How can you measure innovation success in utilization management?

In my experience its not just about how many ideas evolved or how many products are for the second phase It’s about the community of innovation It’s about the knowledge of workers of the possibilities And about the free atmosphere to tell your mind in your work environment

Antes de qualquer passo no ecossistema da inovação, se faz necessário ter o conhecimento de ferramentas estratégicas necessárias para a construção de uma ideia inovadora. Na minha experiência em oficinas de inovação, pôde-se aplicar algumas ferramentas como o Design Thinking, Mapa da Empatia, Matriz CSD, Árvore de problemas, prototipagem , entrevista semi-estruturada, storyboard, entre outros , a partir do conhecimento e aplicabilidade dessas ferramentas , fica muito mais fácil tirar do papel as ideias inovadoras com segurança e modelagem.

Absolutely! Innovation isn’t just about abstract concepts; it’s about real-world results that propel progress and add value. Creating a supportive and open atmosphere is crucial for sparking innovative ideas. Even small suggestions deserve attention, and investing in skill development further fuels the innovation engine.

From my experience including the “why” behind these goals or metrics will allow you to get buy-in. Goals that everyone has bought into are so much more achievable. But in healthcare specifically I believe those goals should always be focused on quality of care ie patient outcomes. I shouldn’t set a goal to reduce falls with a major injury so I can improve my CMS Five Star Rating, instead I want to reduce my falls because I want to protect residents from significant injury I want to enhance the quality of care that I provide because I care about patient outcomes. I know that if I follow quality the rest will fall into place.

Measuring innovation success in utilization management involves assessing how new strategies, tools, or processes improve the efficiency and effectiveness of healthcare services. Cost Savings and ROI: Evaluate financial benefits and return on investment by comparing pre- and post-implementation expenses. Patient Outcomes: Monitor improvements in recovery times, complication rates, and overall health results. Efficiency Gains: Measure process acceleration, such as quicker approvals and reduced administrative burdens. Quality and Compliance: Ensure higher adherence to care standards and regulatory requirements, alongside positive changes in utilization rates.

Na verdade, todo processo inovador além de trazer soluções , também devem ser avaliados e ter métricas palpáveis e atingíveis, uma vez que a iteração vai auxiliar nesse processo de avanço e retomada de ideias. Para isso, deve-se estipular de que forma e em quais momentos realizar essa aferição.

Optar por métricas relevantes e confiáveis é uma peça fundamental no quebra-cabeça da inovação. Ao escolher métricas de processo, você efetivamente monitora a implementação do projeto, avaliando testes, pilotos e iterações. As métricas de resultados destacam o impacto direto nos objetivos, como melhorias na qualidade e eficiência dos serviços de saúde. Além disso, as métricas de impacto, ao medirem os efeitos a longo prazo, proporcionam uma visão abrangente dos benefícios em termos de saúde da população e equidade. Essa abordagem meticulosa na escolha de métricas não apenas assegura uma avaliação precisa, mas também orienta eficazmente o progresso rumo aos objetivos de inovação estabelecidos.

I think success in Utilization Management innovation is pivotal. Performance indicators must evolve to encompass not just financial gains but also improved patient satisfaction, reduced administrative burden, and heightened collaboration among healthcare professionals. The implementation of an AI solution for Diabetic Retinopathy at SEHA AHS facilities is a standout example of precise alignment with AHS strategic goals. This initiative not only elevated patient experiences but also significantly improved care by reducing result turnaround time. Our success underscores AI's transformative power in healthcare—enhancing efficiency and, most importantly, contributing to superior patient outcomes.

Utility management ( UM) is a core tenet of Value Based Care. You need to track metrics to ensure you are making an impact. Reviewing high-cost procedures, medications, and imaging studies and making sure they’re being done for the right reason is critical.

In my experience, personal satisfaction is the key indicator to track among personnel as well as stakeholders in any organisation. In addition, adherence to organisational or goals and strategy, service quality or capacity adjusted productivity valuation should be continuously monitored. One more important value to estimate is the interdepartmental solidarity and how much fruitful is their complementary performance.

A crucial aspect of gauging innovation success in utilization management (UM) is not just collecting diverse data, but also integrating and interpreting it in context. For instance, while administrative data might show cost-efficiency post-innovation, survey and interview data can reveal if this efficiency aligns with improved patient care or staff satisfaction. This holistic approach ensures that the innovation truly meets the multifaceted goals of UM, beyond just quantitative metrics, reflecting its impact on the quality of healthcare, patient experience, and staff morale.

Healthcare Utilization management (UM) is a process that assesses the efficiency, medical necessity, and appropriateness of treatments, services, procedures and facilities provided to patients. UM is part of a health plan and helps to ensure that patients are getting the right drugs. It also helps to make medicine more affordable. Some types of UM processes include: 1. Care coordination programs 2. Medical necessity 3. Case management services 4. Specialty consults 5. Risk stratification tools Some common UM tools include: Prior authorizations, Step therapy, Predeterminations, Preauthorizations.

Examples of data collection in an objective manner are the expert’s external audit, stakeholder evaluation, stakeholder adherence and commitment, employees retention, and continuous progress.

Unsere Systeme erfassen immer Daten der unterstützten Eingriffe. Diese werden, selbstverständlich unter Beachtung der Datenschutz- und Compliance Richtlinien zumeist im jährlichen Service Intervall ausgelesen und bilden die Grundlage zur Verfeinerung unserer Strategie.

Data Collection is always a way to measure the reality of the goals set by the organization. It is a way to compare the proposed goals with the reality

In my experience, without clear communication throw your best ideas in the trash. Staff want to do their best and contribute to the position they hold. Communication empowers them to do just that and you will quickly notice, as well as measure success, in areas you are doing this well, or not so well. Scale up what is working and reevaluate the opportunities as they come across your desk.

Communication is the key to success of any initiative, and UM is no exception. Effective communication with stakeholders leads to better understanding of the proposed innovation and thus engagement and buy-in for the initiative or project. Further, this could result in ownership of the processes, contributing to its success.

In my experience delegating authorities plus close followup, continuous personal motivation and outcome monitoring are the traits of successful leadership in order to achieve goals and evaluate performance. On regular intervals, there should be a feedback briefing to the whole team including open discussions for either approving or reconsidering a certain action plan.

Zur Kommunikation aller relevanten Informationen gibt es das Unternehmens Reporting. Sowohl intern als auch extern. Das Reporting passt sich immer an die Struktur an und ist im Qualitätsmanagement definiert. So wird sicher gestellt, dass alle Beteiligten und Partner die relevanten Informationen erhalten.

Data collected should be analysed and diagnosed to check its reliability for real life situation. It will used for proposing solutions for the present and the future challenges

Nothing more important than regular team meetings, brain storming discussions and building consensus about next steps and/or changing the direction.

Ein sehr wichtiger Punkt. Wenn nicht der wichtigste. Was ist zu tun, wenn sich die Zahlen langsamer oder nicht wie gewünscht entwickeln? Hier sind dann neue Innovationen nötig und der Zyklus beginnt von vorn. Das ist eine der Hauptaufgaben des Management Teams des Unternehmens.

20 plus years of providing quarterly UR Data has created amazing Partnerships with health plans and providers. Take the time!

Nothing can demonstrate opportunities for improvement visual reports of monitoring data! Graphs, charts, etc. Share this data all the way from upper management to the appropriate staff at all levels!

It is very essential to monitor the performance of the innovation at every point in time. This is crucial at not to deviate from the main goals

No goal or project can be achieved alone...and is always more successful if those involved feel they have been part of the innovative change. So alot of work, for it to be successful, should be done, before even setting the goals. It is about finding the human resources to ensure the end result is achieved.. Before the planning even starts. If people are involved and come up with the olan and goals.. Owning the UM... Then success has a greater chance. We often underestimate the need for that very first step... As nearly everyone puts the goals first.

I really appreciated a post from Jennifer J. She mentioned that no goal or project can be done alone and resources are imperative. I echo this, and also, would specifically point out the need for physician voices (and their teams) to be heard throughout the data points. Physicians and their teams are highly functioning in their day-to-day patient care, that it can be difficult to capture what is truly occurring and ensuring these teams are aligning for sustainable and streamlined practices. Over the years, I have seen physician collaboration through knowledge tables and peer training, like ECHO, to be successful due to physician connection and peer to peer training. Fosters support and education across health systems.

Success utilization would be have two mainly consideration, Success of delivery care, treatment, or innovation, Success of patient outcomes (effectiveness, safety, cost appropriate, compliances) and satisfaction: To measure both of these success, the innovation utilization would be appropriate selection, process of utilization from begin to the end process. (Indication, problem solving, time and cost appropriate and lost as least) Customer success would measure by benefits, outcomes, and satisfaction.

In long-term care, QAPI is very unfamiliar to staff, including upper management. Having been an IP in acute care for 35 years before moving into LTC, I feel very comfortable with Quality Improvement and Performance Indicators. This past August, I volunteered to lead our QAPI efforts. It has been a struggle, and it is evident that I need to go back to step one and educate the QAPI team. So education is a crucial step. CMS has excellent online training videos

El diseño de los.objetivos debe estar claramente delimitado por la realidad externa e interna de la institución, en este punto el.diseño de matrices FODA, creo es gráfico ya que nos obliga a buscar lo bueno y lo.malo de nuestra situación actual.