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Where’s Your Constraint in Working to Improve Care and Reduce Costs?

Doctors talking

Often a process with a desired outcome works well at first but then seems to get bogged down. After some evaluation and perhaps some root cause analysis, you may discover that you have a constraint in your process.

Some processes have a singular point where a bottleneck occurs, generally when a process funnels through a constraint related to either one person or one checkpoint. This concept applies both to projects and to ongoing processes. Sometimes a quality checkpoint in a process can become a constraint, especially as it relates to timeliness. A constraint could be your legal department holding up a contract, or accounting holding up payment for an invoice. It could be a piece of machinery. If you’re working in care management, it could be mismanaging your denominator, not understanding what patients are in your denominator, and not accounting for your entire denominator because it seems unknowable.

For example, take the discharge and readmission processes for patients. If you’re not aware of all of your patients who are discharged, how can you work effectively to help those patients stay on a care plan after hospitalization? The patients who are not tracked from discharge are more likely to end up back in the hospital and negatively impact your hospital readmission measure.

Or, take performing an Annual Wellness Visit for all eligible Medicare beneficiaries. If you can’t reliably produce a list of your eligible patients, how can you hope to succeed in providing a visit for everyone who is eligible? This same constraint of generating a reliable list would also apply to helping patients engage with chronic care management by phone.

HealthInsight can help primary care providers get past these bottlenecks. To support our efforts to strengthen primary care, HealthInsight has developed a suite of tools to bolster primary care engagement in providing Annual Wellness Visits, Advance Care Planning, Transitional Care Management (TCM) and Chronic Care Management (CCM). Our TCM Implementation Guide can help you increase TCM visits by getting to 100 percent of your discharged patients, and our CCM Implementation Guide can help you get to a complete list of your patients who are eligible for CCM visits. Completing these processes successfully will result in patients benefiting from a better quality of life, providers getting paid for providing more primary care, and costs decreasing for the health care system.

Constraints cannot be completely avoided and sometimes should not be removed; an example would be a signature required on a medical record or a prescription. However, many constraints can be minimized or removed altogether to improve efficiency and clear the way for significant improvement. Contact HealthInsight for help in streamlining your care processes.

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