Guest post by Jordan Battani, managing director of CSC’s Global Institute for Emerging Healthcare Practices.
There’s a sea change underway in healthcare in the United States, an effort that’s focused on addressing the challenge to improve healthcare quality and outcomes for patients and the population at large, while at the same time controlling and reducing healthcare cost inflation. It’s no small task, and there is no shortage of opinions about how best to make the changes that will be required.
At the core of the discussions, however, is a general understanding that a fundamental change in the traditional orientation to healthcare, and healthcare financing is required. Episode focused, fee-for-service medicine has led to a systematic bias against coordination and collaboration.
The need for change is particularly acute in a world that is increasingly defined not by acute episodes of illness and injury, but by the constant demands placed by the burden of managing the impact of chronic disease. Transformation requires an expansion from the traditional focus on patients and episodes to include populations and the entire care journey experience from wellness, through illness and back again.
In short, an expansion:
- From the needs of the patient to include the needs of the population
- From the support of the individual provider at the point of care to include all providers across the spectrum of care
- From the activities in a particular care setting to include the activities in the entire continuum of care
- From the discrete episode of illness and care to include the activities that promote wellness and prevent illness and recurrence
- From the treatment of chronic disease to include its management
- From islands of automation to integrated information access across the entire continuum of care
The core competency in this new orientation is the ability to practice coordinated care and to manage the financial arrangements that support it. Medicare, and many commercial health plans, refer to this competency as “accountable care.”
Practicing in this new environment requires the ability to expand care beyond the traditional boundaries of a linear provider to patient interaction during a discrete episode of acute illness or injury. In a healthcare landscape characterized by long-term chronic disease, healthcare must include the patient’s lifestyle, environment and long-term personal health risk factors in care planning, delivery and management.
Delivering that care plan cost effectively using complex clinical technologies and innovations requires coordinating and integrating the activities and information from multiple care settings and many different providers. Financing a coordinated care delivery system requires expanding payment for activities beyond fees for the services rendered for a discrete episode to include compensation for the effort and the value delivered from collaboration, coordination and integration across the continuum of settings and providers.
Not surprisingly, the tools and capabilities required for practicing in the era of coordinated care are more complex and far reaching than those required in the traditional episode-based fee-for-service model.
Successful coordinated care requires:
- Clinical information and point-of-care automation to ensure that information about the patient’s entire experience of health and healthcare is available at every patient encounter – and that decision support is available to the provider who is engaged in care plan activities and adjusting the care plan based on outcomes.
- Data management and integration to ensure that the healthcare data assets that are required for practicing coordinated care are rationalized, useful and consumable at all the points in the care continuum.
- Health information exchange that delivers useful and consumable information across the continuum of care and enables the participation of care providers in multiple disparate care settings, systems and locations.
- Patient engagement strategies and technologies bringing the patient into the care planning, delivery and management process, enabling them to act on their own behalf and to use their energies and insights to promote improved outcomes, adherence and quality care.
- Care management and coordination process automation informed by information assets generated across the care continuum, supports the work of care providers in disparate locations, settings and organizations on behalf of the patient.
- Performance management systems and strategies for clinical, financial and administrative processes that ensure that goals of quality, outcomes, patient safety and financial sustainability are achieved and exceeded.
In an environment characterized by multiple, conflicting and interlocking mandates and transformation requirements it’s a difficult task to take on a new set of organizational and technology strategies, and tempting to focus instead on meeting the deadlines and details of the individual programs and requirements.
There is no single road map to success and the timeline, priorities and projects for each organization will vary based on their circumstances. The only certainty is that under the current set of clinical quality, patient safety and financial pressures and requirements, organizations that fail to develop and demonstrate coordinated care capability risk long-term clinical and financial failure.
Jordan Battani is the managing director for CSC’s Global Institute for Emerging Healthcare Practices, the applied research arm of CSC’s Healthcare Group. Battani has a strong professional track record in leveraging technology solutions to deliver business value.