients had placed a different value on many aspects of the care than that expected by the hospital staff.

For example, patients did not place a plush environment as a high priority. The changes made to allow patients to be trained to dialyse themselves had led to better outcomes, lower infection rates and, as a direct result, lower costs. 

HFMA US has picked up this theme as part of its ‘value project’.  This redefines value in healthcare as the relationship between the quality of care and the price paid for it and recognises that value is driving a fundamental reorganisation of the US system.

The US value project promotes the development of capabilities in four areas: people and culture; business intelligence; performance improvement; and contract and risk management.

It may be interesting to self-assess your own organisation against these capabilities. Here in the NHS we may have a good culture of collaboration and accountability. But where do we stand on business intelligence? At the outset the value project recognised that good-quality data, delivered in a timely way and understandable format, was key to sustaining cost improvements. Yet in a sample of US hospitals, costing was more often at the macro rather than the micro level. ‘Yet the ability to micro-cost and manage data by individual will be needed for the environment ahead,’ a US HFMA paper has asserted.

We face the same challenge. We are at least on the move. Service line management and (for some) real patient level costing have already improved the quality of the data for decision-making or have at least highlighted the areas that need addressing.

Often the problems are with the data available to allocate costs accurately, not the costing process per se. We don’t collect the data, we don’t collect it in enough detail or we can’t access it in a convenient way. But even where the issues are data or systems-related, finance has a huge role. We can help colleagues to understand the importance of accurate or more detailed collection and work with clinicians to improve allocations. And crucially we can ensure the data is fed back in a meaningful way that can really help clinicians make decisions to change, retain or eliminate existing processes.

The issue of contract and risk management is also interesting.  In the US this means the ability to develop and manage care networks and predict and manage different forms of patient-related risk. Given the changes in the NHS, I suspect this capability is the most difficult to develop at the moment. 

However, with most organisations squeezing the last out of internal efficiencies, further savings and improvements in quality will only be possible by working with others to deliver effective networks of care in the most appropriate setting.  Let’s hope the distractions of organisation change will settle down and allow us to get on with this important job.