I listened to an H&HN Daily podcast yesterday titled ACOs Need to Focus on Clinical Care, Too. Institute for Healthcare Improvement (IHI) CEO Maureen Bisognano was interviewed, and there were two themes that struck me in particular:
- Fragmentation of the patient experience leads to increased cost and decreased patient experience: Bisognano points out that many healthcare executives believe that engaging patients in the design of care increases costs. However, they found that organizations had better clinical outcomes at lower cost when 1) data is integrated in such a way that design of care can travel across an entire patient episode and 2) patients were engaged in the design of their care.
- Many ACOs are focused on legal and financial structure and not on the redesign of clinical care: This mimics sentiments that I read in the Healthcare Finance News article Payers, Providers Agree – and Disagree – on ACOs. Bisognano is concerned that ACOs will never live up to their full potential with such a narrow focus. Her data actually shows that communities that achieved the lowest costs placed the highest emphasis on the entire healthcare system that patients used to receive care. In some communities competition was rampant, but the leaders that were competing against each other for market share and talent came together to discuss the total burden of illness in the community they served and designed care and services accordingly. By incorporating the critical components of clinical care into executive decisions, these executives better realized quality outcomes and became market leaders with lower cost structures as a result.
Bisagnano ended with a query on how to create an IT system that effectively ties these themes together. Here are my thoughts:
- Increased Data Exchange in Health Communities: I agree wholeheartedly that fragmented data across communities leads to increased cost and decreased patient experience. The ability to exchange clinical information will be critical to ACO success. Beyond the important aspects of delivering quality care, there are real business drivers that favor an environment where clinical and cost information are combined into a comprehensive system delivery model. Health Information Exchange (HIE) is important in establishing this partnership with patients and the healthcare systems within their community. The Enterprise HIE eco-system is one approach that innovative healthcare systems are using to enable them to connect patients and physicians together in a more collaborative environment.
- Increased Collaboration Among Patients, Physicians, and Healthcare Communities: There are many smart options available to invite patients, physicians and communities into decisions related to the design of clinical care. Healthcare portals can be used to empower patients by providing meaningful access to their care and connect a patient to the entire health system that impacts their care. Similarly, community portals can be created to connect patients to those with similar disease states for information sharing, support, and advice. This empowers patients to work with ACOs in creating cost saving, and patient centric, clinical care. Organizations can also use physician portals to connect physicians to the critical components of clinical care which can then be incorporated into executive decisions. This would enable stakeholders of a healthcare system to come together to create better services and relationships within the community that they serve, and, according to sentiments from Bisagnano and many others, increase an ACO’s success as a result.
What do you think? How would you create an IT system to enable the redesign of clinical care?
