Duncan notes that it is important to have a diverse set of hospitals and insurers participate. She also notes the need to demonstrate to stakeholders that the program addresses issues important to them. Duncan remarks, “Our hospitals are cash-strapped, and comprehensive care transition management requires significant resources to build the infrastructure to deliver these services. Current reimbursement policies do not fully cover the costs; hospitals need incentives to invest in complex, broad-scale service delivery changes.” A multi-stakeholder advisory council worked with Duncan to demonstrate that chronic conditions are costly to payers and that transitional care management strategies like COMPASS offer both clinical and financial benefits.
Duncan notes that each stakeholder has a unique perspective that needs to be shared. The patient perspective is fundamental in providing insight about patients’ needs and creating a program that is patient-centered. While a researcher can develop and test a model, unless health system executives and insurers “understand the value and buy into the program, it will not be sustained,” Duncan says.
- Ensure all stakeholder perspectives are heard to foster collaborative learning.
- Recruit stakeholders to serve in formal roles (e.g., including a Medicaid representative on the project’s advisory council).
- Work to align incentives among all stakeholders, taking into account their unique perspectives and needs.