By Brian Fugere, Chief Product Officer, symplr

November 2021 – Why do the changes necessary to survive under healthcare reform distress many healthcare leaders? After all, we’ve met challenges before in quality, patient safety, and revenue. Perhaps it’s because the new order will require nothing less than 100% collaboration, transparency, and data sharing across healthcare operations, including governance, risk management, and compliance (GRC) solutions. There are no more places to tuck away inefficiencies in workforce management that contribute to worker burnout and fatigue. No places to hide disruptive yet lucrative physicians or smooth over subpar provider performance without diminishing reimbursement. No excuses to remain in the dark about the true value of contracts and capital purchases, and the financial drain from making poor decisions due to a lack of visibility enterprise wide.

From an enabling perspective, the ability to deliver safe, high-quality patient care has always depended on an intricate balance of strategic planning, human resources allocation, and data management. COVID-19 upended plans, of course. It put a glaring light on the gaps caused by disconnected systems. It also created a new paradigm for looking at old problems, ranging from seesawing capacity levels to staff shortages and everything in between. Careful attention must be paid to the story that the data are telling, but first we must connect the dots.

The delivery of superior healthcare truly requires a well-coordinated village—but most health systems are interconnected enterprises suffering from multiple enterprise-level disconnections. And now, under value-based payment models, reimbursement is tied to patients’ perceived value, individual providers’ ability to contain costs, and benchmarked care/service quality. Those factors amplify the need for better operations that lead to better outcomes. The level of efficiency that successful healthcare reform requires can’t be achieved using single, siloed solutions for provider data management, workforce management, talent management, contracting, spend management, facility access, compliance, quality, and safety.

For example, in workforce management, it’s crucial to make financially sound staffing and scheduling decisions in all departments and roles to eliminate bottlenecks. In receiving delayed care, your patients see cracks in your healthcare delivery services and may devalue otherwise exemplary care. Delays also create revenue waste in the form of preventable overtime. An eight-week study at Stanford University Hospital found that it experienced specialty consult-related delays annually. The delays were largely attributable to provider staffing shortages. The estimated total cost: About $2.3 million dollars per year (Arifeen, et al., 2019). While every healthcare organization faces unique workforce challenges, understanding the volume of consult requests by specialty can be achieved by analyzing your existing scheduling data. Insights can then be applied to strategic planning to recruit and retain the appropriate number and types of providers.

As another example, COVID-19 exposed the need to consolidate and integrate processes and systems that manage GRC. These areas touch virtually every part of a health care system, including supply chain (think: pandemic-era personal protective equipment shortages) and access management (who is physically and virtually accessing your facilities). Never mind the obvious security and safety breaches. For healthcare organizations that employ or contract with an individual or entity on the OIG’s List of Excluded Individuals and Entities (LEIE), there are serious consequences. The LEIE provides information to the healthcare industry and the public regarding individuals and entities currently excluded from participation in Medicare, Medicaid, and all other federal healthcare programs for potential fraud, waste, abuse, or misconduct. Civil monetary penalties for violations can reach into the hundreds of thousands of dollars—whether the organization knew or should have known about the exclusion, and whether or not the excluded individual physically accessed the facility. In fiscal 2020 alone, OIG investigations and audits:

• Uncovered over 2,148 excluded individuals and entities
• Resulted in 624 criminal actions and 791 civil actions against individuals and entities
• Resulted in an estimated recovery of $3.1 billion

Data-driven insights about GRC operations and pitfalls, such as doing business with an excluded individual or entity guide decision making in ordinary and emergency situations to better protect patients, staff, and organizations.

Technological advances make it easier to streamline operations by using connected suites of software that integrate and coordinate tasks, allowing healthcare organizations and their staffs to better organize the time and resources needed to meet healthcare reform’s goals. Simply put, we’re in an era where operational challenges can be more easily revealed and mitigated by selecting and implementing the technologies and software best suited for your unique landscape and your organization.

Where once healthcare organizations used a labyrinth of technologies and software to avoid risk, maintain quality, comply with regulations, and ultimately keep patients and staff safe, operational efficiency is now the only thing preventing the achievement of these goals, and ultimately, the successful reform of healthcare.

Reference

Arifeen, S. R., Shi, S., Meza, P. K., Justin, L. J., Svec, D., & Shieh, L. (2019). Waiting it out: Consultation delays prolong in-patient length of stay. Postgraduate Medical Journal, 95(1119), 1. doi:http://dx.doi.org/10.1136/postgradmedj-2018-136269

About the Author

As Chief Product Officer, Brian Fugere leads all product management and user experience (UX) design efforts across the rapidly expanding symplr portfolio. During the past two-plus years, he also served as CMO and led the Engineering organization. Bringing over 30 years of go-to-market experience in software companies of all sizes, Fugere was most recently the CMO of Virence Health, a carve out from GE Healthcare. Prior roles include President of The Estimating Edge, COO and CMO of RemitDATA, as well as leadership positions at Belo Interactive, Stryker, and America Online.

Fugere has deep experience in executive leadership, marketing, product, sales, and operations across public, private equity, and venture-backed companies. He holds a B.S. in Electrical Engineering from Cornell University, an MBA from George Mason University, and completed a leadership and business program at Harvard Business School.