The Truven Health Blog

The latest healthcare topics from a trusted, proven, and unbiased source.

Physicians Receptive to Using Data to Drive Value-Based Care

By Michael R. Udwin/Thursday, July 10, 2014
Michael R Udwin imageIt’s not naïve to posit that physicians genuinely want the best for their patients. Historically, this was validated by reputation within the community, peer referral patterns, and personal achievement standards. The advent of technology and commensurate analytics enabled the collection of both process and outcome metrics. With the transition from volume- to value-based reimbursement physicians are in a unique position to define the metrics used to characterize high-value best practice.

It has been suggested that few physicians are actively participating in value-based reimbursement. Yet, the very high adherence to inpatient medical and surgical core measure sets illustrates the effective collaboration between hospital staff and physician community. It also highlights the adage “we manage what we measure.” When physicians understood the importance and visibility tied to core measures, they readily engaged in work flow solutions likely to benefit their patients.

Physicians know better than most what defines meaningful care for their patients. Today, especially in the outpatient arena, value is typically determined by adherence to preventive care guidelines. With the tsunami of process and outcome metrics likely to be available in the coming years, physician insight and perspective will be critical in both selecting relevant outcome measures and establishing bold but realistic benchmarks. In the meantime, thoughtful collaboration with CIOs, CMIOs, and CMOs in the successful development, implementation and use of clinical pathways across the continuum can ensure best practice and set the standard for true value-based care.

Michael R. Udwin, MD, FACOG
National Medical Director

Maternity Care the Ideal Setting for Evidence-Based Practice and PCP/Specialty Collaboration

By Michael R. Udwin/Monday, March 10, 2014
Michael R. Udwin imageThe recent Crain’s New York Business article “Birthing biz booms for hospitals,” captures the complex dynamic of balancing hospital service lines to support revenue, manage costs, and ensure the well-being of a community – in this case mothers and babies. Successfully managing these three objectives requires strong leadership and evolving business intelligence resources. As negotiated reimbursement rates shift from volume to value, it won’t be enough to merely focus on high-margin procedures. 

The best hospitals and health systems recognize the importance of integrating clinical pathways that invite evidence-based practice from both primary care and specialty providers. Maternity care is an ideal setting for such collaboration, since the stakes are so high. Rapid identification of high-risk mothers can not only ensure the health of the mother, but also the well-being of the newborn, with a reduced likelihood of needing to use neonatal intensive care resources.

Effective care coordination for any service line depends on timely, accurate and actionable data across the care continuum. Accomplished leaders leverage such intelligence to identify gaps in care, quality below expectations and costs attributable to inefficiencies. As negotiated reimbursement rates shrink, penalties for avoidable events expand and transparency to consumers evolves, healthcare data will be the medium by which we not just measure our achievements, but ensure the health and well-being of our collective mothers, babies, and families.

Michael R. Udwin, MD, FACOG
National Medical Director

Creative Care Models Could Help Reduce C-Sections

By Michael R. Udwin/Tuesday, March 4, 2014
Michael R. Udwin imageThe recent article “Groups call for safe reduction of C-section” offers fascinating insight into the commendable goal of reducing cesarean sections. Born from concern for both mother and baby and increased costs with surgery, it’s easy to understand why national and local maternity care organizations are so focused on reducing c-sections for first-time moms. 

Supported in the literature and recognized by caregivers, hospitals are seeking creative ways to safely minimize the element of time when managing patients in labor. Birthing coaches or doulas have long been appreciated for their ability to reassure anxious patients unfamiliar with the complexities of contemporary labor and delivery units. They also can be invaluable as consumer advocates when sometimes dated protocols and timetables are summoned to justify surgery for a prolonged labor course.

One promising trend observed at both small and large hospitals entails the use of “laborists.” Similar to hospitalists who are present in the hospital around the clock, these physicians don’t come and go. Rather, they remain in labor and delivery for a given shift, caring for any laboring patients in the hospital during that time. Although this can be a disadvantage to those patients expecting their doctor to be present for delivery, the advantages are quite compelling. Freed from the demands of patients in the office or outside commitments on a weekend or evening, the laborist can deliver the patience likely to ensure best practice and ultimately reduce cesarean sections. 

Creative models of providing care inside and outside of maternity units are likely to be the future, as hospitals, physicians and patients adapt to an evolving landscape.  In this scenario, such changes in practice are likely to not only improve outcomes for moms and babies, but reduce costs in the process.

Michael R. Udwin, MD, FACOG
National Medical Director

The Time is Now

By Michael R. Udwin/Friday, November 22, 2013
Michael R Udwin imageMany hospital executives around the country are cautiously communicating with their boards, medical staff, patients and community; attempting to explain why they are facing reimbursement penalties from processes or outcomes which failed to meet established benchmarks.  Beyond these somewhat awkward conversations, what are these leaders expected to do next?

Of course, a natural response might be to find someone to blame, whether it be subordinates, physicians, payers or even government.  Beyond perhaps feeling better having done so, it is not likely this will reduce the likelihood of facing similar penalties next year.  Since credit is afforded to those institutions that make great improvement, many executives view a “low” starting point as an opportunity to recognize significant gains.

So where do you begin?  Data.  Not just any data.  Validated, risk-adjusted and trusted data is the cornerstone upon which to build a strong yet flexible structure, anchored by transparency, accountability and empowerment. This information can be used to construct a pipeline of opportunities, at the procedural or diagnosis level, representing the greatest gap from best practice and impacting the largest number of patients.  With a clear appreciation of organizational bandwidth, it is then possible to strategically launch, implement, and sustain initiatives that recognize inherent strengths while addressing barriers to best practice.

Given the uncertainty within the healthcare community, it is easy to become reflexive or even despondent. Yet, it is in these times of flux that innovation, courage and true leadership emerges.  The data are there. The talent is there. The commitment to excellence is there. So now is the time to take charge on behalf of board members, medical staff, patients, and most importantly community!  

Michael R. Udwin, MD, FACOG
National Medical Director

How Strong is the Physician-Patient Bond?

By Michael R. Udwin/Thursday, October 31, 2013
Michael R. Udwin imageThe Wall Street Journal article “Comparison Shopping for Knee Surgery” chronicles a successful California Public Employees' Retirement System (CalPERS) pilot, which established a $30,000 “reference price” for hip and knee replacement procedures. Under this scenario, patients were free to pursue surgery at a hospital with pricing above this threshold but would be responsible for the excess cost. As anticipated, patients preferentially selected facilities with pricing at or below $30,000, while many hospitals with pricing above $30,000 reduced fees to mitigate declines in patient volume. Interestingly, this behavior contradicts the axiom: “patients choose the doctor not the hospital.”

This is not the first time we have witnessed fraying in the physician-patient bond. Routinely, outpatient respiratory complaints are encouraged to visit an urgent care center rather than the family practitioner. And the days where the office internist also managed inpatient pneumonia care are long gone, as hospitalists now attend to a large portion of admissions.

CalPERS benefited from an innovative pricing structure designed to selectively encourage high-quality, lower-cost surgical settings. Such an outcome is certainly no surprise to anyone navigating a world of increasing co-payments and deductibles. Beside monetary considerations, are there other factors contributing to physician selection and retention? Of course, word of mouth, referrals, and accessibility are relevant. With enhanced transparency, perhaps quality and patient satisfaction scores will emerge as strong motivators.

The question still remains: “how strong is the physician-patient bond?” Sentimentally, I would like to believe that personal connectedness and longevity determine the strength of cohesion. Yet realistically, perhaps I should be content with the knowledge that if not now, then soon, patients will choose their doctor based on adherence to best practice, outstanding clinical outcomes and appropriate use of resources…and a great personality!

Michael R. Udwin, MD, FACOG
National Medical Director