Value-Based Care: Quality Improvement in Organizations

If you participated in earlier courses, you have learned that the journey from volume to value for any provider organization is one of continuous improvement and change. Successfully moving to a value-based care agreement with a health plan takes many steps and is not completed all at once. In Course 5, new competencies, new roles and responsibilities for staff, and new financial and other measures required for a successful transition to and ongoing maintenance of a value-based care organization were examined, in addition to some of the challenges in the transition and ongoing work. Throughout, it was clearly noted that a big part of success is adopting a Quality Improvement (QI) plan. Why? What does that even mean for you and your organization? In this module, we look more closely at continuous quality improvement, or CQI. In this course, you will again hear the theme, “This is not once and done.” Organizational improvement is a continuous process. To be successful means coming to grips with things you have to do, how they get done, and who needs to be involved. This statement is not intended to overwhelm, as often a small change can make a huge difference. However, paramount to the process is recognizing that every role—every team member—in the organization is important to a successful VBC strategy. Remember, as you read or hear terms or concepts that are new to you, have your digital (Word doc) or analog (paper) notepad handy to write them down. At any time, you can use your favorite search engine to learn more. Be a self-directed learner!

Fragmented healthcare has created the need for healthcare reform. This requires changing how healthcare is delivered and managed by changing the structure and culture of healthcare organizations across the U.S. However, as you explored in previous courses or may know from experience, successful transformation of the current system of fragmented, high-cost, ineffective care to one that is built on coordinated, efficient, and effective care cannot be accomplished quickly. While decisions must be made to determine strategic directions and obstacles have to be resolved, the process is a steady, thoughtful, and reflective journey. And, the key to success is an adaptive leadership able to advance vision and innovation through collaboration. Collaborative relationships between team members and leadership are critical to the transformation. This is not the time to direct teams, but instead to gain buy-in, agreement, and understanding about the organization’s strategy for and vision of value-based care. Listen, understand, and engage team members in developing solutions to challenges, workflows, etc. that directly impact them. Empowering, inspiring, respecting, and valuing team members will lead to the best decisions, care, and outcomes for patients. Believing in team member abilities leads to everyone reaping the benefits—from staff to patients, family members, other customers, and vendors. As the organization transforms, a new culture emerges with the common goal of supporting and advancing how value-based healthcare is delivered. Remember, as you read or hear terms or concepts that are new to you, have your digital (Word doc) or analog (paper) notepad handy to write them down. At any time, you can use your favorite search engine to learn more. Be a self-directed learner!