Q&A: How to build, measure and sustain quality in value-based care

In a career spanning nearly two decades, Meghan Fanning, athenahealth executive director of quality product & performance, has made her mark on all corners of the healthcare industry. From her start on a clinical path to later roles in administration, consultation, and tech, she’s seen how things work from all angles. And, thanks to those varied experiences, Fanning has developed a wide-ranging knowledge of and compassion for stakeholders across the board. This has enabled her to develop a holistic understanding of what quality in healthcare means, along with how to ensure that it’s always at the forefront.

Recently, Fanning shared her thoughts on quality and how to measure it, value-based care (VBC), and what the future of healthcare in the U.S. might look like.

You’ve had a long career in the healthcare industry. Tell me about that journey. 

I’ve been in the healthcare industry my entire professional career, and originally, I intended to become a clinical psychologist. This led to my first role, working in the behavioral health department for a payer, where I got to experience what it takes to help patients coordinate and access care and how to pair them with providers, so it was an interesting foray into healthcare.

From there, I started to get interested in the economics of healthcare more than the clinical psychology route and ended up getting my master’s in business with a healthcare administration concentration. [After earning my master’s degree], I got an amazing opportunity to work for a large academic medical center, where I worked on quality improvement directly with providers and clinical teams.

While I was there, I got to witness a large-scale, third-party EHR implementation, and the sheer manpower [of the implementation] was kind of mind-boggling to me. I’d heard of athenahealth, which had a reputation for doing similar things but in a super innovative way, and this got me wondering if there were any opportunities where I could marry tech with my passion for quality improvement — I’ve now been at athenahealth for eight years!

How do stakeholders and other key roles across the healthcare system need to work together to drive quality? 

I think the compassion part is key because in healthcare, the different stakeholders — patients, payers, providers, etc. — can be viewed as adversarial in some ways. But really, all the spokes in the wheel bring it together. And it really does take them all working together for it to be successful.

Patients are always at the center of that wheel, so when I think about how to define quality, it’s about clinical outcomes where patients are getting the care that they need in a timely, equitable, and efficient fashion. We want it to be safe, consistent, and accessible, and I think that’s foundational to healthcare whether you’re on the payer, provider, or tech side.

At athenahealth, we have a really vested interest in ensuring that our customers are successful, so having a definition of quality aligned across the board is essential in building tools that will enable that success.

And with all those moving pieces and players across the care continuum, how do you measure quality?

I think sometimes the measurement [of quality] can feel more like an art than a science, but there are three main ways to measure quality — outcome measures, process measures, and balancing measures.

Outcome measures are probably the most traditional, then process, which are sometimes thought of as preventative, and then the balancing measures are there to ensure that we don’t create unintended consequences while focusing on the other two.

I think an important balancing measure that sometimes gets forgotten is patient experience. The patient is ultimately a member of the care team, so if you have a disengaged patient who doesn’t feel supported, you won’t see successful outcomes.

So, it’s important for us to get that information back to providers in a way that feels actionable. It’s a particularly challenging one to get data for and act on, but I think it can add a lot of value.

That feels like a nice transition into talking about value-based care (VBC). When you think about VBC, how would you personally define it?

As simply as possible, VBC means tying payment with quality of care, so that cost is connected to outcomes. It means moving away from a goods and services exchange and into a holistic treatment plan for each patient. In the long run, VBC is a more compassionate, proactive approach that drives more favorable outcomes for everyone involved.

What do you see as the biggest roadblocks in the transition to VBC?

So traditionally, the system is kind of a volume game. You provide a test, you perform a surgery, and you get paid for it. It’s a very normal consumer model where you pay for a product or service, and people are used to it — it’s literally how most of the world operates.

VBC is moving away from volume driving revenue and into outcomes driving it, and that can seem like a lot of work for those who are used to the traditional model. I think that impression is probably the biggest critique of VBC as a whole.

[To make the transition], you need to be able to adopt a VBC infrastructure while still running your business, and you need to be able to predict and forecast and manage, which is where a partner like athenahealth comes in.

What does the future of VBC look like?

I definitely think that technology plays a really big part in facilitating the shift to VBC because there’s so much analysis and data management required. Change can be really hard, and if you’re a provider, you’re used to running your balance sheet in a certain way.

[At athenahealth] the question becomes: How can we reduce the administrative burden on our customers and take it on ourselves?

These are things we’re really good at — between data management, analytics, forecasting, and really understanding transparently how the business is doing — which are all things you need to have a successful VBC shift.

Overall, I think we’re going to continue to see an investment in VBC products and systems, and with athenahealth, you have a built-in partner. We have a really unique model where we don’t charge for our software, so when our customers are financially successful, we’re mutually successful.

This really resonates with me and drives that passion for quality, because [in a VBC model] our success is the same success as our customers, which ultimately means the delivery of high-quality care and good outcomes for patients.