Creating value in your practice — especially a nascent one — is critically important; however, this can be challenging. Value is created by meeting the needs and demands of your patients, employees, partners and health system through the delivery of cost-effective, efficient, high-quality health care services that are easily accessible and result in good patient outcomes. Fundamental to delivering high-value care from the surgeon’s perspective, is a good grasp of seven core competencies. These include disease management, outcomes management, patient relationship management, health system management, payer/provider relationship management, financial/cost management and information management.
A fundamental pillar in the creation of practice value and sustainability is effective disease management. This requires examining the disease process along the entire continuum of care (and not in isolation). Not only must surgeons provide high-quality acute and chronic care, they must also focus on strategies and programs that prevent disease progression. For instance, a morbidly obese patient with a recurrent herniated disc may benefit from a multidisciplinary weight-loss program. This may result in functional improvement in their spine-related disease process, potentially decreasing health care resource utilization and the incidence and prevalence of disease, creating added value for your practice and health system.
Outcomes management ensures that the outcomes are the highest quality at a cost-effective price. Outcomes must not only be compared to best practices, but to what is possible, achievable and aligned with the patients’ health priorities and goals. While the use of validated patient reported measures (PRO) are encouraged, it is important to move beyond PROs to a more patient-centered model built upon patient priorities. Understanding your patient’s health care priorities, motivation for seeking care, as well as health care they are willing and unwilling to receive, ensures patient-provider goal alignment, and likely increases overall patient satisfaction.
One could argue that patient relationship management is the foundation on which all other competencies should be built on. I placed this here because an excellent patient/provider relationship that is followed by poor disease management and/or suboptimal outcomes isn’t a strategy for long-term value creation or success. Intentionally focusing on the needs of your patients, both internal and external, by deliberately structuring all care delivery models/processes from the perspective of the patient will ensure that value is created throughout the entire health care system.
Health system management is also critically important. Understanding how you (the surgeon) are viewed by your department or health system is critically important. Familiarizing yourself with topics such as direct contribution margin, work RVUs and supply side costs/case decreases the likelihood of unpleasant surprises and strengthens your ability to negotiate effectively. Monthly or quarterly meetings with your designated quality officer is critical to understanding what metrics are routinely collected, and how you are viewed relatively to other members of your practice. It is important to understand the “who”, “what”, “how” and “why” of QI data being collected by your health system.
Depending on practice setting, Payer/provider relationships maybe more (or less) important. However, it is important to appreciate that as the vertical integration among providers and health systems occurs, and as the bundle payment models become common place, this relationship will become more important. Payers and health systems will routinely collect treatment costs data at the surgeon level and potentially use that information to preferentially steer patients to (or away) from certain providers.
Cost management ensures that care is cost-efficient and effective, and that a marginal profit is maintained to allow continued investment in new technology and continuing medical education to enhance the quality of care and lifestyles for all stakeholders. At a granular level, this involves understanding who the payors are and how the payment models are structured. If you are working on a capitated payment model, it is important to factor this into your treatment decision, when patient care is not compromised.
Finally, information management, through the collection, storing, transfer, sorting and reporting of data is the binding element, or keystone, in providing value-focused care. Next generation medical informatics systems provide invaluable data about the cost-effectiveness of treatment regimens, supply utilization, physician cost-effectiveness and clinical outcomes. Having this type of information readily available will encourage delivery of high-value, cost-effective care.
The key to building a successful and sustainable practice is to create value for all stakeholders. Thinking about these seven core competencies will give you a competitive advantage in an increasingly competitive sector, likely making you the value provider of choice by patients and payors.
