Why is it important to engage physicians in the healthcare transformation process?
What can we do to support physicians as they move to risk and value-based models?
How does the quadruple aim relate to practice optimization?
Dr. Aman Chawla, Senior Medical Director of Navvis’ Enterprise Practice Optimization Program, takes a deep dive into the crucial role physicians play in the future of healthcare in this episode of the Navvis Take 5 podcast.
Listen to this conversation between Dr. Chawla and Chuck Eberl, Navvis’ Chief Strategy Officer, to find out how physicians and their teams can optimize healthcare performance. The transcript is below, lightly edited for length and clarity. You can also access the audio for all Navvis Take 5 episodes here.
Let’s kick it off with an understanding around the core approach for transformation and engaging physicians. Tell us a little bit about how you think about that model and how transformation and engaging physicians actually happens.
Dr. Aman Chawla: We should start off by first understanding what we are seeing in the health systems now. Currently, there is the triple aim, an approach that has been put in place to optimize our health system’s performance by enhancing patient experience, improving the population’s health, and reducing the cost. Think of triple aim as providing our society a compass. It’s pointing us forward in our healthcare system towards value-based care.
But when we’re looking at the triple aim, there’s something missing: provider satisfaction. Provider satisfaction is something that is linked to a lot of the physician burnout that we see across the country.
The stats are quite amazing. There’s a great study that was done in the Annals of Family Medicine that reported about 46% of our physicians across the United States have experienced some type of burnout. On top of that, there was a survey that was done alongside that looked at over 24,000 providers in the country. It reported that around 70% of our family physicians and general medicine physicians wouldn’t choose the same specialty if they could start all over again. That speaks volumes. That tells us that we’re missing something in this triple aim, and that’s provider satisfaction.
What we are trying to do is to lead this approach of practice optimization from the provider lens to try to understand, what are their barriers, what is it that they need in their practices to make them successful in value-based care? That can range from many different activities. It could be implementing new workflows, it could be standardizing workflows, it could be having a pre-visit plan put in place so that we can reduce the time wasted looking at a screen when we’re in seeing a patient. It’s all of these different things that we are trying to address to really help that physician practice at the top of their license. With that, we’re trying to understand what really matters to them. How can we help them through their lens?
As physicians move to risk and value-based care models, what specifically can we do to support them so that they’re successful? From vision to execution, how do we help physicians be successful?
There are a couple of things. Going into value-based medicine, we need to ensure that our doctors have the right tools. We need to ensure that those tools are provided by the right people in the right format at the right time.
What does that mean? Let’s take, for example, data. Data is a piece that providers need in order to practice value-based medicine. Data is not something where I come to your office, give you a report, and say, here you go, here are your data points from last month. Good luck with that. It’s actually sitting with you and looking at your data and then saying, okay, which way are we trending? Are we trending in the right direction that we want to be in? If we are, great. Let’s keep doing what we’re doing. But in most cases, if we’re not, let’s go back and look at those processes and workflows that we have embedded in our practices. Let’s see who is doing what. Are we practicing at the top of our licenses to work better and change these outcomes? It’s having those conversations of linking that data back to our workflows and processes so people really move that dial.
The other piece is, in order to do this, we need to educate our providers on the why. Why is this so important? Why are we doing this to begin with? That is a big piece of this as well. We are able to provide them with the education of, hey, why are we doing an annual wellness visit? What is the importance of that? Why should I be doing it? What’s the value add? Providing that education then gives them an idea of, why am I spending my time doing this? It gives them a sense of purpose. Then there’s the, how do I do this? What are the next steps that I need to do, me as a provider, to move the dial with these data points?
Those are all great examples of what we try to do. Across the country, one activity that is pretty much the same throughout is HCC (hierarchical condition category) documentation and coding. This is one of those activities that a lot of our providers just don’t have the education on. I can tell you that I was never educated on HCC documentation and coding during my education. It’s something that we feel very strongly should be provided, not just at a basic level, but also the how do I apply this HCC documentation and coding within my practice and within my workflows to help my patients.
You used the idea or the term the quadruple aim. I think most people know what it is, but tell us, how does it relate to practice optimization? What’s the bridge from the quadruple aim to the kind of work that you and the team are doing?
The quadruple aim is the structure behind transformation, behind the optimization. What we are essentially trying to do is transform these practices from fee-for-service into value-based. What that requires on the operational end is changing processes, optimizing processes, ensuring that the teams are practicing at the top of license, and then ensuring that there’s the right technology in place to eliminate any barriers that might cause a fragmentation of care for that patient within the practice. Based on these fundamental principles, we then have our own four fundamental principles that have helped us, that are designed to help our partners do this value-based care in the most optimized way.
The first one is the most important, which is doing things with our providers and not to them or around them. We’re not talking down to them, we are not telling them what to do. We are actually sitting with them side by side saying, these are our recommendations, understanding that each provider, each practice is unique in its own way. What would be applicable to this practice and this provider? We’re doing things with them.
The other piece of this is, like I mentioned before, understanding what matters most to our providers. Is it to have three care managers set in place in their practices, or does it mean that they have one? Does it mean that it’s something that they would like to source out? This whole piece of understanding what types of workflows should be implemented into a practice from a provider lens is so critical.
The third piece, which I believe we’ve already talked about, is focusing on the provider wellbeing — that fourth piece to that triple aim of really understanding what’s important to our providers. How can we ensure that our physicians are satisfied with the work that they’re doing within these practices?
Finally, it’s optimizing what they are by enhancements and not transforming them into something that they’re not. This is pretty self-explanatory. We are not trying to be disruptive in any which way. What we are trying to do is build on what they already have. In most cases, when you think of optimization, you think of change, you think of the word transformation. That’s true in some cases, but in a lot of cases what we’re also doing is sharing best practices. In this case, there could be providers that have best practices already set up for certain activities. What we want to do is take those best practices and share it with other practices, and share that physician mindset.
We spent a lot of time now talking about the physician, but obviously in every practice there is an entire care team supporting the physician and even people across the physician enterprise. How do we engage those other colleagues that the physician has in order to move the ball on performance?
Physicians do have a leadership role. In their practices, however, they’re not a standalone. They do have the entire care team within the practice. That is why we also believe in having that care team approach within our practices.
Some of the activities within our practice optimization include empowering and enabling not just the provider, but the entire care team to operate at the top of their license, to improve those workflows and processes to enhance that point of care experience. But at the end there’s the patient, and you’re also improving your performance, reducing variation, and eliminating a lot of the duplication. So absolutely, it’s not just about the provider, but about the entire care team.
That’s really how you have less burnout in general. It’s not just about physician burnout. It’s about the entire care team’s burnout. There are MAs that are burnt out, there are nurses that are burnt out, and everyone in the middle. Burnout is real, and we understand that. Having this care team approach helps reduce that by embracing everyone practicing at the top of their license. This is where we’re able to share the why, not just with the providers, but with the entire care team. Why is this so important? Why are we doing what we’re doing? Why are we looking at this data? Why are we optimizing these workflows?
It’s understanding the why as a collective whole, then sharing the best practices, not just with other practices, but also internally within your own practice. It’s where the provider is able to share best practices with the MA, the MA with the RN, and everyone else in between. It’s being able to do that once you are in this cohesive care team. It gives you more insight into what barriers you really have by breaking down these silos.
Once all these pieces come into place, maybe you can share some examples. How are people performing and how are they delivering on their commitments around value-based care?
Once you have your providers and practice staff engaged, empowered, and enabled, what you’re then able to do is truly achieve this patient-centric, physician-inspired and clinically driven value-based care model. Once you have all that in place, then you start looking at outcomes and see how your outcomes are being improved. One of the activities I mentioned earlier was annual wellness visit completion. Now there are some providers that truly believe in annual wellness visits, 100%. There are some naysayers, and they just have no belief in it whatsoever. What we’ve been able to do is take a lot of those naysayers, show them data, show them how others are performing, and move the dial.
What we were able to do with one of our clients is increase the annual wellness completion rate year over year by 41%. That’s very powerful.
We were also able with another client to perform at a level three quality performance, which is very impactful. A lot of folks probably know that quality measures are a very difficult thing to move the dial on. Despite all of the barriers that we had, we were still able to move the dial because we had the ability to engage, empower, and enable. We were able to overcome whatever barriers came in our way.
About Dr. Aman Chala
Dr. Aman Chala is the Senior Medical Director of Navvis’ Enterprise Practice Optimization Program. A population health expert with decades of experience in quality and care improvement initiatives, Dr. Chala develops innovative clinical programs and strategies to support value-based healthcare. Her work is focused on physician and practice performance, helping physicians perform at top of license to directly impact quality and cost, while delivering an enhanced care experience. Her work ensures that physicians and their practices have the resources and tools they need to be successful under risk-based contracts.