The coming New Year and new Congress of 2019 represents an opportunity to take a fresh look at where we really need to focus in healthcare: transforming the delivery system so people receive the care they need and deserve.
Much of the debate regarding healthcare in recent years has focused on coverage. While having insurance is a step to accessing care, as a physician and chairman of an organization representing thousands of physicians, we speak with one voice in stating that access is only meaningful if it offers high-quality healthcare that yields superior outcomes.
To improve the healthcare industry’s quality and costs, we need a true “system,” with coordinated care delivered by teams linked by technology that closes the gaps in our current fragmented structure. There’s a reason why we lag behind other countries in key healthcare outcomes, including life expectancy. Our inability to implement the type of integrated care that most other developed countries have is a major reason why the U.S. is paying more and getting so much less when it comes to patient results.
As clinicians speaking on behalf of our patients, we propose the following five steps as a path to a better system.
More Value-Based Care
First, we must continue the march toward value-based care and away from fee-for-service payments. Payment by service discourages the cooperation and collaboration each and every patient deserves. Fee-for-service payment increases the likelihood of poor communication. In contrast, when healthcare providers are paid based on their ability to improve the patient’s condition, the care team and the patient can come together to achieve common goals. Consequently, outcomes are better, and resources are used wisely.
The concept of value-based care is still one that is misunderstood. Some clinicians express concern that it will inhibit their ability to do what’s best for their patients. In fact, the opposite is true. Value-based care places patients first — where they ought to be — when making medical decisions. Initial results from care delivered through the most experienced accountable care organizations show better quality outcomes at a lower cost than traditional models.
Second, we need to accelerate the journey toward interoperability. Everyone on the care team needs the latest information on the patient’s condition, at their fingertips at all times. When everyone is connected to the medical record, the best, most timely decisions are made and errors avoided. Even now, the doctor’s system may not talk to the hospital’s system, care provided in other geographic settings is not part of the patient’s record and systems in one state cannot routinely access records of patients from another. The ability to contact care team members by phone or video is a huge convenience to patients, but when the interactions are not documented in the patient record, these advice-giving providers can’t access the patient’s medical history when making recommendations. These information gaps are a prescription for medical errors where services are duplicated, conflicting, or at worst lead to actual harm. In contrast, interoperable connectivity between teams and IT systems can lead to care at speeds not previously possible.
Balance Digital and In-Person Care
Third, we must rapidly move forward to leverage digital communication in patient care and in physician-to-physician consults. Patients are becoming comfortable with the idea their mobile phones are portals to connect with and manage their medical care, just like other aspects of their busy lives. Viewing and understanding test results with the right decision support, being able to do a telephone or video visit with their doctor instead of going into the office and making the specialist available on video in real time while they are seeing their primary care doctor are incredible advances.
The decision by CMS to pay physicians for video visits is a major step forward to increasing the use of digital communication between patients and physicians. As value-based payment evolves, we will see greater use of telehealth. It’s clear that when technology is used with a well-designed care delivery system, the outcomes are superior when it comes to reduced wait times, and making accurate, expedited medical decisions. Getting the right care faster leads to better clinical outcomes when it comes to any number of conditions including cancer prevention, cardiovascular disease, or sepsis. Inevitably, the work to be done is not about installing new gadgets. It really boils down to requiring clinician design when it comes to ideal workflows, patient input into the desired experience, and a measurement process to ensure the goals of telehealth are realized.
Address Drug Prices
Fourth, high drug prices must be addressed and remedied. When patients can’t afford their medications, they can’t get the treatment needed. It is a prescription for failure on many levels. Fortunately, there may be bipartisan support for solving this problem. We need better, independent data to assess new therapies so we truly understand which patients need a particular treatment. We need to subject high drug prices to public scrutiny and oversight and give Medicare, purchasers, and patients more tools to rein in escalating drug prices.
Let’s Set Standards
Finally, we must establish common consensus standards to measure quality care. Patients, health plans, providers, government entities – everyone needs clarity on the high-impact, minimum set of quality measures that capture outcomes and patient experience. We must leverage the electronic medical record to lower the administrative burden of collecting measures.
By maintaining and even accelerating our progress in these five areas for improving care, we will improve the health care system overall, by providing better care, reducing errors, and making the best use of our health care resources.
Stephen Parodi, MD, is chairman of the board for the Council of Accountable Physician Practices (CAPP), a coalition of American multi-specialty medical groups and health systems. An infectious disease specialist, he is also associate executive director of The Permanente Medical Group, and serves as executive vice president for external affairs, communications, and brand at The Permanente Federation.