Risk shared care delivery is the new model of healthcare

The model of health care is changing dramatically. This is having a significant impact on the business of health care, which is moving toward the more general industry lean manufacturing mentality. With a shift in onus of the delivery of care we are seeing the re-emergence of a doctor centric model that is a primary care hub and spoke. The procedural, specialty based fee-for-service revenue model of care has become a dinosaur and the consumer is more empowered with greater capability to make choices, due in part by the fact that payers have lost the power to exclusively enlist their clientele.

With so many disruptors in the market including the freedom of access to one’s own health data and the data of the healthcare providers, healthcare is moving toward a consumerism model. Those that recognize this have taken on the payer mentality of risk management and hence designed more cost efficient, lean and higher touch interventional models of care delivery, focused on the greater care of the consumer.

It is now truly customer centric, although tiered toward the patient with the more significant cost footprint on the current healthcare system. The cost footprint will also begin to change as the delivery of specialty care becomes competitive. Thus, it is inevitable that specialty care will be the next bastion to fall to rational and lean decision making.

All in all this is a positive trend for the patient so long as there are clear quality metrics and, that is the rub. The metrics aligned to the care delivery process are not well aligned with efficiency, outcomes or quality of the care intervention. The care paradigm of the future will be one of optimal navigation of care. Unfortunately, the loose ends in the system are significant and effect the margins to enable scaling. This is why the shared risk model is not ready for commercial production, and is still being road tested at innovative care delivery incubators, widely known as ACOs.

The biggest nut to crack in making this work is to understand and characterize the incoming clinical event, that is the patient management issue. Much like air traffic controllers utilize data relevant to the aircraft such as payload, speed, and position in combination with extraneous weather factors and the assistance of conflict alerts, to manage the complex traffic safely.

Healthcare in its attempts at process change has inserted largely untested standardization that has built a level of inertia to respond to the need of the patient rather than the need of the business. Re-alignment is occurring everywhere as we abandon reporting processes and replace them with patient goal oriented protocols and clinician centric oriented workflow efficiencies. Safety, quality and patient compliance is the mantra of the new age provider who has discarded the ad hoc rules governing engagement with a risk-event prevention plan tailored to each patient.

Policy, reimbursement changes and consumer trends have created extraordinary operational pressure on healthcare; and it’s about time. Choice, the result of mobility and affordable insurance, is the key trend that is enabling the user and forcing institutional healthcare to rethink its product. Accountability is motivating primary care providers to bring a full spectrum of care to the complex care patient. Meaningful use is driving administrative processes to advocate accessibility to timely-care.

A chasm that exists, however, between the supply and demand is the productivity of the care provider and their network. Compromised productivity limits patient access and as the chasm widens it looks daunting from a cost implementation and scaling perspective. The knee-jerk reaction is to jump to virtual care, but first we must consider the complex networks that are at play to better enable access to the care provider at the point of care in a timely manner.

The cornerstone for the success of mhealth care is an accessible secure mobile network. Unfortunately, many hospitals today are still using technology as if they are the custodians of care. Mhealth care will only succeed if these barriers are broken down and virtual flexible care networks, consisting of diverse practices, on any platform, device or network across enterprises, practices and geographies collaborate or simply make themselves readily available.

To do this we have to rethink technology infrastructure, interface utility and task oriented data collection that seamlessly shares across systems. We have begun a process of interoperability but we have not made our network relationship links interoperable.

Proper utilization of technology can simplify workflows to enable links where they once were difficult to navigate or create. Affiliate vendors, care organizations and service providers can then offer services to any available network and engage critical workflow touch points with simple alerts and authenticated actions.

The future of medicine is to have the point of care need of the patient as the singular goal. To reach this goal, relevant data must be assimilated, the care team must be connected and decision modifiers must be integrated and clearly communicated.

Technology must solve for the following critical elements that a system that would need to enable the clinician and their network:

1. Security with safe harbor encryption for mobile devices and networks

2. Capacity and productivity by creating efficient alternatives to traditional communication modalities

3. Efficiency and time saving for clinicians and care teams by enabling responsiveness to appropriately escalated tasks

4. Affiliate networks engaged and connected for referrals and care coordination

5. Patient engagement collecting data real-time and updating interfaces that can customize outreach

6. Patient outreach for compliance and intervention

7. Implementation that is simple and data that is accessible so that it self-incorporates into intelligent outreach algorithms

The industry has long pointed the finger at the physician, depicting him or her as the stalwart and the laggard when it comes to process change and technology adoption. On the contrary, it is the physician that is rapidly modifying behaviors to innovate processes and create new ways to solve a complex care delivery problem. The physician is becoming the most significant consumer of all that is mobile and integrated -data oriented

Kluged legacy systems that create and sustain suboptimal workflows and force compliance checklists inherently don't meet quality of care standards; rather they only achieve quality of process, falling short of the patient's need. The innovative and impactful shared-risk care delivery model is breaking norms by building and adopting user-centric technology by creating and implementing the interfaces, work-flows and infrastructure of a data sharing and data enabling future.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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