- Chief Medical Officers and Chief Financial Officers must put aside their differences and embrace a spirit of collaboration if they are to extract maximum value from big data analytics and value-based, accountable care arrangements, according to a new report from the American Association for Physician Leadership (AAPL) and Healthcare Financial Management Association (HFMA).
Only by establishing a common goal and cooperative roadmap towards leveraging clinical data for financial success can healthcare organizations achieve true value from their efforts to provide safe, effective, and satisfactory patient care.
“In the past, clinical and financial leaders within health care organizations have often operated on parallel tracks,” write Peter Angood, MD, FRCS(C), FACS, MCCM, President and CEO of AAPL and Joseph Fifer, FHMA, CPA, President and CEO of HFMA.
“However, with the advent of new care and payment models, these leaders need to converse and collaborates as never before. The transition from volume- to value-based care affects virtually every aspect of the strategy and operations of hospitals, health systems and physician practices. Its enormity is such that chief medical officers (CMOs) and chief financial officers (CFOs) must bridge the divide between them and find effective ways to work together.”
While healthcare will always be a complex and challenging environment for clinical and financial executives alike, agreement between the two departments can help to bridge the gaps created by poor resource management, wasteful workflows, quality deficits, and unclear priorities.
By understanding “value” as the “relationship of quality to payment,” where “quality refers to the composite of patient safety, outcomes and experience, while payment is the price for all purchasers purchasing health care,” executives can clearly see how important both roles will be in a value-based world.
A survey of HFMA members found that four-fifths of respondents are unsure that they can navigate the downward shift in payments from governmental organizations like Medicare and Medicaid without making some serious investments in quality improvement and ramping up their efforts to drive waste out of the system. Sixty-one percent of poll participants identified clinical processes and workflow redesign as the greatest opportunity to achieve savings over the next three years.
But in order to achieve clinical buy-in for an overhaul of patient care, CFOs will need to make a compelling case to their CMOs, who must then convince physicians and nurses that the changes aren’t just a matter of tightening up the bottom line, but also an opportunity to improve patient safety and quality care. These conversations require bidirectional communication and a great deal of trust between all parties involved.
Success starts with clearly stating these goals in a comprehensive, convincing way. “Leaders of health care organizations must have a clear understanding of the business case for collaboration between clinical and financial leaders,” Angood and Fifer write.
In addition to citing the Triple Aim as a prime motivation for optimizing workflow and productivity, CFOs and CMOs can outline the specific impacts of accountable care to their organizations.
“These demands include the call for improved patient safety, health outcomes, transparency and affordability of health care,” the report says. “They include the drive toward achieving greater value, with an associated shift away from FFS toward shared or full-risk payment models. The demands also include the need to achieve better care management across the continuum, which requires greater clinical integration of care providers, and to address population health and the needs of the local community.”
“These forces emphasize the need for better workforce management with an effective balance between full-time employees and other employment models, and between staffing for inpatient and outpatient settings as care moves progressively outside the acute-care environment.”
Retooling the balance of an organization requires trust and strong partnerships, the report reiterates, as well as organizational mechanisms that encourage open dialogues and the sharing of collective wisdom.
In addition to these cultural competencies, healthcare providers must have the big data to back up their efforts. “The journey toward value is dependent on data,” the report states plainly. Performance on clinical quality measures directly drive reimbursement in an accountable care world, and the ability to collect, analyze, and report upon clinical and financial metrics may be the difference between success and failure for providers attempting to straddle the divide between volume and value.
“The availability of timely, accurate, actionable data is critical to providing the feedback that clinical and financial leaders need to navigate the transition from volume-based to value-based payment,” says the report. “It is also essential for providing rapid feedback and comparative dashboards to align frontline clinicians with organizational goals and inform decisions that affect population health.”
“Although more organizations have acquired the needed IT infrastructure, many struggle with issues related to the lack of interoperability between IT systems within and across organizations,” the paper continues. “The interoperability issue remains a significant barrier to the movement toward value. Another important barrier to optimal data sharing is the difficulty related to amassing data from different IT systems when inconsistencies are present, such as during medication reconciliation.”
Organizational leaders can balance investments in culture and technology by listening carefully to the information collected from employees during feedback sessions and training programs. By developing an environment of open communication that places value on the opinions and problems of clinical and administrative staff, CMOs and CFOs can both keep a finger on the pulse of their organizations.
They must also remain up-to-date with rapidly changing regulatory and reimbursement guidelines. “To successfully navigate toward value, leaders must remain aware of changes to reimbursement programs to avoid penalties and capture all available incentive payments,” Angood and Fifer state. “Leaders must also appreciate the critical role of data in this transition and address potential barriers, such as a culture that undermines the will to try new models and practices.”
“To accelerate the pace toward providing greater value, organizational leaders and boards can hold the expectation that CMOs and CFOs will work collaboratively toward common goals,” the report concludes. “CMOs can communicate to their peers the importance and relevance of financial data. They can remind clinicians that fiscal viability ultimately supports the mission of caring for patients. CFOs can make it a priority to understand the clinical implications of financial decisions and proactively communicate with clinicians.”
“Clinical and financial leaders can work together to stay abreast of payment model changes, advocate for effective IT systems that enable better care and address barriers to providing greater value in health care.”