Executives at the forefront of achieving the Triple Aim discuss barriers to meaningful innovation in an era of shrinking reimbursement and system disequilibrium.
If there's one thing organizations share when it comes to population health, it's that there's plenty of opportunity to refine their strategy.
The top takeaways from this year's HealthLeaders Media Population Health Exchange, a gathering of more than 40 invited senior health executives in Colorado Springs, CO, surrounded lessons learned in overcoming four key widespread difficulties.
Return on investment
The entrepreneurial energy in many organizations is strong, which is great for fostering bottom-up innovation—but the resulting unstructured efforts can be problematic for demonstrating hard ROI, according to Neil Carpenter, vice president of strategic planning, research and transformation for LifeBridge Health in Baltimore.
For example, "physician's research and administrative time is not well tracked for but is a very costly investment for the organization," he said.
"So the care solution that's created by a faculty member may require lots of unfunded time and even administrative support; but you don't see those costs buried in the budget, and you don't know if there's a real ROI on the solution."
As a result, LifeBridge is working to improve its focus on a shorter list of initiatives that are strategically critical to the organization.
"We're trying to get the leadership team to be more hands-on in the pilot phase to make sure it's set up in a way that we can get real cost and outcomes data out of it," Carpenter said. "And if there's hard ROI, we scale those [projects]."
Legal and regulatory opposition
Compliance is complicated, and health system counsel often prefers to err on the side of caution—costing not only frustration but also untold dollars if a project is stalled or halted altogether.
That said, it is possible to make attorneys and compliance specialists partners in facilitating change. "Involve them at the ground level," said Megan Harkey, MHA, director of operations and finance for Houston Methodist Coordinated Care in Houston. "And ask, 'How do we get there?' You want not just a yes or no, but how to get to yes."
Related: 6 Steps to a Sturdy 'House' for Population Health
Pilot Project Overload
"If you have too many pilots and no one managing the air space, the planes crash," said Julie Bietsch, vice president of population health management for Dignity Health in Phoenix, AZ.
Therefore, Dignity makes an effort to diversify its pilot projects into various markets. Then, "once you've gotten past the bugs, you've got to move fast towards implementation," she said.
And while some site-specific customization may occur, the onus should be on entities to prove why variation is necessary.
Fear of failure
However, the nature of pilot projects is that a proportion of them are expected to fail.
To make progress, it's critical that leadership creates a culture that embraces calculated risk and an environment of change, said Parinda Khatri, PhD, chief clinical officer for Cherokee Health Systems in Knoxville, TN.
"In reality, it's much more expensive not to take risk," she said. "You don't get in trouble at CHS for failing. You get in trouble for not trying."
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Debra Shute is the Senior Physicians Editor for HealthLeaders Media.