New models of care, new modalities, and new funding are needed to simplify healthcare delivery for both providers and patients.
For health systems, doctors and nurses, 2022 will feel like the most challenging year yet due to the pandemic. The initial heroic response left the system in financial tatters.Staffed by burnt-out clinicians Those dissatisfied with the paid model of treatment that encourages patient visits over improved treatment outcomes. Rather, it revealed hidden cracks in an already broken system.
America’s cutting-edge innovation and therapeutic care are the envy of the global health ecosystem, but America’s health status lags behind other countries.The U.S. healthcare system is unique among developed nations in that it separates the economic interests of hospitals, health insurance, and clinicians from those of our patients, our customers. In the paid services world, hospitals are paid to treat patients who require inpatient care. In short, lower-cost, more convenient places of care, such as ambulatory surgery centers, pose an existential threat to the thriving hospital ecosystem. Health insurance wants the opposite. Less care means less pay for those who provide care, increasing costs for electronic medical records tailored to optimizing billing, managing pre-approvals and fighting denials To do. Also, physicians who are paid based on Relative Value Units (RVU) earn their income for care input, not care output. Physicians are driven to bring patients in for care even when needs can be met on the street. From the patient’s perspective, none of these financial incentives are consistent with optimizing health outcomes. In fact, they adversely affect relationship-based patient care.
Two key lessons help point the way out of the quagmire in which American healthcare is stuck today.Michael Porter and Tom Lee taught us to look at the entire healthcare value chainUnderstanding what actions create value for customers while directing management’s attention to the factors that matter most. However, few organizations do so because the incentives are not in place. Aaron Martin joined Providence after helping build his Kindle store at Amazon.He told me that healthcare has two basic customers : Patients and their doctors. Just as the Kindle helped ease friction between authors and readers, healthcare needs to facilitate pathways that connect patients who need care with those who provide it.
It’s time to rebuild a fragment of the struggling U.S. healthcare ecosystem by highlighting the fundamental dynamics of healthcare. Better health outcomes for patients by reducing patient-to-patient barriers, reducing typing to fill electronic medical record requests, reducing disputes with insurance companies, and reducing provider-led treatment facilities and make it easier for committed clinicians to practice their profession. By a hospital system trying to survive financially. Simplifying health requires new models of care, new means and new money (i.e. new payment models) ().
During my time in Providence, we systematically worked on all three areas to shape the future of care.
Providence clinicians want to work in a relationship-based system of care where physician-led care teams are responsible for patient outcomes. To that end, we initiated a pilot model of team-based care, supplementing the medical expertise of physicians with nursing educators, case managers, pharmacists, behavioral health practitioners, and social workers.These wraparound services We found that primary care teams that provided ER experienced significantly less burnout, had better patient outcomes, and had lower total costs per patient (due to less frequent patient referrals and hospital admissions). These wraparound services are a smart investment when you have a captive contract that recognizes and rewards you with value. Optimized for value-based care, primary care teams can improve access, experience and patient outcomes by working in tandem with a tightly aligned network of specialists.
We have also begun piloting tools to simplify how physicians deliver high-value care. Two of his ways to take the administrative burden off the clinician’s back are ambient listening. This promises to minimize the time clinicians take to extract and transcribe patient notes (and reduce the presence of a computer between patient and physician). A referral assistance app to ensure patients are referred to specialty care with appropriate pre-consultation assessments as needed.
It’s a truism to manage what you measure. Constantly measuring healthcare inputs (cholesterol, his A1c test, length of stay, nosocomial infections, etc.) allows us to focus on what our patients and customers want when they come to us. You won’t be able to. Are we making their lives better? At Providence, he strategically began using his two sets of metrics to ensure that he measured not only his work as a physician, but also his achievements. execution,Also, Transform Care for our future. The former category measures HEDIS (Healthcare Effectiveness Data and Information Sets) results, indicators from specialized registries (e.g., observed/anticipated mortality and morbidity rates), and safety indicators . For innovative measures, we use patient-reported outcome measures (PROMs) broadly and deeply throughout our system. These are very different from patient experience measures that ask the patient, “How are you doing?” PROM asks the patient, “How are you?” Providence now uses PROM to not only help patients understand how people like themselves will respond to proposed procedures and treatments, but also to assess treatment outcomes and the cost of those treatments. We have enough data to inform physicians about how they are positioned. their fellows. We found that this data (used only for learning, not for judgment or payment) is helping physicians optimize health outcomes at a cost patients can afford.
As my friend and former colleague Jack Cox, MD, often tells me, people do what you pay for. Exactly what you pay them. If we pay a doctor through her RVU to generate clinic visits, procedures, and tests, they do it. They need incentives aligned with those goals if they want to ensure they produce the best results at more affordable prices. We are experimenting with moving to a model of , with a focus on simplifying access when patients get sick to keep them healthy and well. A capitation-based reimbursement system is also more predictable for patients, reducing the anxiety and complexity of unexpected and unexpected expenses. Paying for your monthly inclusive care subscription is much easier to plan than navigating co-payments, cost sharing, and deductibles. Simplifying health care finances would go a long way in alleviating the pain caused by fee-based models that are opaque and meaningless (even to those in the system).
Covid-19 is putting great stress on a health system that was already in need of major changes. Abuse of words should not waste the opportunity of this crisis. Physicians, insurers and healthcare systems need to move quickly to value-based care.we must make health When Make it easier for burnt-out and frustrated clinicians to provide care by leveraging a multidisciplinary team that can handle the complexity of patient needs in today’s technically powerful but inadequate systems will be It is possible; tools already exist to meet these needs and opportunities. Our choice as an industry is to work to maintain the status quo or change healthcare for the better. It’s not time for us all to focus on simplifying health.
Amy Compton-Phillips, MD is a member of the Editorial Board. NEJM Catalyst Innovation in Care DeliveryThomas H. Lee, MD, MSc is Editor-in-Chief and Co-Chair of the Editorial Board. NEJM Catalyst Innovation in Care DeliveryDr. Michael E. Porter is Co-Chair of the Editorial Board.
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