Paving the Way For a Collaborative Future

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Accenture

Despite existing and potential barriers, the benefits of collaboration between the major entities in healthcare remain high. Properly done, collaboration could increase the efficiencies of the entire system, therebyhelping to manage overall costs.

In no other sector of the economy besides health care is the case for collaboration between entities so strong and the existence of collaboration so limited. Due to historical problems with past attempts, a high level of mistrust, difficulties in understanding how each party carries out its activities, a lack of common language, and other barriers, collaboration has been slow or almost nonexistent between the major parties in the health care sector. Surely some progress has been made with the gradual adoption of electronic claims, as an example, but progress beyond that single transaction has been glacially slow when compared to examples of collaboration in other industries.

Yet the promise of benefits remains high, despite existing and potential barriers. Properly done, collaboration between the major entities in health care could increase the efficiencies of the entire system, thereby helping to manage overall costs. Increased efficiencies are not restricted to the multitude of business functions, though there remain a high number of those that can still benefit from a collaborative approach. Collaborating on clinical care, spreading the adoption of evidence- based medical practice, improvements in patient safety, population-based disease management, and improved compliance with therapy are just a few examples of areas where a collaborative approach can have an impact.

We do not know, nor can we know with absolute certainty, what the future will hold for the health system in the United States or in other nations. In the United States, there is widespread disagreement about how the system will look in 10 years. Examples of such predictions include:

• Universal health insurance develops through publicly or privately sponsored efforts. All citizens, regardless of their income and employment status, have health insurance. Even among those who believe the United States will adopt universal health insurance, there is considerable disagreement about what form it would take.
• Evidence-based medicine is used to ensure the effectiveness of services rendered. Patients have access to the information that they need to select the highest quality providers. Money is expended on treatments that have a proven record of success.
• Pay for performance takes hold. Health care providers receive tangible financial incentives based on the outcomes they achieve. Realigned financial incentives restore competition and efficiency to the marketplace.
• Telemedicine, mobile technology, robotics, nanotechnology, and the like revolutionize how and where medical care is delivered. Even the most sophisticated treatments now become available to patients in remote areas. Services are no longer tethered to inpatient hospitals. Patients can receive care at a time and in a place convenient to them – whether it’s in the morning or evening, weekday or weekend, at home or at work, via a phone or the Internet, or in person.
• Genomics helps providers predict who is at risk for different diseases, and helps prevent health problems before they occur. Treatments are tailored to individual patients to ensure the highest probability of a successful outcome.
• Patients have one electronic medical record of all their medical care, accessible to any provider of their choosing, within privacy and security safeguards. Providers can work together in a multidisciplinary fashion to enhance the well-being of the patient. They have access to all of the information they need to make an accurate diagnosis and prescribe the optimal, latest treatments. Patients no longer need to repeat their medical history every time they encounter a new provider. Quality of the digitized information is ensured through automated algorithms. Sophisticated rules and alerts virtually eliminate medical errors.
• Digital information also organizes all financial data in userfriendly formats such as smart cards. The process of securing authorization and getting reimbursed becomes completely seamless and transparent, if not obsolete. Administrative costs are minimized, bringing inflation in expenditures under control.

None of these examples is assured of happening, nor are they dependent on each other to even occur. But some of these scenarios may eventually materialize – if not in whole, then at least in part. What is certain is that the future will require a greater degree of collaboration between the major players in the health care industry than currently exists. In order to develop a system in which clinical outcomes improve and costs are controlled, both the providers and payers must be directly and closely involved.

This will require a major shift from the status quo. Collaboration is a lot more than communication. And while connectivity lays the technological foundation, it is not sufficient to promote collaboration. Collaboration is a two-way process. It’s not about being nice to work with. It’s about a more effective – and ultimately simpler – way of working together for mutual benefit. Collaboration helps people and organizations learn from one another and build better solutions together. It can produce better, faster, and more sustainable results. Collaboration makes business partners stronger by combining what they do best, so that 1+1=3.

There is not one master or right model of collaboration. Collaborations can take many forms and may involve business partners in different degrees of commitment. Organizations can engage in a spectrum of collaborative efforts (see Figure 1):

• Transactional – Organizations are involved in an arm’s-length, zero-sum competition for value derived from working together. Each party in the collaboration can be replaced. There is just enough exchange of information to affect the transaction itself. Access to the Web is often all the parties need to make this type of relationship work.
• Cooperative – Organizations improve business processes across boundaries, jointly address new business opportunities, and build greater customer loyalties. There’s a win-win relationship. To achieve these results, the cooperating organizations must share information, but there are limits to the level of disclosure that is acceptable to each party.
• Share – Organizations rely on each other’s competencies as an essential element of their own success. They outsource functions and tasks to partners that they traditionally have done themselves. They learn to share and create knowledge. They establish clearly stated common goals.
• Co-created – Organizations work together to create opportunities. They have a shared destiny. They work together as though they were one company in order to achieve mutual goals.

Certainly, few organizations today – particularly in the health care industry – are co-creators. Transactional and cooperative ventures are much more common. Arm’s-length relationships may seem prudent, but they inhibit an organization’s ability to get full value. At best, maintaining an arm’s-length relationship is an organization’s cultural way of maintaining the status quo, thus diminishing threats to individuals within the organization. At worst, an organization that keeps the other parties perpetually at arm’s length will lose a competitive edge to those organizations that do collaborate and will founder in inefficiencies and higher costs.

In the past, collaboration has not been tried and found wanting; it has been tried and found difficult. There are inherent risks and difficulties that have presented seemingly insurmountable barriers to organizations that tried to collaborate. The most obvious risk is that the collaboration could fail. Organizations also run the risk of losing proprietary information, competitive advantage, control over operations, etc. In addition, they risk impairing their own performance if the partner fails to deliver.

In the future, collaboration will become a requirement to stay in the game. Health care organizations need to position themselves for that future. So what can they do now to prepare? At the very least, here are some basic precepts:

• Start at home – Establishing collaboration within one’s own organization is a necessary pre-condition for establishing trust and coordinating work with outside partners. Many health care organizations are so siloed that internal departments do not communicate effectively with each other. Breaking down internal barriers is the first step toward building a collaborative environment.
• Get together face-to-face – Collaboration will only be successful if there is mutual trust, which must be established early in any relationship. There is simply no substitute for getting partners or team members in a room together, especially in the early stages. Overcoming misperceptions and historical animosity is an important early step.
• Empower leaders – Organizations need to educate people (especially managers) in collaboration methods and tools. The example of leaders within an organization is much more effective in spreading collaborative behavior than official rewards or sanctions.
• Invest in common knowledge – Collaboration requires an efficient base of common knowledge. According to research, up to 70 percent of the time teams spend working together is spent figuring out what everybody knows. When payers and providers can trust each other enough to look at the same data, they can identify very powerful opportunities for mutual improvement.
• Develop a business case – The motive for collaboration lies in the possibility that the parties involved can improve their individual performance by joining together in a common venture. It is important to quantify the value that parties aspire to achieve and to identify clear metrics of achievement.
• Start small and build momentum – To build trust, it is important to start with manageable collaborative project and to build more ambitious – and riskier – ventures on the back of smaller successes. With HIPAA providing the impetus and framework, payers and providers can start collaborating to enhance administrative efficiency. This can be used to produce short-term, tangible results that can fuel future initiatives. It will be more difficult, at least initially, for them to address clinical issues, although there is a lot to be gained.

There are no business opportunities without corresponding risks, and the two are often proportional. The risks increase as businesses move up the continuum of collaboration. So do the opportunities to create value. In the end, collaborative approaches to the business of health care, and the delivery of clinical services, will occur and be rewarded in the marketplace.