New ways to delivery of health care

While working on a project with a client I am continuing to revisit the key ideas in the book Beyond the Obvious regarding the question of how. What keeps coming to mind is the challenge of looking at health care delivery in a new way, a way that changes how services are rendered. As an industry, we are struggling to make a shift in what we are doing. It is hard to work differently. Physicians are pressured to do more with less and at the same time the threat of malpractice hangs over their heads. Health care providers have to sort out what is essential from what is not needed, and do it right. However, this is not an excuse to do nothing. This brings me to the point of understanding the state-of-the-art in how health care is delivered. Here is what I know.

1.              Shared medical appointments are still being tried as a way to approach the Triple AIM of outcomes, cost, and patient satisfaction. They seem to be more common in procedural services and some chronic disease management. A few small studies have been done, each with positive results. What is needed are some strong case-control studies and broader implementation.

2.              Electronic consultations and telemedicine are ways to use advancements in technology to increase access while reducing cost of delivery.  This includes hospital-at-home and self-service approaches. All of the electronic information becomes part of the personal health record and allows more accurate solutions based on clinical research and analysis. The technology for collecting data is advancing faster then the solutions for analyzing and intervening. In addition, payment lags to allow providers a way to be compensated for their time and talent. Yet, this is promising for public health and timely care delivery.

3.              Defining health more broadly is another advancement where the “how” of health care delivery addresses the person as a whole and gives providers permission to work on the source of illness. A personalized approach to health care  that includes efficiencies. As described by an article in the Stanford Review, this approach is more than the traditional physician-patient relationship. It involves a team who are looking toward improved outcomes beyond treating illnesses.

There are a number of demonstration projects being implemented. These include Accountable Care Organizations (ACO) and Population Health Management Systems PHMS). In addition, payment systems are being tested to align financial incentives with goals. In all of these delivery systems and projects we need to measure and report on health outcomes and the patient experience. This requires thoughtfulness before the change is implemented. With careful planning measurement and analysis has meaning and usefulness.