This blog represents the second in a five-part series that will explore ways to realize greater value by delivering a patient-focused, end-to-end experience. More specifically, the blogs discuss ways to restructure patient care, leverage technology and reduce waste to elevate the patient encounter and take costs out of the system.
Until now, healthcare organizations have structured care delivery and business processes around the needs and requirements of providers and payers, which has resulted in a healthcare environment in which the patient is not the primary customer. It has also led to elevated costs, inefficiencies, and, in some instances, poor quality.
This mindset must change if organizations are to provide greater value. Realistically, shifting care and operations to be more patient-centered is the only way to achieve and sustain value long term.
For many patients, the healthcare experience is fragmented. Different providers and organizations offer care in a vacuum, without coordinating that care with other providers. This siloed approach increases costs and lessens quality—and it frustrates patients, particularly when patients are forced to act as a go-between among providers in addressing complex health issues.
To deliver the level of value needed to maintain long-term financial viability, healthcare organizations must eschew the siloed approach and embrace one that instead supports collaboration and information exchange across the continuum.
New and emerging care models, such as accountable care organizations (ACOs), are slowly pushing healthcare organizations toward greater collaboration. Whether collaborative entities function under one leadership structure or as a group of independent, clinically-integrated organizations, a cooperative care approach can ensure that a patient has easy access to all the resources he or she needs for care. The patient also must be confident that these resources are communicating with one another and keeping the patient’s best interests in mind.
Two recent ACO success stories are Banner Health Network and Monarch HealthCare ACO. Both organizations demonstrate improved care and lower costs, although their approaches to achieving success differ. Banner dispatches hospital-trained nurses to patients’ homes to address key patient needs, while Monarch provides a care-coordination service for beneficiaries with multiple diagnoses who need assistance with managing their numerous medications and care visits (“Pioneer Accountable Care Organizations Succeed in Improving Care, Lowering Costs,” Centers for Medicare & Medicaid Services. July 16, 2013).
Even if a healthcare organization does not pursue a formalized ACO model, future financial stability will be found only through partnerships with other organizations in the community to coordinate care and share information. For instance, by embedding care managers in a hospital, a provider can ensure that once a patient is discharged, the patient's primary care physician is aware of the discharge and can seamlessly pick up where the hospital left off, offering continuing services that limit the likelihood of readmission and sustain the patient’s health long term. These care managers also can act as communication conduits, making sure the hospital and physician practice share data about the patient and the next steps for care, thus reducing costly duplicative services.
For example, Crystal Run Healthcare—a multispecialty group practice located in New York—embedded care managers at a local hospital. The program decreased the 30-day all-cause readmission rate for Crystal Run patients treated at the hospital by 8 percent, benefiting all parties involved (Spencer, G., “Making the Move to an ACO,” hfm, February 2014).
Fundamentally, patient-focused care is based on collaboration. Those organizations that continually strive to look outside their four walls and pursue cooperative relationships with other healthcare providers will position themselves to take a large and financially lucrative step toward value.
Keegan Bailey is vice president, collaborative care strategy, NextGen Healthcare, Horsham, Pa. Follow him on Twitter.
Publication Date: Thursday, July 24, 2014