A quick internet search for the ‘best hospitals’ or healthcare facilities reveals no shortage of lists or league tables. From the Mayo Clinic to Johns Hopkins and Cleveland Clinic, big names vie for the top spot whilst familiar entries appear from other corners of the world, like Albert Einstein in Sao Paolo or Bumrungrad in Bangkok.
But a closer look at the ranking criteria used by different publications offers some insight into how the same hospitals consistently feature in the top spots across listings. As an example, in the Newsweek 2020 rankings, 55% of each hospital’s score was derived from peer recommendation, whilst a comparatively low 30% was generated from a limited set of clinical KPIs. Perhaps then, it’s not surprising that those organisations which are most proficient at marketing themselves tend to score particularly highly.
It’s time to reconsider what we mean when we talk about ‘quality’ in healthcare provision; to move away from generic league tables in favour of implementing a set of universally applicable and verifiable metrics which can be used to accurately measure clinical performance.
Put simply, objective measurements of quality in healthcare are essential if we want to know how likely a patient is to receive effective treatment for a specific condition at one facility compared to another. This is particularly important when we consider that in the field of healthcare insurance, customers are free to access healthcare from any facility which forms part of the insurer’s ‘network’ of providers, therefore informed decision-making is key. Any assessment of care quality must also take into account factors such as the patient experience, safe and appropriate care delivery and the care environment, in addition to performance against recognised healthcare standards from national and international regulators.
Whilst previous measurements of quality have clearly fallen short of producing quantifiable data, we do know that there is an abundance of poor quality care. This encompasses money wasted on bad care as well as incorrect or ineffective treatments, overpriced care and even fraudulent care. The OECD estimates that up to 20% of global healthcare expenditure is wasted, with an additional 6% lost to fraud.
In addition to these worrying statistics, there is also considerable variation in how care is delivered, even in cases where clinical guidelines exist. Until now, this issue has been examined from a financial perspective; we know that there are significant disparities in healthcare costs not only by region, but also at the city and provider level. Furthermore, research tells us that the likelihood of a patient being recommended for a procedure varies by as much as sevenfold between different facilities. This is particularly true of high-cost cardiac and orthopaedic interventions.
A clear understanding of care providers, which is based on quantifiable quality and value measures, will improve the patient journey and significantly improve working relationships.
How can we help drive affordable and predictable healthcare?
In order to achieve world-class provider management, in which quality in healthcare can be measured objectively and monitored effectively, it’s necessary to make fundamental changes to healthcare procurement, not simply attempt to drive down unit cost.
The best way to support the delivery of a long-term sustainable and affordable network of care providers is by introducing a simplified value proposition for working with providers that combines core elements of cost, quality and relationship development.
In this way, providers are held accountable for the quality of the care they provide to customers, working to KPIs and implementing transparent and robust reporting procedures.
In summary
Insurers should focus on relationships with providers that promote greater transparency, high quality and better value. The contracting proposition must move away from percentage point discounts to value-based commissioning. Open dialogue with providers concerning data and care quality improves accountability, facilitates comparisons and enables customers to make informed choices about their care.
The post-COVID world presents an ideal opportunity to radically change the dialogue and relationship between insurers and providers , improving engagement and transparency, that will lead to a dramatic improvement in customer health and wellbeing.
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