While there have been significant strides in providing frontline clinicians with quality information, these clinicians still lack the tools they need to play an active role in controlling the costs of the care they provide. To date, only small steps have been taken at most health care systems (for example, clarifying the costs of specific tests during the test-ordering process), and new clinical analytics systems that offer better insights into costs and efficiency often aren’t integrated into day-to-day clinical care. Worse, discussions at health care organizations about how to increase “overall value” too often degenerate into conversations about cost reduction, with participants forgetting that delivering value means both improving outcomes and lowering costs.
A Simple Way to Involve Frontline Clinicians in Managing Costs
While there have been significant strides in providing frontline clinicians with quality information, they still lack the tools they need to play an active role in controlling the costs of care they provide. To date, only small steps have been taken at most health care systems (e.g., clarifying the costs of specific tests during the test-ordering process), and new clinical analytics systems that offer better insights into costs and efficiency often aren’t integrated into day-to-day clinical care. Worse, discussions at health care organizations about how to increase “overall value” too often degenerate into conversations about cost reduction, with participants forgetting that value means improving outcomes and costs. In 2016, the Scottish National Health Service (NHS Scotland) successfully piloted an approach to value improvement that took both cost and quality into account and turned the management of value into the basic task of the point-of-care manager. Value ceased to be a side initiative or something driven solely by top-level finance and executive leaders. The “lean accounting” method for measuring real, unallocated costs that was used came from the Institute for Healthcare Improvement and one of the authors (Brian Maskell). IHI had partnered with Maskell to combine a version of lean accounting that had been used in manufacturing with a point-of-care management system.