Secret Sauce or Ketchup
Is your secret sauce really just Ketchup?
I hear so many organizations – physician practices, health systems, VBC Enablement companies – talking, even bragging about their value-based care “secret sauce” in addressing medical expense. When you look in their cupboards, though, all they really have is Ketchup. (On the revenue side of VBC, HCC coding and Risk Adjustment, there are some folks with true secret sauces, but I’m focusing today on controlling medical expense. See my previous writings on the importance of med expense control - Reckoning.)
Like the simple combination of vinegar, sugar, and tomatoes that creates Ketchup, most organizations combine the same three basic ingredients of risk identification (many aren’t even stratifying risk, simply identifying it), chronic disease management through clinical pathways or specialty clinics, and big “C” big “M” Care Management.
Don’t get me wrong, Ketchup is a fine and worthy condiment. It’s just not anything special and is probably relied upon too often. Many organizations have created Ketchup, thinking it’s the end all, then they get discouraged when they don’t progress in VBC.
I bring this up not as a criticism of the work being done, but as a call to conversation, collaboration, and cooperation. My experience has been that, to avoid sharing our “secret sauce” (usually Ketchup) with anyone, we also avoid meaningful conversations within the industry about what we’re doing, what’s working, what’s not working, and what we wish we could do.
There are conference topics about population health management and podcasts highlighting some efforts, but for the most part, they’re talking about Ketchup. Rarely do I hear of new ground being covered.
There are some organizations who have successfully moved Ketchup aside as they have added other ingredients to their basic VBC programming, ingredients like mental health programming, PharmD support, Social Workers addressing social risks, Community Health Workers in the homes, Remote Patient Monitoring, and true stratification of their populations’ risk. They have created a salsa, adding onions, bell peppers, cilantro, a little heat, and sometimes, even mango!
While, in the culinary world, salsa is still a fundamental condiment, it can be much more complex and effective at its job than simple Ketchup. When you talk to these organizations, though, they usually stumbled into these extra ingredients, thinking they’re the only ones having created this sauce.
We need to have regular discussions from the operators across the industry about the other ingredients that help a patients manage their care – identifying and addressing social risks, medication management and adherence, identifying and addressing mental health issues, spending more time engaged with the patient in the home and through remote monitoring or asynchronous communication, etc.
These aren’t new and unfamiliar topics. Most organizations just haven’t applied them.
I’ve known organizations who prohibit their employees from participating in conferences or podcasts for fear of revealing their “secret sauce.” Many of these companies, when you look in their cupboards, are just using Ketchup. Nothing special going on.
Others are hesitant to participate because they recognize they are applying a very basic recipe to VBC – Ketchup – and aren’t getting the desired results.
We not only need more forums of open discussion about how we can improve the health and well-being of our patients, but we also need organizations willing to discuss what they’re doing, what they’re not doing, the results they’re getting, and why.
Most of us are very familiar with onions, bell peppers, cilantro, chili peppers, and fruit. We may just not know how to combine them with other ingredients to make a tasty salsa or when to apply that salsa.
Those of us in VBC are not unfamiliar with social risks, mental health issues, in-home patient monitoring or visits, and the problems of mismanaged medications. Where most of the Ketchup users fall short is knowing how best to combine and apply those other ingredients to gain the desired results. So, they don’t.
In his book Better,* Atul Gwande names three elements for success in providing healthcare:
1) Diligence – ALWAYS do the things we know work (like handwashing, time-outs, med reconciliation, etc.).
2) Do what’s right – Healthcare includes a hefty dose of human interactions, not just genetic or biochemical ones.
3) Ingenuity – Thinking anew about the things you know need to be done. Part of this is possessing the character to admit failures and the willingness to change.
Salsa makers of the world, share your recipes. Help the others do the things that we KNOW work, like addressing social risks, better med management, mental health support, appropriate RPM, etc.
Ketchup users, recognize your need for more ingredients combined in different recipes, possess the character to admit your shortcomings, and have the willingness to create better ways of optimizing health and well-being.
Who knows, we may even find the best ways of adding in Carolina Reaper peppers.
*Gwande, Atul (2007) Better, Picador, New York
