Politico gathering shines a light on healthcare's sticking spots.
In a week filled with headlines about the government shutdown, on Wednesday the media outlet Politico hosted a gathering in Washington, D.C., featuring panelists whose careers are devoted to moving healthcare forward. Perhaps the mood of the nation's capital was contagious; the conversation focused on sticking points in healthcare innovation, shining a light on issues that must be resolved for innovation to be successful.
Panelists discussed a broad range of topics of interest to health systems, including how payment models, infrastructure, and big data impact innovation and patient experience. They also touched on one place where innovation may be missing the mark: the elderly.
Following are select highlights from the meeting.
- Peter Basch, MD, medical director of ambulatory electronic health records and health information technology policy at MedStar Health
- Jay Desai, CEO and co-founder, PatientPing a Boston-based care coordination platform that seamlessly connects providers to coordinate patient care through real-time notifications when patients receive care, as well as provides patient stories, to give information context
- Ann Hwang, MD, director, Center for Consumer Engagement in Health Innovation, Community Catalyst, a Boston-based non-profit advocacy organization working to build the consumer and community leadership to transform the American health system
- Mona Siddiqui, MD, MPH, chief data officer, U.S. Department of Health and Human Services
1. Healthcare is Caught Between Two Worlds
As healthcare transitions from a fee-for-service model to value-based care, the misalignment of payment incentives creates chaos. "The healthcare system is in this very awkward phase … [with each foot] in two different canoes that are going in totally different directions," says Hwang. "In one system, you're trying to do more coordinated care, trying to provide care more efficiently. In the other, you're trying to bring more volume into your system. They're diametrically opposed." Resolving that tension will bring balance to the system.
A couple of panelists mentioned a program Blue Cross and Blue Shield of North Carolina announced this week as a positive sign of progress. The payer launched Blue Premier, a value-based care model in which Blue Cross NC and five health systems will be jointly responsible for better health outcomes, exceptional patient experience, and lower costs. It includes agreements with Cone Health, Duke University Health System, UNC Health Care, Wake Forest Baptist Health, and WakeMed Health & Hospitals.
2. Transformation is About Much More than Financial Incentives
Often people imply that alignment of financial incentives will result in a better patient experience. But the financial component is only one part of the story, says Siddiqui. "To say that [aligning financial incentives is] going to automatically translate into an incredible patient care experience is not correct. We often conflate the two and I think the patient experience is going to require a lot of nontraditional people to come in and help"
Hwang agrees. "Once you have those financial incentives in place, there's still a last mile problem of its own," she says. "Making the potential of these models a reality requires a lot of work on the ground with consumers in partnership with providers."
3. Bricks & Mortar Facilities Are a Problem
Today's capabilities are out of sync with healthcare infrastructure. The practice of delivering care in hospitals creates challenges because most healthcare can be delivered in the home or other places in the community, say the experts.
"If we were to start with a clean slate and think about how we would redesign a system … that system, for the vast majority of us, would not be centered around a brick and mortar place," says Siddiqui. Besides ICU and surgery, most care provided in hospitals can be done elsewhere."
"How do you actually change the entire way we look at the logistics of healthcare to be more focused around a patient's home?" Siddiqui queries. "That's a really hard problem to solve. There is a lot that we can do in a patient's home, and it shouldn't require having a family member or friend who is part of the healthcare system to help you navigate and coordinate all of that. That's actually what happens right now."
From transporting patient records, to scheduling appointments, much of the burden for coordinating care is a patient's responsibility, says Hwang. "As we talk about new models of care, … there is a need re-center the healthcare system so it's not around what it does, or what I do I as a provider … it [should be] centered around what does this person as a patient need? Use that as the construct."
Some health systems already are moving in that direction. Basch points out. Leaders at systems like MedStar, where he works, think of their organizations as distributed care networks, he says. While the hospital is still necessary, "prompt care, home care, primary care, specialty care, big boxes, and lots of other offerings are available. When you couple that with technology, remote monitoring, and virtual visits, you can begin to think about what is right for a particular patient and their particular condition. A hospital system that thinks it will remain as the center of healthcare as a brick and mortar hospital [is] not going to be around for a long time."
4. Innovation May Be Missing One Group that Needs It Most: The Elderly
One place that innovation may be missing the mark is with the elderly population. While one panelist said that many needs could be met in patient's home with a smartphone and a few connected devices, others pointed out that many older patients, particularly those in low income groups, may not possess, or know how to use, such devices. Other patients with vision or hearing loss, dexterity issues, or other disabilities may also be excluded.
There's a "digital divide," concludes Joanne Kenen, Politico executive health care editor, who helped moderate the panel.
5. There's Too Much Hype About Big Data
Arthur Allen, eHealth editor for Politico Pro, asked panelists for their input about the value of big data, transparency and useful information.
Hwang pointed to the recent release of hospital prices as an illustration of how data can impede patients' ability to understand healthcare. She cited several reasons for her stance. First, "they're not real prices: they're what I call the 'Nordstrom Rack prices.' You know that sweater is not really $200, but those are the prices that are out." Second, the information is not understandable and third, the lists don't cull out useless data. "Having more intentionality around what data is shared and how data is shared," she says, "will be really important for making that information meaningful."
"Data can help to inform us in ways that we've never had possible before," adds Basch. "But I think we have to remember that the data that we get is imperfect. It can be misleading, and it does not contain what can be most important in a clinical setting, which is the patient's narrative, the patient story."
Mandy Roth is the innovations editor at HealthLeaders.
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