'Patient-focused' health care is still a myth – but not for long …
By Graham Hughes, MD
Ask most every hospital and physician in the United States, and they'll tell you they practice "patient-centered" care. With all the vision statements, mission statements and marketing brochures displayed so prominently in their waiting rooms, we expect nothing less, right?
I’ve been hearing politicians, insurers and providers talking about patient-centered care for the past 10 years – maybe longer. "High-quality, patient-centered" care sounds pretty good, and it’s hard to argue for the opposite. After all, who really wants low-quality care centered on the needs of the health plan, doctor or hospital? If there is a choice, sign me up for the patient-centered option, please.
The problem is, despite the efforts of a number of pioneering organizations, comprehensive and pervasive patient-centered care just doesn't exist today.
That is not to suggest that our doctors and hospitals are somehow intentionally failing us or that our health-care providers aren't committed to delivering excellent health care. Rather, the problem lies at the foundation of our health-care delivery system.
Conquer the divides
The current US system prevents physicians and nurses from providing comprehensive, coordinated care. Instead, they must operate according to the clear separations between primary care and specialty care, specialty care and acute care, as well as hospital care and long-term care.
In the vast majority of cases, these partitions prevent one setting of care from sharing with another even the most basic information about a patient's health history.
That doesn't sound patient-centric to me. Worse, our current system actually provides financial incentives to providers who create and maintain these fiefdoms, and it rewards them even when the care they provide is excessive, wasteful or potentially harmful.
Change from within
The good news is, all that is beginning to change – not just because of the sweeping provisions included in the Patient Protection and Affordable Care Act, but thanks to a groundswell of activity from groups of like-minded providers, health plans and regional employers.
They share the belief that they possess the ability to deliver high-quality, patient-centered care at lower cost. Some of these pioneering organizations already have created structures that bear striking resemblance to Accountable Care Organizations (ACOs) powered by primary-care-led Medical Home models of care.
Many of them have created mechanisms that look like a win-win-win, where health-care providers take on more financial risk for selected patient populations based on ability to reduce utilization while maintaining high quality. Providers share in the savings, health plans spend less per patient, and employers spend less on insurance premiums for their employees.
What's more, such models light the way for the federal government to steer payment from the old fee-for-service approach to one that rewards organizations that deliver on improving the health of the general population and providing high-quality care at lower costs.
The Rx is IT
What I'm hearing loudly from these pioneers is that they cannot function effectively in this model without a strong IT infrastructure. To succeed, they must – at a minimum – achieve paperless, or near paperless, point-of-care workflow through meaningful use of Electronic Health Record technology and be able to exchange data seamless across the broader, virtual network of the new organization via some form of Health Information Exchange.
To thrive, the emerging ACO must leverage tremendous volumes of cross-organizational data to gain up-to-date insights on both clinical and financial performance. As well, it must clearly understand future risk and opportunity – insights gained by forecasting cost, utilization, revenue and quality under a variety of care-delivery models.
The bottom line is, we're on a journey toward a care-delivery system that is truly "patient-centric." When we get there, you'll know because that's precisely what it will look like. Your health-care providers will have skin in the game, working with you as a partner to keep you healthy and providing high-quality care when you need it. And when we get there, I'm going to choose a primary-care physician who has achieved certification as a Patient-Centered Medical Home (PCMH) and is partnering in some form of broader ACO.
I look forward to the day when primary care, specialty care, acute care and long-term care all leverage advanced analytics to serve as my coach, mentor and advocate to help me stay well, live better and receive the best care should the need arise.
Dr. Hughes is Chief Medical Officer for the SAS® Center for Health Analytics and Insights