#SystemsofCareInsights: Accepting Tradeoffs and Capitalizing on Nuance (2/3)

systems of care insights 2

Accepting Tradeoffs:

Effective coordinated care networks require numerous moving parts to work together. Managers of these systems must acknowledge the inevitability of issues in their systems. When things go off course, it’s essential to recognize tradeoffs. Some metrics can be optimized at the expense of others. 

One of the main tradeoffs discovered by researchers in the IBM report is the interplay between accuracy versus efficiency. For coordinated care networks, better accuracy leads to better effectiveness. In other words, clients who receive accurate care and referrals gain better results than clients who receive inaccurate care. However, accuracy doesn’t always align with efficiency. Researchers were surprised to find that, in actuality, accuracy and efficiency were negatively correlated across the 11 AmericaServes networks. Instead of proving that accurate referrals were also more efficient, researchers discovered referrals that receive care from the first requested provider (instead of having to go through multiple providers) take longer to receive responses. Why? Two possible explanations for such a phenomenon are limited capacity and discomfort.

It may take an extended amount of time for a client to receive services from their first referred provider due to the provider’s limited capacity for certain services, leading to extended wait times for low-supply services. Providers may also take longer to respond to clients for fear of reprisal. In other words, providers may feel uncomfortable rejecting referrals, even when they should.

Furthermore, the researchers found that accurate referrals do promote case resolution but tend to have a longer time to care compared to inaccurate referrals. It makes sense that some clients may need to wait longer for better, more personalized care, and yet the truth is that many clients may not follow through on pursuing services if they have to wait too long. Care providers have voiced their concern about this lack of follow-through, claiming that while faster certainly isn’t always better, coordinated care systems should also be careful to avoid excessive wait times. 

Conversely, researchers found that accuracy and effectiveness metrics are positively correlated– in other words, referrals that enter care on the first try are likely to result in effective services for the client. Awareness of their network providers’ capacities and resources allows the Coordination Center to match referrals that lead to successful care.

As for the relationship between the efficiency and effectiveness metrics, researchers found no correlation among the referral networks studied. However, although there is no direct link found between efficiency and effectiveness, that does not exclude the possibility that one could lead to another. Utilizing the existing negative correlation between efficiency and accuracy may provide an indirect path in which efficiency impairs network effectiveness. In that case, the Coordination Center may have accurate knowledge of the best provider for the client and effectively resolve their case. Still, that efficient entry may not offer the client the best possible results.

Managers of coordinated care networks need to be mindful of how their various goals (accuracy, efficiency, and effectiveness) interact and trade off with one another. Care and referrals must be accurate and effective, yet still efficient enough to encourage clients to actually follow through with receiving care. Balancing these metrics is key to providing exceptional service in systems of care.

Capitalizing on Nuance:

The next management insight found by researchers in this IBM report relates to the nuances within and between different networks. The 11 AmericaServes networks analyzed in the report all followed the same service delivery model but exhibited different performance profiles.

These findings indicate that performance can’t be simplified to a single measure that describes the overall effectiveness of networks. Instead, each different network had different areas of strengths and weaknesses. Accepting nuanced perspectives in evaluating and measuring network functioning can significantly advance network management practice and research.

Let’s say that a few organizations within a network are having issues. Understanding the nuances behind these issues will allow network leaders to determine precisely which organizations are struggling and where their struggles stem from (are they falling short in effectiveness, or are their services taking too long and harming their efficiency?). Another example in which capitalizing on nuance would be beneficial is in comparing the effectiveness of different organizations serving the same types of clients. Which organization performs better across the key three metrics? Why is that? What is the other organization doing that could be impeding their capacity? Once leaders understand the nuances within the basis of the problem, they can better address it. Nuance could also come in handy in the training of Coordination Center employees. Working with others is a nuanced practice, and training employees to make proper referrals certainly comes with challenges. Employees must comprehend the nuances of the requests they receive to match clients to services and providers that will offer them the best possible care.

Nuance plays a key role when leaders must segment a network into smaller groups. Network management doesn’t refer to managing an entire network, but rather targeting specific sections that need help and managing them to improve the network’s collective performance. A manager can break up their network into sections along many different criteria, depending on what makes the most sense for the network in context. It may make the most sense for a manager to break the network up into groups addressing similar types of service leads. On the other hand, it may be best for a network to be split into sections of groups serving the same clients. Managers have the freedom to establish these guidelines for sectioning in whichever way they best see fit according to the areas they wish to target. Leaders can use data to uncover these targeted areas with speed and accuracy. For example, a network may need to establish new partnerships to grow capacity, work with current partners to determine issues behind performance struggles, or review current procedures– these are all areas in need of improvement that can be targeted through data analysis. 

Nuance is key. Evaluating networks on metrics that don’t account for individual nuances can cloud the areas in which networks are both performing well as well as where they may be struggling. When these measures hide the weak points of well-rounded networks and overshadow the strong suits of others, the areas in which the network needs help will continue to suffer. This blurred view of network performance can lead to more issues, such as network mismanagement and misalignment of reward structures. When ignoring nuance, evaluation shortcomings may exacerbate systemic issues within the network that, in turn, harm the communities and clients that these systems are meant to serve. 

Instead of managing the network as a whole, focus on managing the areas that need assistance. It’s easy for managers to get overwhelmed and spread both themselves and their resources too thin when attempting to stay in tune with all of the moving parts of a network simultaneously. Delegating more hands-on management to the parts of the network that need help most urgently ensures that operations run smoothly. 

Managers must capitalize on the nuance available within the data collected by coordinated care technologies. By knowing how to retrieve and interpret this data, networks can establish actionable insights and focus managers’ efforts on specific areas for improvement, thereby reducing managerial burden.

Want to learn more? Check out the full research article here:

Collaborative Networks: The Next Frontier in Data Driven Management | IBM Center for The Business of Government. https://www.businessofgovernment.org/report/collaborative-networks-next-frontier-data-driven-management.