Why Operating Models Matter

By: Marj Green 

Many healthcare organizations spend an inordinate amount of time and money today doing 'rework' which is fixing things that were not done correctly the first time. This consumes a huge number of resources and adds absolutely no value to the customer /patient. One study we did of a chart to bill audit, to see how closely the claims represented what was on a chart, showed a 98% mismatch. A large system recently did a study on their top 200 high risk patients to see if their medication records were a match to what the patient was actually taking and found a 100% failure rate. Many departments in hospitals do nothing more than correct erroneous information, for example, denials teams, PFS departments, etc.. Imagine the costs that could be taken out of healthcare if there was a “system” of doing things right the first time. A sound operating model weaves processes, organization, technology, performance measurement and suppliers in a cohesive way so that errors are minimized at the point of origin. Changing today’s models which rely on fixing errors to prevention, to one that is designed to prevent the errors and drive continuous improvement would change the entire culture of healthcare to one of true consumer focus.