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The Five Elements of Success for Health Care Providers

Friday, September 11th, 2015

Some people think timing is everything.

URAC President and CEO Kylanne Green believes that, while time and place are not everything, they are the most important part among five “elements of success” common to prosperous healthcare providers. Green highlighted these elements to hundreds of industry leaders in attendance at the recent Leavitt Partners Healthcare Value Summit held in Salt Lake City.

During a forum discussion that also featured Leavitt Partners Chairman Michael Leavitt, Green drew upon her decades of experience as a healthcare professional to chronicle how she’s seen organizations rise and fall in the rapidly-changing environment of American healthcare and how they did so in relation to their adherence to her five elements.

1. Right Time, Right Place

Time and place, as mentioned, are the most critical elements of success. Fortuitous timing aided the “genesis” of many organizations’ success, but time and place are actually “integrated” in most health care success stories. And a poor reaction to circumstances can play a role in failure, no matter how timely or well-placed an organization may be.

As Green explained, throughout the modern health care era, most organizations have tended to fall into four categories:

• “Pathfinders” who understood local needs and traditions and who used that wisdom to become (and remain) giants in the health care industry – still paving the way for others.

• “Early adopters” whose niche is created by circumstance (a recently example being the Affordable Care Act) and who are savvy enough to identify as well as navigate emerging trends.

• “Hugging the curve” – organizations flexible enough to function with two separate payment systems that now perilously follow the curve of change while simultaneously holding onto the past.

• “Late to the party” organizations whose earlier success made them reticent to change – a behavior that has diminished past success along with current ability to compete.

2. Culture

Culture is another important element in success. Most notably, there should be a patient-centered dynamic that springs from “common goals, common purpose, [and] social connectivity.” Organizational culture, Green noted, should not be dictated by special interest pressures from either inside or outside of an organization.

3. Incentives

People do unnatural things when money is involved. That which is unnatural is not sustainable, and care must be exercised with incentives for healthcare providers lest they become a pitfall.

Success, Green explained, often depends upon how incentives are defined. “Process measures and process incentives,” she warned, “are detractors” from a successful organizational framework. Instead, she said, “[w]e have to incent results.”

Rather than being distracted by an incentive that is paid simply for following a rule, health care providers must be spurred by a “motivation of outcomes” that is equitable, creates momentum, and fosters productive results.

4. Business Model

When it comes to business models, a cardinal rule is “to have a structure that facilitates what we’re trying to do – and we need to keep it as simple as possible.”

It’s also important to prepare for uncertainties of an ever-shifting healthcare system:

It’s critically important that we have physician leadership through all of this, and that we allow… [and] expect physicians to govern themselves. We need systems, processes, and people that allow us to process transactions – from the very simple to the very complex – in real-time with no mistakes. We have to have data that is both robust [and] reportable. We have to have the talent to analyze it. We have to have the leadership to say we will take action and create plans, and we have to do this all of this while payment streams are changing…

An organization that cannot establish contracts, either with an affiliate to provide services or other providers, cannot succeed.

5. Support

Success additionally requires support, which can come from two places. The most vulnerable, Green noted, is funding “from government stimulation” or from payers such as BlueCross BlueShield for the development of accountable care. “Unless there are safeguards that say these objectives will be met and we have some way of validating what’s happening,” Green warned, “[the] pure funding approach will not be successful.”

Support can come from “in-kind” services” that strengthen the payer/provider relationship. This is the type of support, Green noted, “will be the most helpful over time.”

Green’s lessons were well-received by the audience of her healthcare industry peers. Additionally, they nicely complemented Governor Leavitt’s earlier calls on that same forum for providers to take on new, expanded duties in care and that incentives should align with long-term goals rather than short-term process.

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