United States: "Moneyball" And "Hoosiers": Models For Optimizing Participation In The QPP

Last Updated: September 28 2017
Article by Tom S Lee

Participation in value-based programs is on the rise. Growth of ACOs is up 11%, and CMS estimates that 30% of Medicare payments are currently flowing through alternative payment models (APM). This milestone was reached 11 months ahead of schedule according to the Department of Health and Human Services (HHS), which expects Medicare payments flowing through APMs to reach 50% by the end of 2018.

The Quality Payment Program (QPP) under MACRA is one of the main driving forces behind this movement. Medicaid, Medicare Advantage and commercial payers will follow suit toward the same objective. Industry analysts observe that commercial value-based contracts are keeping pace with the growth of ACOs and APMs.

With this sea change underway, healthcare leaders are recognizing the need to transform their mindset and their approach to value-based programs so that they can effectively participate, compete and win. With our clients, we see this transformation occurring every day on two fronts—analytics and culture. To illustrate the effective application of these concepts, we look to the movies "Moneyball" and "Hoosiers," and the 2016 World Series champions. 

Lessons from "Moneyball"

Analytics is a powerful tool in healthcare, providing insights into patient populations and serving as the foundation for risk-based contracts. Analytics also has the power to provide insights to optimize clinician performance in value-based programs including MIPS and advanced APMs. Consider Moneyball, the story of the Oakland A's baseball general manager, Billy Beane, told through the eyes of Hollywood. Hampered by a small budget for player salaries, Billy took a contrarian approach to managing his team. He relied on analytics, above all else, to identify, recruit and manage players. Billy converted the A's to a surprising division-winning baseball team, achieving a record-breaking 20 game winning streak along the way.

Healthcare is no stranger to small budgets. Like Billy Beane, healthcare managers can use value-based program analytics to proactively engage clinicians on actions that will drive the most value. 

Lessons from "Hoosiers"

Analytics can be a catalyst for change, but it is not typically the driving force in healthcare. The driving force comes from the organization's mission and culture. Consider Hoosiers, the true story of a down-and-out college basketball coach who turns a dysfunctional rural Indiana high school basketball team into state champions. Norman Dale reshapes the mindset of this small Indiana town by instilling a mission and set of values to engage and respect the contribution of every member of the team. Change in healthcare requires this type of leadership to drive toward a common mission and motivate change through strong cultures and values.

Together, Analytics and Culture Will Create Positive Change

Neither analytics nor culture individually will create the change we need to achieve the championship in healthcare, which is the Triple Aim. Continuing with the sports analogies, consider the Chicago Cubs who won the 2016 World Series in baseball—their first championship in more than 100 years. Working within a constrained salary cap, the Cubs' president of baseball operations, Theo Epstein, led the team to victory by artfully applying analytical insights while instilling strong team cultures and values. This same approach was successfully applied by Epstein with the Boston Red Sox in 2004, which ended an 86-year championship drought and spawned two more championships since then.

View MIPS and APMs as Training Grounds

Success in healthcare comes by strategically combining substantive analytics in support of a coherent and galvanizing mission. MIPS and APMs serve as training grounds for healthcare organizations to leverage analytics and build a culture to lay the foundation for ongoing success in value-based healthcare.

SA Ignite has a longstanding history of working with healthcare organizations to optimize performance in value-based programs. SA Ignite is a HORNE partner that helps organizations transform to value-based care. To learn how clients are combining analytics and culture to optimize performance in MIPS and transform their organizations to value-based care, watch this ABCs of MIPS webinar. Or, read a recent blog where we discuss in detail the top 3 decisions to optimize MIPS Quality scores.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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