gqOS – Acting on the Evidence

There has always been plenty of talk about “evidence-based” care. Large sets of anonymized data, scraped from clinical records and payment claims have been aggregated by providers, insurers and third-party analytics firms and used to assess the most effective clinical pathways to achieve the best outcomes across a range of health conditions and patient types. Over time this data leads into “standards of care” across both primary care and specialities, within health systems and in individual practice. It’s an exciting evolution, moving us to an environment of more predictable outcomes for many common issues and procedures and enabling us to measure both preventative but also predictive practices.

But it needs to be evolved even further. In spite of the reams of data in, for example, primary care, the large data sets do not provide the agility to customize a care journey for the evolving needs of a specific patient, at a specific time. Nor do they generally incorporate the records, insights and trends from non-primary care activities such as behavioral health, physical medicine, or health coaching. 

As I have noted in many previous posts (here, here, and here), Crossover Health is a national medical group delivering Primary Health, a proven care model driven by an interdisciplinary team inclusive of primary care, physical medicine, mental health, health coaching and care navigation. Each of these services is organized across the country into “guilds” – each as craftsman of their own discipline, with their own expertise, practice patterns, specific measurements, and standards of care. Each discipline measures, monitors, and is constantly improving their own practice across the country, consistently by discipline, and individualized for every provider. Our measurement model had to  interdisciplinary and allow us to act on all of the evidence. Thus, we began the process of developing what we call the Guild Quality Outcome System (gqOS) which was launched just over a year ago. 

Since that time, gqOS has changed  the way we deliver care and measure our clinical performance. Our providers now have access to real-time feedback, enabling them to make informed decisions and deliver measurement-based care to our members. Our clinical teams have been utilizing the gqOS to gain valuable insights into the status and quality of our care model, identify top performers, share best practices, and highlight unique challenges amongst various client populations.  This has allowed us to make continuous refinements and enhancements to our care workflows and compare various theoretical approaches on outcomes within defined populations to our own work, resulting in improved service design across all of our Primary Health service lines.

One of the most significant achievements of gqOS has been its ability to empower our clinical managers and care teams with data-driven insights across a health center or modality, across provider types and across individuals and patient populations. Additionally, gqOS has facilitated effective communication of the value our multidisciplinary care model creates for our employer-clients. Our Account Management team can now share trended and summarized health outcome data, providing our clients with a clear understanding of the impact our care model has on their employees’ well-being. This transparency has strengthened our relationships with our clients and further solidified our position as a leader in value-based care for employers. 

And, as always, the proof is in the numbers that we can share across all service lines:

The therapeutic alliance scores noted in the chart are particularly noteworthy, as well as impressively high. The concept of “Therapeutic Alliance” arose in psychotherapy, is a measure of the alignment of member and provider – the higher the score, the more in sync these two partners in care are and the greater likelihood that agreed therapies will be adhered to, leading to the probability of improved outcomes. Note what I wrote earlier about real-time feedback built into gqOS. Being able to acknowledge and tune the care provided for each patient is a powerful proof point for a member that we actually have their specific issue and goal in mind as we engage with them. We’re not simply slotting them into a diagnostic and therapy box based on a pattern derived from population data. The evidence in our evidence-based care is both general and individual.

We still have important work ahead as we strive to achieve the quadruple aim of better outcomes, lower costs, improved patient experience, and increased provider satisfaction. We will continue to refine gqOS to incorporate even more data points and enable an even greater specificity of care for each of our members, while maintaining practice based on the best evidence. But, at this one year mark, it’s important to acknowledge the incredible work our team has done to ensure we deliver “health as it should be.”