About six years ago, Rebecca Guess, associate vice president of quality at Baptist Health Medical Group in Louisville, drew a mock-up on a legal pad of a dashboard for tracking and reporting on quality metrics across the health system. Baptist Health was looking to refine and standardize their metrics reporting and analysis to elevate quality throughout the system—no small task for a system of its size.
Baptist Health comprises more than 1,500 employed physicians and nonphysician providers across Kentucky and Southern Indiana, covering more than 75 specialties within about 400 outpatient facilities and eight hospitals. Baptist Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Today, Baptist Health is among the top quartile in the country for quality metrics and value-based care. For example, the quality metrics include breast cancer and colon cancer screening, advance care planning, diabetes A1c testing and control. Each metric aligns with the health system’s value-based care partners.
“Rebecca has done an incredible job of really being transparent with the data,” said Shelley Shaughnessy, chief operating officer at Baptist Health Medical Group in Louisville. “Between partnering with our physicians, partnering with operations, and creating a structure that is really driving the results that we want, her vision became a reality.”
Providing value-based care is often quantified through the lens of a simple equation: Value equals quality plus patient experience divided by cost. While this formula can be applied to any health system, it doesn’t even scratch the surface of the unique and complex needs within each varied part of a system.
Baptist Health leaders had their work cut out for them.
“Originally, we had an a la carte menu of metrics that varied in range and specificity depending on the area of care,” said Guess. “I saw a few areas where there were different goals for the same metrics.”
That single sheet of notebook paper soon grew into a comprehensive approach that got much of this large health system on the same page. Here is how.
Start a countdown
Baptist Health’s new value-based model was developed with partnership and alignment serving as the guiding principles.
“We began by looking at what metrics are we responsible for with our value-based partners, and then how can we align that across service lines and across the system?” said Guess. “From there we asked ourselves, ‘What goals do those payer contracts have with requirements that we need to meet? What do those goals look like?’”
Once the groundwork was laid for Baptist Health internally, leaders then factored in national benchmarks, such as the Healthcare Effectiveness Data and Information Set (HEDIS). This included effectiveness of care, access and availability of care, experience of care and measures reported using electronic clinical data systems.
These efforts led to a single goal: To be in the top quartile for quality and patient experience, and be in the bottom third for cost, by Jan. 1, 2024. Baptist Health succeeded. The metrics are Medicare Merit-based Incentive Payment System Clinical Quality Measures and are also National Quality Forum-endorsed.
With a deadline set, the countdown officially began. Clocks were distributed throughout the leadership team.
“That countdown became a mantra across the organization,” said Shaughnessy. “On any given day, any leader could tell you how many days we had to reach our goals.”
The final goal established a frame in which smaller, sprint-style goals could be created. Team leaders could send out status updates and let their direct reports know what was expected in the next 100 days, or other blocks of time.
In time, Baptist Health found examples at the service line, team and facility level to share across the system and apply toward their own quality improvements.
“We made sure notices like that went to a broader audience than just leadership so that our managers, our quality leaders, our safety coordinators, were also looking at that and noting that we are really counting down and paying attention to all of this,” Guess said. “It became a team-based approach to quality metrics rather than each department operating independently.”
Use a scorecard
While the calendar served as a motivator, the scorecard gave a direct view into how quality changes would be measured. The scorecard allowed everyone to see effectiveness at the system level, and at a market or facility level. This included inpatient readmissions, mortality and reoperation safety.
“If we're looking at efficiency, for example, we may have 10 to 12 measures in there, but it rolls it up into one score,” said Guess. “It’s similar to a grade-point average. We can see how all those measures combine against that national benchmark to give us a grade.”
One measure included on the scorecard is for colon cancer screening. It reports the percentage of adults 45–75 years old who had an appropriate screening for colorectal cancer.
Building out the scoreboard required taking in a great deal of feedback and requests from across Baptist Health. It was designed to offer flexibility in available data, all while aligning the disparate areas of the whole system into a set of quality standards.
It needed to be as helpful for a physician “as it is for a clinical leader, a practice manager and a medical assistant,” said Guess. “And it was important that all these data points be available in one dashboard. Each user should be just a couple of clicks away from the data they want.”
“As a physician, it is great to see all of my individual quality metrics on a single dashboard. Providers also receive real-time best practice alerts while seeing patients in the clinic,” said Brian W. Chaney, MD, medical director of quality and utilization management at Baptist Health. “This makes it easy to identify and address any care gaps related to our quality metrics. If a patient needs certain immunizations, breast or colon cancer screening, Hemoglobin A1C testing, or any other number of items, we see these in one place without having to search them out.”
Ensure quality coordination
In acknowledging that physicians and other health professionals in all areas and specialties are experiencing burnout and strain, Baptist Health brought in quality coordinators to help implement the changes.
Baptist Health’s quality coordinators provide training and education, among other assistance. The coordinators go through intensive process improvement training to become proficient with quality improvement, workflow development, tracking and Epic.
“The medical assistants are critical for driving outcomes and the coordinators have been really effective and supportive while working closely alongside them,” said Shaughnessy. “Additionally, our physician leaders have taken real ownership of our quality and ensure that providers in each region know what to do. They’ve become experts in how to use the standards to improve quality beyond just the numbers.”
Physicians, coordinators and medical assistants “work together to fill each other’s needs,” she added.
The results are shown in patient-experience scores.
Additionally, “we can see how many more patients received breast-cancer screenings, depression screenings and A1c interventions because of this work,” said Guess. “This is closing care gaps, enabling us to reach more patients, and helping more people get access to care they need.”
In tandem with patient satisfaction is a sense of engagement from Baptist Health’s physicians.
“They are sitting right with us at the table helping us make these quality-improvement decisions,” said Shaughnessy, noting that having physicians and medical assistants “participating and feeling a sense of ownership in this effort has gone a long way.”
Learn more with the AMA about data-sharing best practices for value-based care and advancing value-based care with alternative payment models in Medicare.
