With the tsunami of changes occurring in the healthcare industry today – ranging from increasing cost of care, shifting government regulations, technological advances, and the move from volume- to value-based care, the need to focus on population health holds utmost importance. Undeniably, all healthcare sectors hold the same shared goal of providing the best care to consumers, but each of the different (and often competing) sectors also holds varying interests, values, and points of view. In order to be best positioned to meet that shared goal of improving health outcomes and quality of life, industry leaders must foster an ecosystem view, which prioritizes population and community health through cross-sector collaboration.
A healthcare ecosystem approach, where sectors operate interdependently, has the potential to create greater value for consumers (patients and populations) by balancing and leveraging expectations, needs, resources, and contributions across the sectors. Working as an ecosystem, the sectors have the potential to deliver higher quality value and meet the critical imperatives currently facing the industry, such as patient-centricity, population management, cost reduction, improved coverage, utilization and optimization of value-based payment models, and leveraging technology and innovation.
The problems facing the healthcare industry are too complex and wide ranging for any one sector to solve. The greatest challenge to an ecosystem view of healthcare is determining how to capitalize on the shared goal of improving health outcomes, while at the same time optimizing the individual interests of each sector. Cross-sector collaborations are successful when sector leaders recognize the value of working together and understand each sectors’ respective contributions to – and challenges encountered within — the industry at large. To do this, stakeholder organizations seeking to form collaborations must engage in an open dialogue in which the parties share their respective business objectives, financial pressures, and operational challenges. This allows the parties to perceive the healthcare environment from one another’s perspectives, which will serve to identify mutually-beneficial solutions.
The following provides an example of how one leader navigated across sectors by leading with an ecosystem approach.
The Situation. With the implementation of the Affordable Care Act, a leading payer organization realized they would not be able to cover healthcare costs alone and would need to think more broadly. The population they served was overwhelmingly unhealthy, rural, poor, and being served by primary care providers that were largely unorganized, independent, small, and lacking in electronic records or infrastructure. The organization was tasked with finding a way to change their relationship with providers to better support the providers’ ability to care for populations and to be rewarded for good primary care.
The Solution. Working with the provider sector, the payer organization designed a program that supported the state’s Family Practice Academy as well as several hospital-based systems. The program aimed to invest health plan resources into strengthening the relationship between the payer organization and the providers, as well as supporting primary care doctors while allowing them to remain independent. The program involved the creation of an IT infrastructure, which included electronic medical records (EMRs), access to claims data and pharmacy claims data, and pulled in clinical data from EMRs to populate registries. The registries provided doctors with new insights and allowed the payer organization to provide care coordination and outreach for the providers. Additionally, the data enabled the payer organization to understand quality and performance metrics and set up a rewards system for physicians who provided outstanding care to patients with chronic diseases.
The Outcome. By the end of the first year, the program improved quality of care across chronic diseases and reduced the total cost of care by approximately $25 per member per month.
The Healthcare Ecosystem Leadership Model (HELM™) offers a framework for how leaders can generate cross-sector solutions to the healthcare industry’s most pressing needs. HELM is geared around the following capabilities:
- Envisioning the Future. First and foremost, leaders must have a clear vision of the direction their organization is heading and what it hopes to achieve. Then, they can begin to generate ideas about how collaborating with organizations from other sectors can contribute to achieving that vision. Thinking with an ecosystem view allows leaders to generate solutions they may not have otherwise considered.
- Align Stakeholders. As organizations bring stakeholders from other sectors into the conversation, leaders must allow these stakeholders to build on their original vision and incorporate their inputs and interests to develop a shared solution. This way, the stakeholders will feel a sense of ownership regarding the solution. Throughout the conversation, it is important to develop a relationship built on trust, respect, and open dialogue, without which there would be much tension and resistance to moving forward.
- Manage Boundaries and Obstacles. Along the way toward developing collaborative solutions, the partnership will likely be faced with some bumps along the road. To overcome these obstacles, it’s important that leaders focus on opportunity, and remind themselves as to why the partnership was developed in the first place. This may lead to difficult conversations, but in having these conversations the stakeholders can resolve points of tension, clarify roles, and re-align on ways the respective organizations can interface effectively.
- Act and Learn. Of course, leaders must take steps toward advancing the shared vision that was created at the onset of the collaboration, which may require acting under uncertain conditions. It is critical to be open to giving and receiving feedback in the interest of evolving that vision to the benefit of all parties.
Cross sector collaboration requires adoption of an ecosystem mindset, commitment of time, development of trust, alignment on business priorities, and certainty regarding the value of collaboration. Generating ecosystem solutions to solve complex healthcare challenges is a dynamic and ever-evolving process. However, development of the HELM capabilities for individuals and teams within sectors will enable the industry to realize cross sector solutions to our most pressing and complex healthcare challenges.