Six Characteristics of ‘High-Performing’ Health Systems

The American Medical Group Association (AMGA) recently defined a “high-performing health system.” Does your health system make the cut?

"As health reform continues in the public and private sectors across the nation, we've seen a lot of confusion about what constitutes a 'high-performing health system,' and why these systems should be incentivized," Donald W. Fisher, AMGA president and CEO said in a statement.

Ultimately, the AMGA came up with several benchmarks it says health systems should meet:

Quality improvement: As quality plays a growing role in reimbursement - think the Medicare Shared Savings Program and Patient-Centered Medical Homes - practices will need to focus more on quality improvement efforts. The AMGA benchmarks reflect that movement.

High performing systems measure quality and take steps to improve quality, according to the AMGA. Those steps include targeted preventive care and chronic disease management; patient outreach; analyzing outcomes to determine effectiveness of treatment and processes; and conducting patient satisfaction surveys and making those results publicly available.

Team-based care: In keeping with a common theme we’ve noted throughout this year, the AMGA states that high performers utilize a team-based care or coordinated care approach to patient care.

This team-based approach applies to the care provided within a particular health system, and also throughout transitions of care and across health systems.

Technology tools: Of course, a key aspect of health reform is the movement toward EHRs. Again this is reflected in the AMGAs definition of a high-performing system.

A health system that isn’t “meaningfully using” interoperable health IT and comparative analytics doesn’t make the cut, according to the AMGA. High performers must use such tools to assist with clinical decision making, improve patient safety, monitor and track patients, and prescribe.

Incentivized compensation: As the movement from volume to value reimbursement intensifies, health systems need to incorporate new incentives into their compensation plans to encourage their physicians to align with this shift.
 
A high-performing practice does just that, according to the AMGA. It encourages its physicians to improve patient outcomes providing them with compensation incentives, such as those that depend on patient satisfaction scores and quality metrics. 

Cost consciousness: Physicians and practices are facing a lot of pressure to reduce healthcare costs, especially if they are participating in accountable care organizations or bundled payment initiatives.

This style of practicing is reflected in the AMGAs definition. It states that high performing health systems assume shared financial responsibility and risk for managing cost of healthcare, improving the patient experience, and outcomes.

Physician leaders: In a recent article, we noted that as reimbursement shifts from volume to value, physicians will play a key role in determining a health system’s financial success or failure. That’s because physicians work closest with patients and they make the key treatment decisions.  As a result, they play a key role in determining the quality and cost of care provided. 

This is reflected in the AMGAs definition. It states that high performing health systems have strong physician leaders that also share non-clinical responsibilities.

Fisher said he hopes government and CMS officials will use the definition of a high-performing health system “to ensure that these providers are recognized for their efforts.”

What do you think of the six benchmarks? What would you add or eliminate?