Paduda: Why Are You Utilizing That Metric?| Employees Compensation Information

By Joe Paduda

Friday, April 16, 2021 | 0

I’ve had several conversations with claims and managed care reps over the past few months to measure 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 process-oriented, too deep 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 this metric? Why do you think this is the right metric?

Sometimes I’m (very) slow to learn, but I’ve finally found out that asking these questions is far better than telling the person what to do. Saying something to someone prevents the opportunity to think about what they did, why they did it, and whether it was the best thing they could have done.

It forces him to step back and question himself, his assumptions, his preconceptions.

It’s easier – and more ego-pleasing – to tell someone what to do. I’ve found that this can move the discussion in a far less productive direction where the customer may disagree in order to defend what they’re doing. If you hear someone say what you have been doing for X years, it is wrong.

Second, metrics are almost never directly aligned with the overall goals of the company. The aim of medical management is, for example, to improve the combined ratio. Has anyone in your organization verbalized this? Ever?

If yes, then:

• Wouldn’t give any savings or discounts to the heck of a rat.
• Would focus on the overall expenses.
• Would not rate providers based on how much discount they give, but on what their services cost and how this is compared to other providers.
• Wouldn’t rate networks based on how big their directory is and how much their discounts are, but on the quality of their providers and the cost of their services.

And that is just the beginning.

Once you’ve established the “why”, the “what” is pretty straightforward – with one major caveat: every time you decide what to measure, go back and see if it matches your “why” “Matches.

Don’t be surprised if it takes time to realign your thinking. Be patient – with yourself and others. It took me 30 years so hopefully you’ll learn a lot faster.

what does that mean to you?

It takes time and thought to ask the right questions. If you don’t have time to do this right on the front end, you never have time to fix it.

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