Today, one of hospitals' and health systems' biggest priorities is achieving higher value, cost-conscious care that emphasizes quality and eliminates waste. Much of healthcare organizations' ability to achieve this is predicated on the decisions and individual behaviors of their physicians. According to Health Affairs, organizations can create supportive systems to best position physicians to deliver this desired care.
Accountable care organizations are a common example of a strategy to decrease waste by aligning business incentives with efficiency and quality instead of volume. However, hospitals and health systems outside of ACOs can also create the structure needed for physicians to provide high-value care.
Based off of research from 10 focus groups of 62 primary care and specialty physicians in nonprofit healthcare organizations, Health Affairs proposes three strategies for creating these physician-supportive systems.
1. Nudge physicians in the right direction, but promote their clinical judgment. Organizations that give their physicians complete leeway in clinical decision-making open the door to needless practice variation and waste. However, an overly restrictive culture blocks successful individualized care. An organization somewhere in the middle — one that aims to provide physicians with some direction but preserves and supports their clinical judgment — is best positioned to produce cost-conscious and patient-centered care.
2. Encourage relationships and open communication. Organizations can encourage appropriate resource use through dialogue and forming relationships. According to Health Affairs, physicians commonly make tradeoffs between the time it takes to convince a patient that his or her requested service is unnecessary and the cost of the requested service. By encouraging physicians to form relationships with their patients and take the time to communicate, unnecessary and expensive services could be avoided. Physicians tend to order more tests when they don't know the patient, while relationships between patients and physicians are associated with better outcomes.
3. Promote low-tech, high-touch care. According to Health Affairs, low-tech, high-touch therapies such as acupuncture, massage therapy, physical therapy and counseling can effectively manage a variety of chronic symptoms. However, if access to high-tech procedures that are well reimbursed exceeds those to low-tech, high-touch care, it is in the best interest of the patient and organization to administer the high-tech care.
For example, if a patient comes into a hospital with a severe headache and they can either get an MRI within a few days or acupuncture within several months, if both are covered by insurance, the hospital may as well choose the more available option, even if it is more expensive.
If healthcare organizations expand access to low-tech care, which often carry less risk to the patient and are less expensive, physicians will be more likely to avoid or delay pursuing more expensive options.