BRINGING OUR VALUES INTO VALUE-BASED CARE

A conversation on care transformation with Guidehouse’s Dr. Apurv Gupta

According to Dr. Apurv Gupta, provider organizations can sometimes miss the point of including values when they strive for value-based care. These are the critical human elements shared by care team members and their patients which are the essence of value.

That was one of many insights from a recent discussion with Dr. Gupta, who serves as director of healthcare performance improvement at Guidehouse–a top-ranked consulting firm. Guidehouse’s Health team helps providers, payers, government agencies, and life science organizations deliver innovative services to their communities and customers. His leadership and expertise focuses on provider engagement, high-reliability management, and care transformation.

Guidehouse and Innovaccer, both Best in KLAS organizations, recently announced a strategic partnership to help healthcare organizations unlock the power of their data and improve their digital transformation journeys.

Our conversation took a deep dive into healthcare’s workforce crisis, robotic process automation, clinical culture’s impact on care transformation, operating model redesign, as well as the impact of data integration on driving greater value.

Note: Interview responses have been edited for clarity and style. You can also watch or listen to the full interview down below.

Steve Ambrose: The latest American College of Healthcare Executive (ACHE) survey notes staffing shortages as the number one challenge confronting hospital CEOs. How are hospitals and health systems tackling or planning to tackle labor shortages?

Dr. Gupta: Every single client of ours is actually facing this very issue. When we go into work with them on any other aspects of care transformation, it always starts with, “we don't have enough staff.”

First we need to recognize that the workforce crisis itself cannot be solved by just adding more workforce. There's not enough doctors and nurses to go around; and if we can find them, we're usually paying premium dollars and stealing them from other health systems–only to have them stolen back in return. It's a constant game, unfortunately, of moving people around, and that's simply untenable.

When we speak with physicians and nurses, they estimate that as much as 25% to 33% of their daily workload is paperwork, administrative work, chasing after information, and chasing each other around. There's a lot of inefficiency and waste that we've built into the system. We’re not simply going to find a new pipeline of nurses or doctors; but instead, we need to be thinking more intelligently about how we effectively unburden our physicians.

Ambrose: One of your passions at Guidehouse is robotic process automation, or RPA. How is RPA uniquely different in focus and benefit from traditional automation tools?

Dr. Gupta: I think the challenge goes back to my previous answer. We have overburdened and disempowered clinicians, and we need to be more effective in engaging them in improving the design of clinical workflows. Unfortunately, the manual and nuisance tasks they are being asked to do is creating a lot of frustration and burnout.

That's the promise of RPA. I'm particularly excited about it because, as opposed to artificial intelligence or machine learning, which also has a lot of promise in healthcare, I think we're missing the impact that a bot or automated process can have by taking a repetitive task that a doctor is doing and offloading it from that doctor or nurse.

I think it's about taking activities that we don't require clinical intelligence for—and there's a lot of that kind of activity unfortunately in healthcare—and having it performed by a digital worker rather than a clinical worker.

Ambrose: Where are you seeing the biggest push in both investments and process change as related to driving down costs at health systems and hospitals?

Dr. Gupta: Health systems are placing a lot of emphasis on capacity. Hospitals often don't have enough nurses and techs to actually manage the number of patients they would normally be able to carry. They don't have enough transport and environmental support staff to be able to move the patients from place to place within the hospital and to clean the rooms. They're operating under capacity, and that's a crisis for hospitals.

Our health system clients are acutely focused on improving capacity, and that’s what they are investing in. You could argue that over the course of two or three decades, leaders were interested in throughput or capacity or discharge planning, and length of stay. But I and many of my colleagues have never seen this heightened sense of urgency for clients who, in the past, would've simply shrugged it off and felt that they would be able to solve these issues on their own.

Ambrose: With respect to clinical culture, what impact should physicians and care teams have on operational excellence and organizational performance?

Dr. Gupta: Physicians, nurses, pharmacists, case managers—all of them need to be involved in the process. Unfortunately, so many of them have been beat up by the system, they often feel disempowered because their voice is not being heard. They become disengaged as a result.

Imagine this happening in any of our own work scenarios. We need to put ourselves in their shoes. Even if we’re not clinicians, we can understand the frustration of feeling disengaged, disempowered, and on the brink of burnout. How are you going to be able to engender the hope, the compassion, the confidence that you need to be able to communicate your capabilities effectively to your patients?

This is why we need a culture of engagement, and why that culture is so important. We've got to be able to figure out how to have clinicians at the table; how to make sure we're listening to them; how to make sure they feel that their voices are being heard and their priorities are being accommodated. And if there's change happening, how to ensure they understand why the change is happening, and what their role is in the process redesign itself.

When we have the clinicians at the table, they feel better about themselves and their roles, as any of us would in the same type of job situation. As a result, their morale improves, their satisfaction improves, and by no surprise patient engagement and morale improves as well. It is critical for us to ensure that clinician engagement is paramount in the culture of the overall enterprise within which we, as leaders, are operating.

Ambrose: Guidehouse and Innovaccer recently announced a strategic partnership. At a high level, what are some of the initiatives that you see coming from that collaboration?

Dr. Gupta: At this point we've got two Best-in-KLAS organizations that are joining hands. And I think that represents tremendous promise to the industry and our clients. In addition to all of the other challenges we've laid out in terms of the workforce, culture, and margin pressures, ultimately they also need the right data. Innovaccer has the promise of being able to bring that data together across multiple platforms, and Guidehouse has the promise of being able to help healthcare organizations meaningfully leverage that data across many different work streams.

At Guidehouse, we work with health systems, hospitals, physician groups, and other providers. We also have a large life sciences practice; as well as government clients at the federal, state, and local levels. And for all of these different areas, having access to the right level of data to drive insights is critical to solving the operational challenges that they're faced with.

Even if we're talking about something as straightforward as length of stay, throughput, capacity management, population management—all of that needs to be data driven. The promise of this partnership is being able to fundamentally change the dialogue that's happening at the table, because we finally have and can bring the best data and insights to the table as well.

Ambrose: Hospitals and health systems have thinning margins and higher costs. How do you see value-based care becoming more widely adopted, and eventually becoming a preferred model over fee-for-service?

Dr. Gupta: Within the context of value-based care, we usually think of value as defined by quality over cost. Sounds fairly simple. But I think what's missing from the equation are the ideas of “values,” which is the human dimension. When we focus on quality within value-based care, there's unfortunately a tendency to just check the box so that we can meet the right criteria to get paid.

Are we really delivering quality or are we just making sure that we met some screening measures and made sure that we were able to see the patient enough times? It’s a reasonable surrogate for quality, but it may not be sufficient.

When we think of costs and controlling those in order to deliver value, that often then just winds up becoming constraints within the system. There's a limitation to that equation, and that's why I think it might be interesting for us to think, well, there's a “values” element also identified within the term that perhaps we haven't emphasized enough.

That's the human element, right? That's the people; that's the physician, the nurse, the case manager, the pharmacist, the environmental support staff, and the transporter. All of them who we've already mentioned, not to mention the patient and the family member, right? How are their goals from the healthcare system being captured within that equation?

That's critical, because without that, the system reduces to a transactional relationship. And then we're not really delivering value-based care. We may think it's about metrics, and we may think it's something that can be defined neatly within an equation. But unfortunately, it continues to escape us, because ultimately the goal of value-based care is to deliver a holistic approach to the patient.

That’s not simply managing them as a widget and taking care of their blood pressure over here, and maybe their congestive heart failure on another side; rather, it’s being able to really deliver a holistic experience that makes them feel like they have been heard, and that they've had all of their needs answered.

Ambrose: Pick just one problem today in healthcare. Snap your fingers and it’s fixed. What’s that problem?

Dr. Gupta: I think the challenge we’ve outlined in our discussion today is that clinicians are disengaged, and as a result, patients are disengaged. That’s the real problem I’d like to fix.

We really need a true consumer-centric model of healthcare. I think the system, as it's currently designed, is oriented around the insurance company, because it's how providers get paid. And so healthcare needs to be built from the inside out around the needs of the health system. It's been built around the needs of the insurance company; it’s built around the needs of the providers; it's built around the needs of the nurses … and at some point we get to the needs of the patient.

What we can do, if we really take a true consumer-oriented approach, is flip the system inside out, which a lot of people are trying to do right now. I fully agree with the notion of consumerism and digitization, and meeting the patient where they're at. I think that movement has a lot of promise.

And I'd like to see that get accelerated, because I think if we're truly responsive to the consumer, who is also the healthcare worker, mind you, then we can ensure that the system is delivering the value and the values that the consumer is asking for; that we’re delivering the level of holistic care that’s responsive to their needs.

To some extent you could say it's more market based. I think it will require a lot of reform in the way in which we pay for services. It will require a lot of reform in the technology and the data that we are partnering on, because we’ll have to bring more patient-oriented data to the table, rather than system-oriented or provider-oriented data used mostly today.

Let the patient have the insights about what to do with the data, and that drives the process. I think it would potentially spawn an industry of advocates, coaches, and therapists that would be needed to actually support the patient in their decision making. It may not solve all of our ills, but it could certainly go a long way towards reorienting and realigning the system to where it needs to be, so we are valuing and we're prioritizing the right things.

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