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在医疗改革的时代, new payment methodologies built around value and shared risk are replacing traditional fee-for-service reimbursement models. 支付结构的转变象征着医疗保健领域的变化. 合作伙伴ships and mergers are reshaping local and regional markets; patients are expecting greater value, 访问, and transparency; and legislative and regulatory mandates – along with their associated opposition – are contributing to an air of uncertainty.
为了生存,组织必须做的不仅仅是对不断变化的环境做出反应. 而不是被迫采取行动的外部驱动因素, responsive organizations are proactively designing and executing near- and long-term positioning strategies. Leaders in these health systems understand the importance of responding quickly to changing market conditions, 付费模式的转变, 不断变化的病人需求.
作为我们正在进行的关于以价值为基础的企业的一系列对话的一部分, 特里翻滚, 负责心电图的合同和报销业务, 分享她对在改革时代如何成为一个反应灵敏的组织的看法.
很简单,一个组织的“响应性”是什么意思??
It means being nimble – having the ability to modify components of a strategy and day-to-day operations when certain market or organizational factors play out. Being responsive doesn’t require an organization to change its mission, vision, or strategic goals. What it does require is being agile enough to make course corrections when executing your strategic plan in order to achieve objectives and support your organization’s mission. 当我们制定战略计划时, 例如, 我们确保它是灵活的,以便随着市场的发展, 组织有能力在不失去对其愿景的关注的情况下修改该计划.
在实践中,这看起来像什么?
我将试着用一个例子来回答. 如果一个bet8网站备用在一个季度内经历了意想不到的财政压力, 它需要了解这些压力的根本原因,并作出适当的反应. It may be that the system’s formation of a clinically integrated network is successfully transforming care, 结果就是 of accomplishing efficiencies and decreasing the total cost of care for its patients, 这家医院的收入下降了. In that scenario, a responsive organization wouldn’t sit back and wait until it was forced to react. 相反,它将加快向付款人合同下按价值支付的过渡. It may also redesign its organizational structure and functions to support a more value-based model.
为什么组织不这样做呢?
医疗保健行业现在有很多不确定因素——它是混乱的、动态的. 在过去, 报销环境稳定, 因此,医院和bet8网站备用可以预测他们如何获得报酬. 他们因提供bet8娱乐而获得报酬, and if they provided more services they were paid more; if they provided less, 他们的工资更低. Now, the way that providers – health systems, 医院, and others – are getting paid has changed. 除了, the Affordable Care Act has caused shifts in the market in terms of how patients are covered by insurance. So an organization can’t establish a 5-year strategy and simply execute on all the elements exactly as it intended. 每年,关键的市场和组织因素都会发生巨大变化. 由于没有认识到做出反应的机会,组织可能会被抛在后面. If you’re not able to change with the market, then you’re going to struggle to compete in the market.
Is there another industry we could look at and see highly developed examples of responsive organizations?
科技行业的一些角落就是很好的例子. A firm called Undercurrent [specializing in organizational design and strategy] named Google the most responsive company in the world for 2014. 当你想到一个每天都与客户生活息息相关的行业, and the innovations that Google comes up with – they’re responding to and even anticipating people’s needs. They’re connecting with their customers in innovative ways through the services they provide and the products they create. 医疗保健是非常个人化的, and providers are transitioning toward being more responsive so they can better meet the unique needs of their patients. 以吸引更多的患者参与, a lot of providers are looking at ways to interface with the personal health devices that their patients are using. 例如, 几家领先的机构已经在试用HealthKit, 苹果的健康监测智能手机应用.
![基于价值的企业图形](/user_area/uploads/Value-Based-Enterprise-Graphic-01.jpg)
什么系统在这方面做得很好?
在医疗模式转变和医师整合方面取得进展的系统, 医院, 医疗保健系统的付款人组成部分浮现在脑海中. Intermountain、Geisinger和Kaiser就是很好的例子. They’ve been ahead of the change in terms of driving their strategies toward transformation of the clinical system but also connecting that to payment for value. 他们三个都有自己的健康计划, 所以他们已经把医疗bet8娱乐和支付结合起来了.
Of the clients you see or organizations you are aware of: on a scale of 1-10 (1 being not very responsive, 10是反应的高度), 他们的平均反应程度是多少?
该行业的反应越来越灵敏. 我觉得以前是在3到4之间, 而是因为最近的环境要求他们更加灵活, 现在更接近6, 7, 甚至是8, 这取决于组织.
临床和财务上,反应系统的优势是什么?
响应式系统的优点有很多. Responsiveness can lead to differentiation of services in the marketplace and help maintain financial stability, 尤其是在当前的环境下. 从临床角度来看, responsive organizations are using data to drive best practices in care delivery to their patients. 在金融方面, organizations that are responsive are changing their payment arrangements with payers to get paid for value rather than volume. 他们已经改变了医疗bet8娱乐模式和他们获得报酬的方式, 结果就是, they don’t see major negative financial consequences because they’re not as reliant on fee-for-service.
当我们谈到反应能力时,通常指的是bet8网站备用. 这是否适用于小型企业? 比如说,社区医院? 医疗集团?
它适用于任何组织. 响应性主要取决于组织的内部流程, 他们的才华, 他们的领导. 这同样适用于任何组织,无论大小,任何行业.
What are some of the common roadblocks that organizations might encounter when they’re looking to become more responsive?
最大的障碍将是文化. 文化胜过一切,包括战略. Responsiveness often requires a cultural transformation that drives the organization toward being innovative rather than being simply reactionary. 文化变革可能需要多年时间,并且需要持续的内部协作.
例如, 你可能会有一个医疗小组, 从历史上看, bet8网站备用们一直很独立,他们觉得自己做事的方式是最好的, 在临床护理方面. 为了做出反应, 他们需要合作, 看可靠的数据, 然后决定另一种方法是否会更好. 在这个例子中, physicians will need to be empowered within a health system to lead the organization toward clinical excellence.
如果系统没有响应,它会遇到什么风险?
最终? 成为可有可无的. 他们可能会失去病人,失去市场力量,失去金融稳定. 在一个高度发展的市场中,我们看到消费者正在期待变革. The performance of our health systems is more transparent to patients, employers, and the community. 如果组织没有对患者和付款人所期望的变化做出反应, 他们会失去客户和关键人才, 无论是临床还是行政方面.
“响应”与基于价值的企业的其他支柱有什么关系?
Responsiveness with regard to care and payment transformation typically spans the full spectrum of the healthcare delivery system, 从住院病人到门诊病人再到行为健康组织等等. 这需要积极地制定战略,以实现最佳整合, 按比例缩小的理性的,知情的.
反应灵敏的组织正在根据可靠的数据做出明智的决定. They also recognize the value of partnerships and integration across the care continuum to improve the systems of care available in our communities. 现在比以往任何时候都重要, it is critical that health systems and payers continue to examine their performance and strategies and remain nimble on the execution of those strategies in order to drive toward a better healthcare delivery and payment system.
特里翻滚 has nearly 20 years of healthcare consulting experience and has recently worked closely with health systems, 医院, 医疗集团, 支付方建立有利于临床整合的合同结构, helping them develop and execute the types of arrangements needed to successfully respond to healthcare reform.
2015年7月15日出版