Understanding the Bottom Line: How Utilization of External Support is Affected by Finances

Cynthia Perry, PhD, FNP-BC, FAHA, Co-Investigator, ESCALATES


EvidenceNOW is testing what kinds of external support, like practice facilitation or data infrastructure development, help practices make quality improving changes (see story on external support strategies). In his ESCALATES post on “Context Matters,” Kurt Stange noted that understanding the context in which an intervention is provided is essential to being able to transport it to other practices. The ESCALATES team asked the 7 Cooperatives involved in EvidenceNOW what factors shaped a practice’s ability to make use of external support so that other practices not involved in EvidenceNOW would be able to assess whether similar support might be helpful to them.


Financial factors had the biggest impact on a practice’s ability to make use of external help. Included among these were concerns about health insurance coverage for extra services and impending national policy changes regarding payment approaches, especially worries about impending value based payment reform (MACRA/MIPS). This CMS program was confusing for some practices, but a source of motivation to engage in EvidenceNOW for others. State budget pressures and the lack of Medicaid expansion in some states also created financial uncertainty and stress, diminishing the priority placed on engaging with EvidenceNOW for some practices. Particularly for FQHCs and independent practices, the costs, complexities, and challenges associated with setting up the data infrastructure needed to produce measurement data for quality improvement made many practices glad to have help. Finally, the financial status of the practices and their patients influenced practice motivation and ability to implement change. As with many other aspects of life, the bottom line financially was a major determinant in what practice leaders did about the opportunities provided them through EvidenceNOW, and understanding what financial barriers or drivers are in effect at practices is an important step in providing or utilizing external support.