We hear the term “transformation” but we don’t always share a common language to define it. In essence, “transformation” means the activities necessary for each organization to rethink and redesign their processes for better efficiency and impact. Transformation is unique to the group or organization, but industry best practices are the common goal. Lisa White, MS, SSGB, CFDS, is a Transformation Executive at Clarify Health. She has many years of experience working with providers and payers leading transformation efforts to make the healthcare system better. In this video, Lisa defines value transformation and shares the key steps for value transformation success.

Video transcript:
You know, transformation in healthcare is one of those big nebulous terms that most of us misunderstand. The idea behind transformation is improving processes and procedures and holistic environments for the healthcare system. Ultimately, this benefits patients, and that’s what we want.
I’m Lisa White. I’m a transformation executive at Clarify, which means I work on big-picture strategy with our customers around how to leverage our insights the best. I’ve been working in bundled payments since around 2015, various iterations of value-based programs. Most recently, I led value-based programs for a large single-state blues plan where I had all lines of business. So, I’ve been working with providers and payers for a long time to make sense of how we make the healthcare system better.

It’s interesting because payers and providers have a really different perspective of what transformation means. I think the first step we have to take is joining together and creating shared goals about what that means and how we’re going to reach those goals together for the betterment of the patients. So, let’s dive in a little bit deeper to what that means.

In healthcare, there’s huge focus on primary care transformation. That’s because we want people working with a primary care provider, you know, the old, what I call the “old country doctor” model, where you had one doctor that saw you for your whole life and knew everything about you. We really have lost a lot of that personal touch that ultimately leads to better engagement, better outcomes, and better care management. So, as we talk about transforming healthcare and particularly transforming primary care, the idea is we need you to have a quarterback. We need you to have someone in the center of your healthcare sphere making sure you get everything that you need.

Okay. So how do you know when you’re in a position to move transformation forward? The first step is really having honest conversations between payers and providers. I don’t think any of us is in this business for the wrong reasons. I think we just have different ideas of what that should look like. So coming together and defining a shared goal, and then making it very specific, you know, saying reduced cost is this big nebulous thing with no detail around it. The better thing is, we want to focus on improving outcomes for maternal care or improving outcomes for total knee replacements, and creating a shared goal so that then we can create shared accountabilities and a shared pathway.

Next, let’s talk about those shared accountabilities. We all know that there needs to be a lot of data exchanged, and that data needs to make sense, but we also need to understand that those shared accountabilities mean we are in this together. You know, I’ve always told my provider partners when I was on the payer side, listen, if don’t get a check at the end of a shared savings year, we both failed. And so coming up with a pathway of, I’m accountable to you for this, and you’re accountable to me for that, is the first step toward making that transformation and getting to those goals.

Next, you have to ensure you have the right support. Who is involved from your team and your partner’s team? Do you have a shared discussion every month or every quarter? Do you have clinical and business voices in the partnership? These are very, very important factors to make sure that you are successful in those shared accountabilities and shared goals that you set up for your transformation.

Let’s talk about success factors. Some of the biggest success factors in a transformation engagement, particularly if you’re moving towards something like a value-based care arrangement or a shared risk arrangement. Success factors are really built on those goals that you define together. Do you have the right support? Not only do you have the right support from a provider-payer perspective, partnership, do you have support at the executive level? Does everyone above you support what you’re doing? Does everybody understand what you’re doing? And ultimately, can you use the same metrics, the same yardstick to understand, hey, here’s where we succeeded and here’s where we fell short and can do better next time.
Bringing this all together? Transformation means taking something that you’re not happy with and turning it into something a little bit better.

As we’re talking about primary care and transformation and the transformation that actually help happens in healthcare systems between payers and providers, ultimately, we’re looking to improve the situation for providers and patients. And that takes a lot of shared discussion. I would encourage you, anytime you want to take on a transformation activity, start simple, start small, and start with agreement, because we know that the number one success factor is a shared vision.