Navigating toward a sustainable health care system
Daniel Frank, MD, Chief Medical Officer, Optum Care
In the United States we spend substantially more than other countries on healthcare, without improved health outcomes.1,2 Indeed, the pace of increase in healthcare expenditure as a proportion of the United States economy is no longer sustainable.2
As one of the largest healthcare systems in the United States, serving 19 million people, Optum Care is at the frontlines of the health care delivery transformation – from a fee-for-service to a value-based model.
Value-based care is critical to creating a sustainable model.
Optum Care is bringing together the unique assets of an organization rich in clinicians, providers and caregivers, as well as data and strategic partnerships with the payers, to create a system that drives improved outcomes at a sustainable cost for patients.
What does such a transformative approach look like in action? It ties back to the Quadruple Aim of enhancing patient experience, improving population health, reducing costs and improving the work life of health care providers.3,4
At Optum Care, we are drawing upon our strengths to navigate our way toward a more sustainable health care ecosystem, using the Quadruple Aim as our North star.
Organizational strategy driven by care providers
A key tenet for drafting this improved system is creating an opportunity for clinician-directed and -influenced organizational strategy and future planning. This provider-led approach is implemented through a shared Clinical Governance.
The Physician Executive Council, for instance, is one such body tasked with tackling important pieces of the Quadruple Aim and helping set our organizational strategy.
Another example is our Clinical Councils, where we bring together physicians, clinicians and other leaders to drive tactical decisions about our long-term operational approaches.
Our councils ensure that we are being deliberate in empowering our clinicians to drive how care is provided.
The Optimal Care model in action
Developing and leveraging technological innovations at the point-of-care is another key nationwide investment that ties back to the Quadruple Aim.
For instance, we are using technology to facilitate the referral workflow so that our systems can help providers select the highest quality provider for specific referrals, as needed, without requiring multiple steps or access to different portals.
Similarly, we are establishing intuitive processes for medication management, so the system is there to support clinicians with evidence-based guidelines for pharmacological interventions.
These tools are not intended as cookie-cutter solutions, but rather to support clinical decision-making by providers.
Technology is integral to our Optimal Care clinical model. Optimal Care is an evidence-based approach to addressing practice challenges and developing clinical support algorithms.5
We are using a focused approach to tackle the largest variances in practice, such as discordance with emerging evidence using internal data-driven analytics.
As an example, we are piloting an AI-enabled voice-activated technology as a stand-in scribe for note taking during a patient-physician interaction to ease the administrative burden for providers.
Another example is a nationwide re-evaluation of best practices for assessing cardiac risk in low-risk patients with chest pain, using coronary computed tomography angiography instead of stress test, which is more difficult for the patient, costlier and associated with downstream negative consequences.
The Quadruple Aim Index scorecard
We want to bring the Quadruple Aim to life; to live, demonstrate and succeed at it, we need, first and foremost, to be able to concretely measure the key pieces.
With this in mind, we developed the Quadruple Aim Index (QAI) scorecard, based on a subset of metrics that we track within the four Quadruple Aim pillars:
- Patient satisfaction: Patient Net Promoter Score (NPS) and full/global risk-delegated patient retention
- High-quality patient outcomes: HEDIS Star Ratings and the average Practice Health & Safety Assessment Score
- Clinician well-being: Changes in contracted and employed primary care providers between sequential quarters and provider engagement metrics
- Affordability: Ratio of actual medical spending over the budgeted amount and trend in medical expenses
Although Quadruple Aim frameworks have been put forth by the Institute for Healthcare Improvement and other organizations, we co-created this QAI framework in partnership with our markets to enable a sharper focus on the most important metrics.
In addition to tracking QAI metrics, the scorecard includes a rating based on the comparison between the current value of the care delivery organization’s metric and the 2025 goal for that metric enabling long-term monitoring of progress.
In the first ten months of 2020, for instance, patient retention increased by 14%, bringing Optum Care within 4% of its 2025 target of 90% retention.
Animating the Quadruple Aim is a daunting task, requiring long-term commitment. One of the first adjustments necessary for this task is a cultural shift – one of moving from a fee-for-service mentality to a value-based one.
While many Optum providers have already undergone that journey, others may still be straddling both models.
Adding to this complexity are practice-/market-specific considerations. With a deep resource pool of providers and a genuine commitment, we can make the transformational shift needed to actualize the Quadruple Aim.
It is critical for every clinician and member of the care team to consider our aspirational vision for achieving the Quadruple Aim and ask ourselves how we can best integrate the available tools to foster the patient-provider link and improve the state of health care in the US.
- Office of Disease Prevention and Health Promotion. Access to Health Services. Healthy People 2020 Social Determinants of Health. Accessed June 17, 2021. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/access-to-health#1
- Syed ST, Gerber BS, Sharp LK. Traveling Towards Disease: Transportation Barriers to Health Care Access. J Community Health. 2013;38(5):976-993. doi:10.1007/s10900-013-9681-1
- Chaiyachati KH, Hubbard RA, Yeager A, et al. Rideshare-Based Medical Transportation for Medicaid Patients and Primary Care Show Rates: A Difference-in-Difference Analysis of a Pilot Program. J Gen Intern Med. 2018;33(6):863-868. doi:10.1007/s11606-018-4306-0
- Nguyen DL, Dejesus RS. Increased frequency of no-shows in residents’ primary care clinic is associated with more visits to the emergency department. J Prim Care Community Health. 2010;1(1):8-11. doi:10.1177/2150131909359930
- LeBlanc A, Vais S. Subsidized Non-Emergent Medical Transportation for Health Equity. HealthCity. Boston Medical Center. Published June 22, 2020. Accessed June 18, 2021. https://www.bmc.org/healthcity/research/subsidized-non-emergent-medical-transportation-health-equity
- Bruce Jaspen. Why Health Systems Need Ride-Share Partnerships. HealthLeaders. Published January 20, 2020. Accessed June 18, 2021. https://www.healthleadersmedia.com/strategy/why-health-systems-need-ride-share-partnerships.
This publication is informational and for educational purposes for practitioners only. The views and opinions expressed herein are those of the authors and do not necessarily represent the views of Optum Care. The views and opinions expressed may change without notice.