Mobilizing for value

Mobilizing for value

KPMG’s network of healthcare professionals have extensive experience in both public and private sector health systems, and many have initiated and managed major organizational transformations to delivered significant value improvements. We work with payers and commissioners of care and provide practical, hands-on advice and support. Our teams work can help with care system redesign, working across regional health ecosystems to rethink patient pathways and shift the provision of care to more appropriate settings.

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As many healthcare systems have discovered, the road to value is paved with hazards and obstructions. KPMG’s maturity matrix (see below) on the following pages presents achievable targets for becoming more value-oriented. Providers and payers can use the matrix to assess their current positions, strengths and weaknesses, and monitor progress toward value maturity.

Payers tend to be the driving force for change, but providers will also have to transform their approach to healthcare to become more outcome-oriented. Patient representative organizations can also be influential, by demanding patient-defined outcomes, self-care and accountability.

Most of the elements in the matrix are interdependent, so progress in one area needs to be supported by advances in another. As health systems reach the higher levels of maturity and achieve integrated care, the buy-in of local politicians, patients and community groups can accelerate the transformation and aid wider strategies for public health.

A blueprint for change: evolution not revolution

  • The five elements of the KPMG value maturity matrix must progress concurrently. Failure to do so could hold back the move to a value-based organization. For example, value-based contracts cannot be achieved without accompanying measurements of outcomes. Many organizations choose to start small, transitioning some of the care for one disease or patient group, requiring amendments to part of the contract.
  • The objectives of payers, providers and patients should be aligned, to ensure a common understanding of value and a willingness to work together. Governance and contracting provide the glue to make such partnerships stick, by rewarding/penalizing the right/wrong behavior.
  • Change cannot happen overnight and financial provisions need to be made for providers or individuals as they adapt to new targets, to ensure that income does not suddenly fall dramatically. Although competition should raise quality standards, it is important that entire hospitals do not suddenly fail, as this would jeopardize care provision.
  • Contracting should similarly evolve slowly, by adapting certain parts of the agreement, such as a modest (5 percent) shared bonus for meeting new outcome targets. Over time, incentives must constitute a larger proportion of payments, in order to truly incentivize significant improvements.

KPMG Value maturity matrix (5=high; 0=low)

   

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