Healthcare Musings April 2012

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Collaborative Workflows: An Economic Imperative for Thriving in an Era of Payment Reform
by Mark Blatt, M.D.

Mark BlattApril 2012 - The simple truth about healthcare in the US is that the product the industry offers is too expensive for anyone to actually afford. Healthcare has been unaffordable for individuals for a long time.  More recently, healthcare costs are threatening to bankrupt not only large self-funded corporations, but also states and now the federal government. Even insurance products, designed to help with affordability, are rapidly becoming unaffordable.

To my mind this means healthcare is in a bubble. When prices rise to a point where NOBODY can afford the product, the end is always the same. You have a crash, and that is the likely outcome in healthcare.

Simply bending the curve and growing healthcare spending more slowly than the current 18% - 20% of GDP will not suffice.  We simply have to lower prices, which means we have to lower costs.

Here is a challenge: as an industry, tell me how we are going to lower real costs? How you can reduce spending from 18% of GDP to, say, 14% of GDP over the next decade to restore affordability and fairness to the system?  Maybe it’s “Moore’s law for Healthcare:” Treat twice as many patients for half the cost.

So how might we make this type of dramatic change? One answer lies in the need to improve communications and collaboration among healthcare providers. Before I joined my current employer I practiced as a family physician in rural Connecticut. I viewed much of my job as helping my patients safely navigate the healthcare system, and coordinating complex care for chronically ill patients with a group of specialists. This took time for which I was not compensated. I did it, like many doctors, because it was the best thing for my patients. According to a 2008 study by the Commonwealth Fund,1 less than 50% of all US docs even do one basic care coordination function for their patients.

When clinicians (doctors, specialists, nurses, pharmacists, EMS, therapists, community care workers, etc.) talk, they can improve care delivery for their patients.    Real team collaboration can improve outcomes.

Evidence exists that by collaborating we can:  

  • lower unnecessary 30-day readmission rates (to close to zero) 2  
  • reduce hospital admission rates by 40% 3
  • reduce ED visits by 30% 4

These dramatic cost savings make it possible to lower prices without sacrificing quality or access.

Imagine if, at the time of discharge from the hospital, the discharge nurse communicated directly with a nurse who was going to receive the patient in the ambulatory setting. They securely shared all relevant records in real time so questions could be resolved. Further imagine that the patient was directly involved in this collaboration and, if the patient wished, a family member was also invited.  Would this type of real time synchronous communications, data sharing, and caregiver involvement lower readmissions? The above evidence suggests it would, yet this type of workflow is rare in US healthcare. Collaboration is not the norm.

The work that is expected of clinicians is about to change.  Simply treating patients expertly and following evidence-based medicine (which is expected of you) will not be enough to change outcomes. Only by collaborating and communicating with our colleagues in real time, can we really control costs and change outcomes.

Collaborative workflows have to become the norm, not the exception, for US healthcare providers to thrive in an era of payment reform.

Good luck.

 

Citations:

  1. Commonwealth Fund Survey of Public Views of the U.S. Health Care System, 2008
  2. American Hosp Association Jan 2011 ACO Case Study: New Physicians West
  3. Arvantes, J. Geisinger Health System Reports That PCMH Model Improves Quality, Lowers Costs. AAFP News Now. May 26, 2010
  4. Sweeney L, Halpert A, Waranoff J.  Patient-Centered Management of Complex Patients Can Reduce Costs Without Shortening Life. Am J Manag Care. 2007; 13:84-92.

 

About the Author

Dr. Mark Blatt is currently Worldwide Medical Director, Enterprise Solution Sales, in the Sales and Marketing Group at Intel.  He joined the company in 2000, holding previous roles as Director for Healthcare Industry Solutions and Director for Global Healthcare Strategies in Intel’s Digital Health Group.  In the area of care delivery reform Dr. Blatt has worked with care delivery systems in many countries to enable cost effective, sustainable systems that will allow Clinicians to provide “virtual care” to patients in diverse rural and remote settings. He helped design Intel’s Payor and Pharma strategy as well as worked with the team that brought Intel’s Mobile Clinical Assistant (MCA) computing platform to market. Dr. Blatt received the Intel Achievement Award (Intel’s highest honor) in 2007 for the MCA design.

Prior to joining Intel he was the managing partner of a five-provider group in Family Practice. He practiced family medicine for 15 years before returning to Yale University to earn his MBA (2000) in finance. Dr. Blatt earned his Medical Doctorate at Albany Medical College of Union University (1979). He completed a residency in Family Practice at the University of Connecticut (1982). He then served two years as a Commissioned Officer in the US Public Health Service before starting private practice.

Dr. Blatt is a member of the IEEE Medical Technology Policy Committee, the American Telemedicine Association, HIMSS, a Life-time member of the American Academy of Family Physicians and a diplomat of the American Board of Family Practice (1982-2010).

You can reach Dr. Mark Blatt at (916) 377-0002. 

   

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