Navigating Government Affairs In Healthcare: Driving Quality Improvements

“Quality is Job 1.” That slogan, which Ford Motor Company used for decades, applies more than ever to healthcare.

That’s nothing new, of course. The federal government has been championing quality initiatives at least since the formation of the Agency for Healthcare Research and Quality (AHRQ) in 1989. And 2015’s Merit-Based Incentive Payment System (MIPS) tied clinician reimbursements directly to performance.

Now, after years of focus on quality improvement (QI) initiatives in acute care, there’s an increasing attention to QI in the skilled nursing facility (SNF) and senior living sectors. For example, the Center for Medicare and Medicaid Innovation (CMMI, also known as the Innovation Center), has launched more than 50 different alternative payment and care delivery model tests, with 33 models now or still operational.

In part due to such research, we’re seeing new regulations in areas like alternative payment models, quality metrics, and patient satisfaction surveys. Those regulations are driving operators and broader industry groups to think more creatively about how they operate and how they incentivize their staffs.

We believe that very soon governments at the state level will establish quality measures for senior living that facilities will need to report on and eventually be judged on. (The federal government seems unlikely to get involved with oversight of senior living.) Of course, when you know a regulation is coming, it’s always a good idea to get ahead of it, taking the time to explore the implications and consider what opportunities exist for your organization.

What enables quality

These developments are a good thing—assuming the right infrastructure is in place. (More on that in a moment.) Given rising costs and a challenging reimbursement environment, long-term and post-acute care (LTPAC) organizations need to focus more than ever on care that is safe, effective, patient-centered, timely, efficient, and equitable—the six domains of healthcare quality AHRQ defines.

Quality doesn’t just happen, of course. It requires a focus on value-based care. It requires increased patient engagement. And it requires interoperability of data systems and adoption of new technologies.

Those last two factors lay the foundation not just to incentivize better outcomes but to effectively influence them—in other words, to make sure they’re delivered. At PointClickCare, we believe you can’t have an effective incentive-based, pay-for-performance model unless you have a digital platform to collect the data that it runs on. And the data must be collected efficiently so time-crunched staff members aren’t forced to spend excess time answering questions related to quality measures.

The gold standard is a tech system that’s easy for staff to use and that generates reports that are easy to interpret, share with agencies, and act upon. When you have that, you create a cycle of data generation and data analysis that can drive proper data-driven decision-making and better outcomes.

How tech can support better outcomes

Let’s consider a simple example of how AI-enabled technology can improve outcomes. A relatively small percentage of patients or residents accounts for the vast majority of healthcare spending. So, anything that can proactively identify those people would be immensely valuable. AI can do just that. By looking at big chunks of patient datasets, it can uncover the kinds of insights that humans alone can’t. That means you can better predict risk, plan better treatments, and drive better outcomes. All of this is immensely helpful in a capitated environment, where efficiency is paramount. While none of that technology will ever replace human clinical expertise, this example shows how you can combine human and artificial intelligence to make a real difference.

As we’ve already noted, successes like that rely on investments in technology. And not just on the part of operators. The government needs to help them address the challenges they’re facing, something we at PointClickCare advocate for.

Successes like that also rely on breaking down the data silos that plague just about every aspect of the healthcare system. Anything we can do to break down those walls is going to lead to better productivity for operators—both acute and post-acute—and lead to greater value in care delivery. That’s one reason the Centers for Medicare and Medicaid Services (CMS) has been focused on national interoperability and improved data governance. At PointClickCare we don’t miss an opportunity to champion the importance of real-time, bilateral data exchange. Only seamless sharing of data can improve the ability of risk-based entities to assess and manage the risk they’ve assumed.

In healthcare, serving people is the real Job 1. But we can only do that job effectively through a relentless focus on quality. At PointClickCare, we stand ready to do our part.