The Future of Healthcare? It’s Quality Performance

In a moment when AI is dominating every conversation, what’s really next for healthcare quality? For clues, I would suggest taking a closer look at our company’s recent growth. In the last three months alone, Medisolv, the national leader in healthcare quality data management, has completed two major acquisitions, launched game-changing new products like the Hospital Star Rating Analyzer, and rapidly expanded our AI capabilities in areas as diverse as patient engagement and chart abstraction.

I’m certainly not saying this to brag. I want to share the real story behind that growth, and why I believe it’s a bellwether for healthcare organizations that want to lead, not follow, in the new era of value-based care.

Why Our Core Mission Hasn’t Changed

Let’s start with the elephant in the room: with two major acquisitions in one year, how do we make sure Medisolv doesn’t lose sight of what made us, and all our clients, so successful in the first place?

In many ways, Medisolv hasn’t changed at all. Our ethos is the same as it has been since our founding in 1999: healthcare quality improvement starts with healthcare quality measurement. You can’t improve what you can’t measure.

But healthcare quality measurement continues to be very challenging for our nation’s healthcare system. The rules that make up quality measures are complex. The data that must be gathered is hard to get your arms around. It takes experience and wisdom for healthcare leaders to be able to look at measure output and know what it’s telling them.

Combining human wisdom with the power of analytics to ultimately understand what healthcare quality data is telling us and what we should do about it: that has been the core of Medisolv for 25-plus years, and it’s going to be the core of who we are for the next 25 and beyond.

What’s changed is that we’re expanding our focus, taking that core mission to a greater variety of stakeholders across a variety of healthcare settings to have an even bigger impact on the things that really matter for our nation’s healthcare system.

What Really Matters for Healthcare Organizations Right Now

So how do we define the “things that really matter” right now? To be perfectly blunt, our most urgent concern is helping healthcare organizations protect and strengthen their financial outcomes as our nation undergoes the massive shift from fee-for-service reimbursement to value-based care.

Everything a mission-driven healthcare organization hopes to do for its community hinges on financial stability. Patient safety. Patient experience. Patient outcomes. Employee retention…it all starts with being a financially healthy organization. We’ve all heard the saying, “no margin, no mission,” and nowhere is that truer than in healthcare right now.

Moving Beyond Compliance

At Medisolv, we can, and always have helped, guide healthcare organizations to better financial outcomes. Avoiding penalties and messy audits through quality reporting and compliance is certainly a part of that, but it’s not the whole picture.

For us, making sure healthcare organizations are compliant is table stakes. Healthcare organizations can and should do so much more with the quality data they have at their fingertips.

The challenge with focusing just on quality compliance is that it’s always looking backwards, treating quality measurement like a report card on past performance rather than a strategic tool for future success and mission-driven growth. Well-managed, proactive quality improvement initiatives have the power to lower healthcare costs, strengthen brand reputation, and improve payer negotiations…so many things that ultimately lead to better outcomes and greater financial stability.

What we need now from healthcare organizations is a mindset shift. Strategically, operationally, and culturally, healthcare organizations need to rise above the quality compliance “check-the-box” approach and embrace a quality performance focus. Value-based care is demanding it, patients are expecting it, and we are purpose-built to help them get there.

Defining Quality Performance

What do I mean by quality performance, and what does that look like in a healthcare setting? Our vision is crystal clear: we believe every healthcare organization should have a closed-loop quality performance system that operates across their enterprise, continuously driving improvement. The ideal closed-loop quality performance system is one that:

• Connects, validates, and makes sense of all the quality data from all the disparate sources operating within and adjacent to your healthcare organization: clinical data, patient-reported data, claims data, registry data, and more, all working together.
• Helps your leadership team intelligently predict performance outcomes, strategically prioritize where the organization should improve, and act faster to close the gaps in quality.
• Recalibrates automatically to help your leadership team stay ahead of and move on to the next performance improvement opportunity as goals are met and new challenges emerge.

The healthcare organizations that have a quality performance system like this in place will be the ones who always win, because they will not just be in a state of continuous improvement. They will be in a state of continuous strategic improvement, meaning they are intentionally and proactively focused on the areas of improvement that will generate the greatest value for the organization, their patients, and their community.

Making the Quality Performance Vision a Reality

The good news is that our vision of a closed-loop quality performance system is not far off. Medisolv is actively building all of these capabilities as we speak, and our recent acquisitions of Lilac and Health Elements AI are allowing us to get there even faster.

With the addition of Lilac, we’ve expanded our capabilities to include claims-based quality measurement, HEDIS performance analytics, and predictive insights that help organizations identify risk earlier and improve performance faster. Lilac’s agentic AI technology also allows healthcare organizations to collect critical patient-reported outcome data and engage patients at scale.

In the same vein, Health Elements AI’s AI-driven abstraction technology expedites and improves access to meaningful clinical data that has historically been bottlenecked by manual data input, and opens up the concept of collaborative, technology-enabled performance improvement with new settings like clinical registries and specialty-driven quality initiatives.

In both cases, you can see the vision already coming together: we’re taking control of data that has previously been difficult to capture, incomplete, and fragmented within healthcare organizations and across the healthcare system, and we’re making it attainable, cohesive, meaningful, and actionable for healthcare leaders. This is how we help organizations go from simply measuring quality for reporting purposes to predicting performance and maximizing impact.

AI as the Means to Orchestration

AI plays a significant role in Medisolv’s expanded capabilities, because it will undoubtedly play a role in healthcare quality performance moving forward. But AI in and of itself is not the end goal for us; AI-enabled orchestration is. Orchestration turns insight into coordinated action. Orchestration makes sure the right work happens next.

Imagine, for example, a measure is trending off track for your hospital. AI can flag the measure and locate the issue, whether it’s a data issue, a documentation issue, a clinical issue, or something else. Then it can route the corrective task to the right owner, track its completion, update the measure’s forecast, and even escalate the issue if it goes unresolved. All of these tasks are burdensome administrative tasks, not essential human jobs. AI has never and will never replace human expertise. It simply allows humans to do their work better and faster.

The Essential Human-In-The-Loop Element

This is why Medisolv can be such a useful guide for healthcare organizations who are navigating the breakneck technological advances of our industry: we have always understood the critical balance of human expertise and technology that needs to be achieved to advance healthcare quality outcomes.

The expertise of Medisolv’s advisors, many of whom have served as clinical informatics leaders, quality leaders, and nurse leaders on the frontlines, will always be our special sauce. You just can’t replace the wisdom, the context, the nuanced insights that our staff has accumulated over all the years of being on the floor and being in the data and being with such a diverse range of healthcare organizations that we serve. That’s something quality leaders know they can always count on us for, no matter how much the technology, the regulatory environment, or the industry changes.

One of my favorite examples of our success with the human-in-the-loop approach was a client who recently came to us wanting to improve their CMS Star Ratings. Medisolv’s predictive analytics technology, the Star Rating Analyzer Module, helped them drill down on the areas of improvement that would deliver the best “ROI” in terms of a higher rating. But it was Medisolv’s advisors who, knowing the realities and nuances of the client’s hospital, helped them laser in on the CLABSI measure in particular and build out a hospital-wide “Zero CLABSI” initiative that transformed their entire approach to central line care.

This is the magic of Medisolv. Our technology gives you usable data. Our people show you how to use it for maximum impact. It’s why more than 1,800 of our nation’s healthcare organizations entrust us with their quality data, and ultimately, their quality performance. It’s an awesome responsibility, and that’s why we’re growing: to make sure the healthcare leaders who rely on us are always ready for what’s next.