Value-based care programs are being introduced increasingly on a global level. However, progress is slow as many hospitals are unclear where to start.
While radiology is among one of the most impacted specialties in the shift to value-based care through changes in the reimbursement scheme, imaging-specific metrics are still largely undefined. This presents radiology leaders with the opportunity to shape which aspects of imaging will be the most influential in delivering and reporting on measurable value to support the transition to value-based care.
When and where does the role of imaging have the greatest impact on value-based care? Because diagnosis is often the first outcome in care delivery, it is an area where imaging can make a high impact in value-based care globally.
Healthcare leaders must focus less on the “why” and more on the “how” they will move toward value-based care. With the Quadruple Aim—better health outcomes, improved patient experience, improved staff experience and lower cost of care—as a guiding principle, radiology departments should keep the following four steps in mind.
Step 1: Define leading metrics to evaluate evidence-based improvements
Value-based care requires clearly articulated objectives and leading, as opposed to lagging, metrics. Radiology departments should start by addressing key challenges across the imaging value chain, whether it is outcomes- or productivity-based, examining how to overcome them, and establishing clear ownership for each milestone.
The typical value metrics focus on access times, utilization rates of imaging equipment, turnaround times and accuracy. However, there are several additional elements that can be considered to make these metrics more value-oriented and evidence-based. These include appropriateness of imaging studies; radiation dose management; enhancement of characteristics of the reports; and timely communication between physicians or radiology staff and patients.
The transparent and trustworthy exchange of patient data between systems and stakeholders is vital to successfully define measurement standards and identify gaps in high-quality care. Artificial intelligence applications and healthcare informatics are helping clinicians and health systems to not only quantify results but also support better decision-making around key metrics to guide continuous improvement efforts.
Step 2: Ensure the patient experience is the focal point at all stages of value-based care
Patient-centric imaging focuses on the patient experience while also driving higher operational efficiency across the value chain. Research has shown a strong correlation between a positive patient experience, clinical effectiveness and patient safety.
Ensuring a relaxed and comfortable environment helps to reduce patient motion and is fundamental to the acquisition of high-quality images leading to more confident diagnoses. It also reduces the need for rescans which lowers the cost of care. According to results of a recent MRI global study of 40 radiologists and radiographers, for example, 20 percent of all MRI scans have to be carried out again because of patient motion, and this has a major impact on departmental efficiency.
Patient-centric care delivery can be improved and measured in many ways that facilitate reimbursement and contribute to efficiency. The key is to determine which areas produce the most quantifiable and reproducible improvement gains that align with value-based care metrics and strategic goals for each hospital, patient population, and region of the world.
Step 3: Increase stakeholder collaboration with a systems-view approach
Imaging should be seen from the point of view of a health system in which technology and data connect seamlessly to empower all the stakeholders to drive the transition to value-based care. A systems approach recognizes multiple opportunities across the imaging value chain for enhancing outcomes, and highlights the various patient-to-health system touchpoints where there could be value leakage.
These touchpoints include scheduling and preparation; image acquisition; data interpretation; reporting; therapy and treatment; and, outcomes and follow-up.
Health data is often distributed and sequestered across many applications and departments, which makes it hard to compile a comprehensive view of individual patients across these touchpoints. With powerful data analytics networks and health informatics, care providers can connect clinical processes and workflows from end to end, enabling clinicians to interpret information from multiple sources and make the best-informed decisions in real time.
Value-based care requires collaboration across all stakeholders and a shared commitment to a methodology of “measure, optimize, repeat.” With imaging solutions that are integrated, AI- and data-driven, healthcare providers are in a better position to identify and achieve short- and long-term improvement gains.
Step 4: Understand the “econometrics” of radiology’s role in value-based care
Ultimately, the prioritization of metrics for value-based care in imaging is driven by local-market economic pressures and policies. Measuring patient outcomes is essential in countries where national reform or deregulation are underway, and value-based care now translates to payment or reimbursement models that incentivize providers based on performance measures.
Each market is at varying levels of maturity, and differs in the extent to which healthcare costs reside with public versus private sectors. As the economic models that will incentivize and/or penalize stakeholders vary by location, the industry will need to adapt with innovative payment models that share the risk, and align incentives across care pathways and providers to advance value-based care initiatives.
The conventional model for value-based care was limited to maximizing outcomes and minimizing costs, but the time has come to evaluate the broader impact of imaging to improve outcomes within a health system by taking into account multiple touchpoints across the imaging value chain. The widespread adoption of value-based care requires openness, trust and strong collaboration and partnerships between all healthcare stakeholder groups.
We can best prepare within radiology and work toward the goals of the Quadruple Aim if we demonstrate the critical role imaging plays and tangible metrics it can deliver, in healthcare’s value-based care future.
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