In psychology, Abraham Maslow’s pyramid-shaped Hierarchy of Needs clearly defines the path to self-actualization – the Holy Grail of personal fulfillment. In Maslow’s view, the first four layers of the pyramid have to be mastered before reaching the fifth and top layer of self-actualization. Basic needs, like food and shelter, must first be met before tackling more complicated areas like having a sense of belonging and gaining the respect of others. But each layer must be mastered in order, working from the bottom up.
The same methodical, incremental approach can be applied to health care reform in order to achieve the Holy Grail of accessibility, quality and efficiency. With its four-year implementation schedule, the Patient Protection and Affordable Care Act of 2010 provides a clear framework for transformation.
Beginning in 2011, the Transformation Hierarchy calls for establishing governance, management services organization (MSO) operations, and practice management. This is the most important strategic step in the process as it creates the structural, operational, and financial foundation for developing a comprehensive, patient-centric delivery model required of an Accountable Care Organization (ACO). This process includes:
• Developing a future operating model (MSO process model)
• Assessing practice management system scalability
• Migrating organizations to a common platform
• Defining performance benchmarks
Next, the implementation of a physician alignment strategy can begin. The physician partnership should be in place by 2012 and depends on communications, transparency, and data transfer. Doctors need to have the freedom and tools to practice medicine, and a strong partnership will enable them to focus more on patients, less on business.
The next layer, slated for 2012, is devoted to efficiency and patient satisfaction. Quality care begins to materialize when health care providers can deliver care efficiently and patients are satisfied with the care they receive.
In 2013, the focus shifts to collaboration and coordinated care – one step closer to the Holy Grail of Accountable Care. As we’ve seen, this is no easy task, but with the right structures, partnerships and metrics in place, it becomes achievable.
And finally, by 2015, we ascend to the top of the Transformation Hierarchy, and “quality not quantity” becomes our mantra.