I’ve had several conversations with claims and managed care folks over the last few months about measuring performance, outcome metrics versus process metrics, and the challenges of data collection, aggregation and analysis.

Joe Art

Two takeaways.

Too often the discussion has been too focused on process, too down in the weeds, too concerned about how and what to measure. While process and detail are important, they are secondary to the “why” question.

The most important question is “why.”

Why are you doing this? Why are you using that metric? Why do you think that is the right metric?

Sometimes I’m a (very) slow learner, but I’ve finally figured out that it is far better to ask those questions than to tell the person what he should be doing. Telling someone something eliminates the chance to think through what he's done, why he's done it and if it that was the best thing he could have done.

It forces him to take a step back and question himself, his assumptions, his preconceived notions.

It’s easier — and more ego-gratifying — to tell someone what he should do. I’ve found that this can shift the discussion into a far less productive direction, one where the client may well disagree, to defend what he is currently doing. After all, to hear someone say what you have been doing for X years is wrong will make anyone bristle a bit.

Second, metrics are almost never directly aligned with the organization’s overall goals. For example, the goal of medical management is to improve the combined ratio. Has anyone in your organization verbalized that? Ever?

If they have, then you:

• Wouldn’t give a rat’s rear end about savings or discounts.
• Would focus on overall spend.
• Would evaluate providers not on how much of a discount they give but on what their services cost and how that compares to other providers.
• Would evaluate networks not on how big their directory is and how deep their discounts are, but on the quality of their providers and the cost of their services.

And that’s just the beginning.

Once you establish the “why,” the “what” is pretty straightforward — with one big caveat: Every time you settle on what you will measure, go back and see if it aligns with your “why.”

Don’t be surprised if it takes a bit to reorient thinking. Be patient — with yourself and others. It took me 30 years, so hopefully, you’re a much faster learner.

What does this mean for you?

Asking the right questions requires one to invest time and thought. If you don’t have time to do it right on the front end, you’ll never have time to fix it.

Joseph Paduda is co-owner of CompPharma, a consulting firm focused on improving pharmacy programs in workers’ compensation. This column is republished with his permission from his Managed Care Matters blog.