What is Your “I” in ROI?

After spending decades in roles associated with deploying healthcare information technology solutions in both acute care and ambulatory settings, I’d venture to say that it’s relatively straightforward to make a judgment on technical success. But after that evaluation, customers will most certainly ask a harder question to answer: “Was it worth it?” Judging the business or clinical success will generally translate into deciding if their return on investment is measurable. If you read our blogs regularly, you’ve seen that Holon’s recent blogs have focused on that very subject.

However, as Holon’s CollaborNet ambulatory-centric solution has reached more and more providers and our footprint grows, it seems that “investment” has a different meaning to different folks…. and for some, what it means is not necessarily intuitive to those charged with measuring ROI in a classic sense.

As we’ve worked with providers in practices to implement our software that supports the movement to value-based care, it’s apparent that there are investments beyond the financials involved, and even beyond the time expended.  Specifically, some investments are proving to be significantly impactful to the providers themselves, with the added complication that they are the resources directly involved:

• Investment 1: Changes in behavior at the point of care. With Holon’s Insights solution, we can efficiently offer gaps-in-care alerting (or surfacing interactive insights as we like to call it) to providers as they work within their systems and office workflows. While the concept appeals to every individual who sees a demonstration and/or tries the product, as we go live in a practice, it has been clear that some providers have had to adapt how they interact with patients. Perhaps that change is merely absorbing a new data point as they review charts before the encounter, or maybe it’s guiding that short window of conversation into addressing specific actions as a follow-up to the visit. In any case, there’s a basic need to utilize this information to effect change. It sounds simplistic, but in the end game of providing care under a value-based model, getting data to providers is of little use if not actionable or acted upon.
• Investment 2: Costs of data collection. Beyond the financials inevitably incurred in data collection, there’s an investment to make in charting “technique.” With the clinical-based metrics that organizations need to accommodate the various measures utilized in value-based care, many providers face a new rigor to the capture of data within their EMR. The good news is that it seems EMR vendors have generally provided a means to capture data in an appropriate form, even to the point of in-system guidance, but all such features are irrelevant if not fed properly. Gone are the days where all information is dumped into a text-blob-based progress note. Now there are needs for discrete data entry, whether that be a straightforward question like “Have you smoked in the past 3 months?” where the answer is a pick between a field of “yes” or “no”, or more complex entry like why a particular screening has not been performed, where a selection of canned choices is presented.
• Investment 3: Voice of the provider towards change. There are always early adopters, and there are likewise always laggards. Arguably healthcare has more of the latter, for reasons of habit, scarcity of time, or many other valid reasons. But if the goals for the model of value-based care are to be met in networks where many partners/practices are involved, a majority must sign on for the changes inherent in the transition and execute accordingly. As anyone who has worked with a busy practice knows, time seems to be the most valuable of commodities. With all involved in running a business that is a medical practice, prioritization is the name of the game, and it will be a very special and rare physician who will establish that something as non-glamorous as software is high up in the priority list. The investment to make is to find that rare physician who understands and brings a respected and objective message to his or her peers to make the needed changes and answer their questions. We’ve seen this happen, and it is far more effective than a vendor such as Holon or even a sponsoring ACO or health system mandating change as outsiders.

As an operations guy, I often find myself wondering if pointing out these concepts may discourage an organization from embarking on a project, or otherwise impede progress. In the end though, I try to reach a point where success is all but guaranteed and considering these sorts of concerns and managing through education and planning get the project team there with a minimum of surprise and frustration. When the goal includes calculations of ROI that by definition include investments in the denominator, even the soft costs should be considered.  Please reach out to our team so we can help you “Liberate the Data” and help you achieve your value-based care investment goals.