The nervous system of your practice.

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© 2018 Beacinsight

Providers are medical experts,

not operations experts.

Future State

We envision a unified, continuously adapting delivery system.

We envision a fully unified, continuously adapting delivery system.

In this ”just-in-time” system, each clinic, lab, imaging, and operating area are connected to one another through a single nervous system continuously adapting to changes in supply, demand, and feedback. The system is both predictable and reliable in spite of the uncertainty and variability that is inherent to human processes.
 
Patients experience a personalized, curated flow through the system. Expectations for who they interact with and how much time they spend with each provider, at each appointment, and across the entire experience are determined in advance and updated as they arrive and move through their visit in real-time.
 
Similarly, expectations for caregivers and staff are based on reality—not only the work required to achieve those targets, but also how they accomplish this work.  Their workflow is individualized and responsive.

 

Administrators and executives have their fingers on the pulse of the organization’s operations.  Real-time visibility into the flow of operations enables them to not only see, but also predict, breakdowns in processes.  As new demands or priorities arise, they are able to experiment with processes and resource allocation with the same scientific rigor applied to the rest of patients’ medical care.
 
Within this system, access to, and ease of use of, transparent systems of record—administrative, medical, and operational—allows stakeholders to engage using a common language.  A language that constructs an intuitive story of care through who, where, when, what, why, and how long.  This enables organizations to have informed conversations on the definitions and trade-offs of cost, quality, and service.
 
This is our vision and the actualization of years of development.  Are you ready for the future?
 

Core Care Loop

Care is an inherently human activity rooted in time and place.

Despite all advances in technology, when we require care, we need to be face-to-face with a human being.  The same fundamental steps must be completed any time a patient receives care.  Whether it is a parent taking care of their child staying home from school or the most advanced surgical procedure, these needs must be met for a person to deliver care to another.  We call this the core care loop.

In the smallest number of steps, we can describe the process of delivering care as:

A person seeks care (becoming a patient)

The patient accesses care services (i.e. a care visit)

The provider prepares for the visit

The provider cares for the patient during the visit

The provider follows up on the visit with the patient

Depicted as a simplified continuous loop:

Optimize Delivery

Care delivery, despite its inherent variability, is both predictable and manageable when understood.

For a care delivery organization (CDO), whose primary business function is to care for patients, the core care loop represents the steps all customers must go through for the CDO to generate and realize revenue. Therefore, if this loop is broken or inappropriately managed at a given step, then the business will show symptoms of inefficiency (higher costs for lower productivity), high production and service variability, and/or missed revenue opportunities.

CDOs attempt to optimize this loop by automating, outsourcing, or simplifying business activities at a given step.  However, what is required to advance to the next step, or the underlying need, must be met. This is called the job-to-be-done (JTBD).  CDOs can fulfill the JTBD by designing a new process or employing the appropriate technology.  For example, if the JTBD is to ingest medication, it can be fulfilled via pills, shots, or skin patches (to name a few).

As the healthcare industry has matured and grown, the JTBDs at each step have grown increasingly obscured by buzzwords, inappropriate selection of technologies, and misaligned incentives.  But it is critical to recognize that the underlying JTBDs have not changed.  These JTBDs are best categorized into three major functional groups:

  • Administrative

  • Medical

  • Operational

The JTBDs for each of these three functional groups are depicted below as subsets of the core care loop.  Taken together, these JTBDs enable the CDO to efficiently complete the core care loop.  The most commonly employed solutions available in the market addressing the JTBDs in the cycle are described underneath the diagram.

PATIENT NEEDS CARE:  identify high-risk individuals within local population, regularly follow-up with patients previously seen, or enable patients to walk-in in response to an acute event

PATIENT SEEKS CARE:  schedules a visit with a provider, walks-in to an acute care center, or calls a friend/relative

PROVIDER PREPARES FOR PATIENT’S VISIT:  obtains medical supplies, reviews existing medical information, orders preliminary testing, and/or reminds patient to come in for visit

PROVIDER DELIVERS CARE:  finds location with sufficient capacity, coordinates required resources and personnel, listens to patients’ symptoms, obtains medical history, diagnoses patient, and recommends course of management and/or performs procedure

FOLLOW UP ON VISIT:  follows progression of patients’ symptoms, evaluates compliance with management, provides additional education and recommendations, replaces supplies used during visit, coordinates transport and/or transfer to additional medical care, and collects payment for care provided during visit

There are two key takeaways upon evaluation of the JTBDs and currently available market solutions:

1.  Both the administrative and medical business activities have a dedicated system of record: revenue cycle management (RCM) and electronic medical record (EMR), respectively.  Conspicuously, the operational aspect of care delivery has no system of record.

 

2.  Most JTBDs have purpose-built solutions designed to make their designated activity easier, faster, and better.  However, despite the critical and complicated logistics involved in coordinating and optimizing the flow of resources to deliver care during the visit, there is not a dedicated, modern, scalable solution for facilitating in-person operations decisions or accelerating process improvement.

In an attempt to still address these JTBDs, existing solutions are being stretched beyond their intended purpose.  This is the equivalent of using duct tape instead of glass for a window (while it meets the need of protection from the external environment, it does not allow one to see through it).

The result is evident in today's delivery of care.  Currently the system lacks an objective definition or method of measuring value, is plagued by systemic inefficiency, and has a ceiling on CDOs' ability to improve. In addition, the experience of care is unpredictable and service expectations are unrealistic resulting in frustration for both patients and providers.  To reach an optimized core care loop, and thereby deliver high-value care on-time and efficiently as well as maximize revenue, we need a purpose-built operational system of record.

Realize Value

All the value in any conceivable system is only realized in the actual delivery of care, when hands touch patients. Everything else is ancillary.

The future of health care is clear.  The future is value-based.  The shift is both an emotional and logical imperative.

 

What value-based care is called can be subject to the latest buzzwords and trends, but the core principles remain the same: practice the highest quality medicine, delivered with the best service at the lowest cost. 

Yet, up until now, CDOs have struggled to measure value with objective and easily understood metrics—particularly in the ambulatory care setting.  Let's analyze these variables one at-a-time:

 

Quality (Q):  While progress is being made to define quality medicine in terms of health outcomes, this is still opaque to the customer (i.e. prospective patients do not make decisions to see one provider versus another based on this type of quality).  Instead, the majority of customers are looking to have their health question answered or need fulfilled in a way that is reasonable to them. Research has shown that the greatest determinant of satisfying this requirement is the amount of time patients spend face-to-face with their provider.

Service (S):  Unlike quality, customers are increasingly more capable—and familiar with—evaluating service.  What do customers really care about?  Predictable and consistent progression through a transparent schedule of activities without excessive delays.  Yet, CDOs today do not measure the wait time durations across a patient's entire experience nor are they able to set expectations when the patient will be seen or be able to leave the clinic.  Instead, CDOs measure patient's satisfaction with service through surveys which are subject to recall bias, subjectivity, and non-normalized metrics. 

Cost ($):  In today's fee-for-service world, what care costs to a patient depends on a number of factors due to insurance coverage, etc. However, from the CDO perspective, what are the two largest costs? Like any other business they are salaries and rent.  Yet, CDOs lack a granular understanding of provider or room utilization.  In a value-based world, such costs need to be understood at a per-patient level.

To summarize, Value (V) is equal to:

Quality (Q) = Total duration of patient-provider face time.

Service (S) = Appropriately set expectations without excessive delays.

Cost ($) = How much time resources were used to enable that patient-provider face time.

 

What underlies all of these factors?  Time.

 

Current State

Ideal State

The size of circles is proportional to CDOs annual spending on the respective functional grouping.

OPR

Beacinsight addresses a systemic lack of data about the delivery of care with an Operations Performance Record (OPR).

Evaluating the core care loop, we recognize a critical lack of data related to the actual process of delivering care in-person.  Day-to-day this means:

  • Who's where, when, doing what?

  • Who's with whom?

  • What rooms are in-use or available?

  • Who or what is causing a bottleneck?

  • What can be done to address a given bottleneck?

  • Which patient should be seen first?

  • How long will this appointment take?

  • What resources are needed to see this patient?

None of these questions can be addressed today by a singular solution.

 

To be able to answer these questions (and more), patients' and clinical staffs' movement, time, use of space, as well as their interplay needs to be captured.  Moreover, these data points need to be connected to the existing systems of record (i.e. EMR and RCM) to ensure relevant decisions are represented in context.

In doing so, an Operational Performance Record (OPR) can be created that tells the story of who, where, when, what, why, and how long in an intuitive manner that all stakeholders can understand.  Only then will patients, providers, CDOs, and payers obtain a complete, genuine, and objective record of care.

 

OPR  Impact

OPR is the nervous system of the clinical setting, which enables predictable and reliable care to be delivered. 

Delivering value to all stakeholders across the spectrum of the care is critical, particularly when it is so central to the fundamental purpose of healthcare: having a person deliver care to another person.  The OPR enables value to be delivered to each stakeholder and enhance the value delivered by complementary solutions.​

Patient Benefits

Service expectations set and delivered upon

Minimal wait time in care setting

Allocation of time with care team based on needs

Frictionless experience moving through care setting

Comprehensive, legible, and objective record of care

Care Team Benefits

Recoup time lost during day due to inefficient ops

Spend less time on unnecessary documentation

Feel prepared to deal with uncertainty

Spend more time with patients

Know when they will be able to go home

Admin Benefits

Visibility into top- and bottom-line drivers

Minimal wait time in care setting

Plan process, resource, and workflow adjustments

Communicate with team in common language

Scale improvement initiatives