Most us are wondering, how will the new president impact health care?
Future historians may conclude it was not the most important question of the day. Rather it was, how do we do manage both? Health care and health.
For this discussion, let’s define health care and health.
Health Care – diagnose and treat conditions. An imaging scan and/or blood test (diagnose) followed by a prescription and/or surgery (treatment) to address conditions.
Health – understand and address health behaviors. Get to know the patient and what’s important to them (understand) and offer help, including non-medical interventions, to address determinants that impact their health behavior.
We have a healthcare system that provides health care. We need an efficient and cost effective framework for managing health. The recent election doesn’t change the fact that we can’t sustain spending 50% more than any other country, while finishing last in performance in a study of 11 countries. While our healthcare system likely delivers the world’s best health care outcomes, emerging new payment models now require addressing health outcomes as well. Managing both (health care and health) efficiently and effectively could have more impact on lowering costs, increasing disability free life expectancy and improving quality of life than any healthcare innovation breakthrough.
Volume & Value – It’s both
Our success is not about moving from Volume to Value, it’s about doing both. We need to be extremely cost effective in managing health care (volume) and managing health outcomes (value). We need to leverage the fee-for-service, value-based and alternative payment models to manage health. Fee-for-service payments, such as Chronic Care Management and the upcoming Diabetes Prevention Program, can help with managing health. Achieving value-based payment incentives improves quality, wellness and health. Alternative Payment models, such as Accountable Care Organizations and Episode-Based Payments, will bring us team-based approaches and aligned incentives to our fragmented system to help improve health care and health.
How do we manage Health?
Research – We need managing health insight. What are the determinants of individual patient health? Which non-medical interventions are cost effective? Which managing health programs, such as disease management, are cost-effective? What is the patient criteria for the non-medical interventions and managing health programs? We have managing health program models for high-need-high-cost and transitions of care patients, what cost-effective programs do we need for the other 90-95% of the population? How do we help prevent patients from becoming pre-diabetic and diabetic? How do we help diabetes patients manage their health care and health to ensure they stay out of the ER or hospital?
Patients and Family Engagement – Patients and families need to increase their health literacy, improve their health behavior, and actively participate in shared decision making with their physicians. Just 20% of health outcomes are attributed to the healthcare system, so we need to empower people to address the other 80% of their determinants that impacts health behavior. One study showed just 2.7% of people in the U.S. are leading a healthy lifestyle.
Organizations – Every organization has a role and will benefit from improving health. It could be education, wellness programs or making it easier for caregivers. Communities need more bike paths, new buildings should return magnificent stairways to their prominence in the front of buildings, and youth activities volunteers need to engage kids in physical activities more than Pokemon Go.
Healthcare systems and physician practices doing both – For healthcare systems and physician practices to efficiently and effectively manage both, they need insight from new research, patient and family engagement, organizations to help and a managing health framework integrated with the managing health care framework. This has been my personal focus over the past several years working with healthcare systems and physicians. This effort has many major challenges as I described in 22 Reasons For Slow Value-Based Payment Adoption.
It will take years to build competencies to cost effectively manage both. It would be a success if we achieved just half of the triple aim of improving the experience of care, improving the health of populations, and reducing per capita costs of health care. It will require substantial progress in developing competencies in the following areas:
Team-Based Workflow – team approach, care plan alignment and communications with physicians, nurses, social workers, therapists, pharmacists, health coaches, caregivers, social services and patients. An efficient work flow that ensures each task is cost-effectively completed and is aligned with payment models to ensure financial sustainability. A workflow that takes administrative tasks away from physicians so they can focus on clinical decision making and developing trusting relationships with patients.
Performance-Based Contracting – develop effective value-based and alternative payment contracts between payers and providers that drive alignment and effectiveness. Ensure physicians and staffs are rewarded for their performance with doing both. Implement performance-based contracts with network providers, vendors and life sciences to be clear on how to achieve both and to share financial risk.
Technology – ensuring physicians and care teams have an accurate real-time picture of patients by integrating EMR data, Medical Claims, ER and Hospital alerts, discharge summaries, lab, imaging, specialist, post-acute, care manager and patient provided data. Develop actionable intelligence, notifications and worklists that enables efficient workflow. Providing care management technology for efficient communications, coordination and follow-up on closing care gaps.
Care Management – ensure accurate attributed patient population (PCP & Episode attributed). Build trust with regular patient engagement in helping them improve their health behavior and health outcomes. Physician engagement to ensure they have everything they need to effectively do both. Care coordination within care teams and external resources.
The innovations coming to health care are mind boggling. Genome testing of our DNA, epigenome proteome, microbiome, tumor cells and circulating cell-free DNA, will bring us precision medicine that will improve health care outcomes. It needs to be combined with research into the determinants of health and what works to address them, engaging patients and families, and a framework to manage both health and health care. 30 years from now, the historian narrative could be how we achieved the triple aim by doing both without any mention of the presidential election.