According to a July 21st New York Times article called “Trying to Save by Increasing Doctors’ Fees”, the latest "new, new thing" is the Medical Home, being piloted by payers across the nation. As stated in the article:
"The idea is that by paying family physicians, internists and pediatricians to devote more time and attention to their patients, insurers and patients can save thousands of dollars downstream on unnecessary tests, visits to expensive specialists and avoidable trips to the hospital."
Here in Pennsylvania, where I live, IBC, Aetna, and Cigna are spending upwards of $13M on these programs over the next 3 years.
The way I see it, there are striking parallels between these ideas and some of the fundamentals of well-deployed Balanced Scorecards. To explain, let me translate the Medical Home concepts into Balanced Scorecard speak. The goal of the Medical Home is to save money on “downstream” costly conditions (i.e. lagging measures) by spending money on less costly “upstream” activities (i.e. leading measures). This is exactly the type of thing you would want to see on a Balanced Scorecard for a Primary Care area of a health system.
In a deployed Balanced Scorecard framework, there should be alignment between the lagging indicators of performance (e.g., the number of patients with expensive conditions) and the leading indicators that impact that measure (e.g., t he number of preventative efforts that have been shown to improve or prevent those conditions).
Here’s an example used in the Times article that illustrates
the kind of linkage we create through cascaded Balanced Scorecards.
Activities such as adding patient educators or hiring additional staff
to help monitor patients’ treatment and follow-up can be translated
into Balanced Scorecard initiatives or improvement projects. Measures
that track the percentage of a doctor’s roster having timely
mammography and colorectal screenings are the leading indicators that
those activities are intended to improve. Outcome measures, such as
breast cancer and colon cancer rates, are the lagging indicators to
which these leading indicators align.
The goal of the Balanced Scorecard is to have your leadership monitoring progress on initiatives, such as the Medical Home, that will move leading indicators in the right direction. These leading indicators are predictive in nature, they are measured more frequently than high-level lagging measures, and they make it possible to make mid-course corrections, all of which drive toward better strategic outcomes in the long run (improved patient care, better financial health, better utilized employees, and a healthier community).
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