Scale and Stability In

Risk Adjustment

Teamwork in a Risk Adjustment Program. The Process within the Process.

In the best and most stable of times, change in any kind of business strategy can be risky. This change has impacted the healthcare industry, which is already experiencing rapid change and physician/healthcare worker burnout. It’s no wonder health care leaders fear pivoting their business strategy by adopting an alternative direction such as a Risk Adoption program.

Adopting alternative business models can be risky. Adding more change is like throwing gasoline on a burning fire. Results could potentially be explosive and possibly irreparable. Why would any organization, particularly healthcare, willingly push major change like adopting a Risk Adjustment program? And how can you bring about the change you want, without bringing a crisis down around you?

Maybe it not a question about “why.” Maybe the right question to ask is "how."

Avoiding Crisis – Having a Vision

Healthcare leadership must paint the picture they are moving their organization ahead with, in a clearly defined purpose. This should come from the top of the organization. With Risk Adjustment, like all big initiatives, planning is crucial. What is beyond the horizon really isn’t as important as figuring out how to overcome the mountain in front of you. For most people working in healthcare, mountains seem to be everywhere.

Aligning Teams

Teams will form the foundation for any Risk Adjustment program to succeed. They can take on a multitude of meanings and enable extraordinary outcomes. There is no better motivator than a team to help individuals find their personal reserve, dig deep, and realize their untapped potential.

As an example, one large integrated health care system in the Northeast, a Vee Healthtek client, aligned three teams with critical functions:

  • Team 1. Information Technology and System Security
  • Team 2. Physician Engagement and Education
  • Team 3. Reporting and Outcomes

The overall program had a leader and the teams were guided by the program manager. While there were no specific individual team leaders, each team was essentially leveraging the strategies psychology author and professor Brett Steenbarger described in an article in Forbes magazine entitled, “Three Strategies for Making Your Team Work.”

Steenbarger defines effective teams wherein each member makes the others better. “There is always synergy. People learn from each other, support each other, help each other. Among less effective teams we see conflict and clashing agendas, taking without giving, and lukewarm commitment.”

These are the very traits we saw among the teams formed at Vee Healthtek’s client as they developed their Risk Adjustment program. They created teams with the same three characteristics Steenbarger says are imperative to have successful teamwork:

  • Appreciation - It begins with a “clear, shared definition of what needs to be accomplished and then explicitly draws upon the strengths of team members to brainstorm means and ends.”
  • Strength - Steenbarger described this strategy, as much like parenting. “Members will naturally take on different roles depending upon their experience, interests, and capabilities.” In that way, each team member acts as a leader “within the sphere of his or her expertise and experience.”
  • Communication - A single team leader guiding members toward a preset outcome is no longer the goal. “It’s replaced by a highly interactive process in which expertise is shared. Every member must be able to communicate clearly and effectively.”

By following these three strategies, hierarchies are nonexistent within teams. Meetings run efficiently by focusing on critical events. Business rhythm is kept within and among groups through communication. A successful program means every team succeeds.

Leveraging Partnerships

That’s not to say that everything must be done in-house. Taking stock in the fact an effective Risk Adjustment program needs outside support has helped countless health care leaders. Leveraging partnerships plays a critical role.

The integrated health care system mentioned above leveraged Vee Healthtek to assist with an initial retrospective coding and documentation review. That included 8,000 patient encounters. In a follow-up capacity to the retrospective review, Vee Healthtek assistance continues with concurrent coding review.

Partners like Vee Healthtek are a natural extension of your program. Outcomes and services will align with the critical events and goals of the program. Covenant partnerships will carefully align with teams and the organization’s mission and values.

Operational alignment between outside resources offers the work-life balance essential to program success. And it addresses the need for scale and stability with processes, key performance indicators, business metrics, and outcomes.

Re-affirming Commitment to the Vision

Fully optimizing the value in a Risk Adjustment program allows leadership many opportunities throughout the journey to recognize successes. Every organization has different strengths to harness and weaknesses to assess.

According to Ashish K. Jha, MD, MPH, et al., the authors of “A Crisis in Health Care: A Call to Action on Physician Burnout” (http://www.massmed.org/News-and-Publications/MMS-News-Releases/Physician-Burnout-Report-2018/), “Physician burnout, a condition in which physicians lose satisfaction and a sense of efficacy in their work, has become widespread in our profession, driven by rapid changes in health care and our professional environment.”

Source Material:

https://www.forbes.com/sites/brettsteenbarger/2018/06/29/three-strategies-for-making-your-team-work/ Steenbarger is a Clinical Associate Professor of Psychiatry and Behavioral Sciences at SUNY Upstate Medical University in Syracuse, NY.