12.19.23
有效的工作流程 are the chassis of care delivery, regardless of whether your organization operates under a fee-for-service (FFS) or value-based care model. Well-designed workflows are especially important in value-based care, because these models involve more team members and typically require additional coordination and new tasks.
As organizations begin transitioning to value-based care models, they need to leave their FFS workflows behind. Value-based models need workflows that emphasize communication and collaboration across care team stakeholders to succeed; and prior to implementation, organizations have to reexamine each step in their day-to-day operations and better understand what may need to be be changed or altered.
在一个正在进行的系列中, we’re exploring the shift to value-based care and how organizations can succeed under risk-based models. 在我们的第一篇文章中, we examined the accountable physician enterprise and why it’s a powerful 太l to meet success in this growing area.
在这篇文章中, we will explore how physician enterprises can operationalize their value-based care plans through redesigned workflows built on value. Redesigned workflows in isolation will not bring the transformation, but workflows that tie together the practice’s goals, 工作人员, and optimized technology will drive high-value care for their patients.
FFS的工作流程与. 基于价值的保健
从历史上看, workflows have been focused on performing high-volume, high-quality patient care and ensuring that documentation reflects the work provided. FFS payment mechanisms produce a transactional encounter, which is reflected in FFS workflows focused on reducing cycle times and maintaining throughput expectations.
基于价值的护理, 因此,该集团的动机发生了变化, workflows must evolve to meet new objectives, 包括:
- 实现人口健康目标.
- 整合团队护理.
- Providing care that reduces avoidable, high-cost events (e.g., hospital admissions/readmissions, ED visits).
Figure 1 shows how the incentives impact the practice under FFS and value-based care as the prevailing forces in each model drive different behavior and outcomes.
While the principles of effective practice management still apply and are, 事实上, 比以往任何时候都更重要, the FFS-based workflow does not position the practice for success under value-based care. Many old habits and tasks have been ingrained in FFS workflows that will now need to be reconsidered. When transitioning to workflows that consider value-based care, 组织必须重新分配任务, 减少浪费, 简化流程.
Changes to Ambulatory 操作 and Workflows
Taking the above factors and incentives into account, ambulatory groups need to focus on two factors related to their ambulatory operations and workflows when pursuing their value-based strategy:
1. Invest in and develop new capabilities and associated workflows.
- 护理管理和全面护理
- 以团队为基础的护理
- 上门探访(e.g.(家庭保健、虚拟支助)
- Documentation that supports risk stratification
- Clinical decision support embedded in workflows
- Improved capture of risk adjustment–based elements
- Clinical monitoring and response mechanisms
- Remote patient monitoring in the home and outside of the clinic
- Better access to virtual visits and nurse advice phone lines
- 额外临床分诊
- More effective patient triage, with pre-visit check-in and screening
- 使用虚拟症状检查器
2. Refine existing workflows to align with new incentives
- Redesign in-person encounters to maximize care teams.
- 团体教育探访
- 有明确交接的室内分诊
- Improve care team and patient communication.
- Bidirectional communication 太ls (typically within the EHR)
- Patient outreach and preventive health campaigns
- Increase the use and validity of care protocols and delegation.
- Readdress care protocols and determine whether they still hold for value-based care.
- Determine whether team tasks are still appropriate and at top of license.
- 调整调度规则和策略.
- 急症和当日就诊
- Linked visits with other services, such as dietician and behavorial health specialists
As the practice is reframed to align with the new incentives, 病人的旅程也随之改变. Much of the value-added work happens behind the scenes, with the care team conducting pre-visit planning and following up on orders and referrals to ensure the patient receives the services they need. 与病人的联系改变了, 太, as the practice focuses on maintaining the patient’s health rather than solely delivering care when they are sick or injured.
If a provider organization can develop new capabilities and refine existing workflows to align with new incentives and reshape the practice, it will have accomplished one of the primary steps in becoming an accountable physician enterprise. 有效的工作流程, coupled with revised 工作人员ing models and technology integration, will provide the platform for executing on value-based care operations.
有效的工作流程, coupled with revised 工作人员ing models and technology integration, will provide the platform for executing on value-based care operations.
编辑: 马特杂粮面包