Thinking beyond the hospital walls to improve patient care

As a result of the shift to value-based care, healthcare providers are under constant pressure to achieve the much-talked-about Triple Aim: lower healthcare costs, better outcomes and improved patient experience. A natural response for providers is to look for clinical strategies, and there are many of them available.

But what about the nonclinical strategies?

Not to downplay clinical strategies - they play a vital role in achieving the Triple Aim - but by relying on these alone, healthcare organizations risk leaving not just money on the table, but also better patient outcomes and experience. By using nonclinical strategies, the benefits include increased reimbursements and CMS bonuses, reduced readmissions, better patient satisfaction scores, higher patient and family affinity, and a clinical team that themselves have a better experience of delivering care.

Before sharing some non-clinical strategies, it helps to consider how providers and patients view healthcare. When providers look out at the healthcare landscape from their own perspective, or "hilltop," if you will, they tend to see challenges in terms of their financial impact on the organization. For example, in one direction they may look out and see unacceptably high readmission rates. In another direction, they may see low patient compliance with treatment regimens. And in still another, they may see restrictive bundled payment limitations and shrinking reimbursement rates.

The view of healthcare from the patient's perspective, meanwhile, differs dramatically. Patients look out from their hilltop and see challenges to regaining health in very practical, human ways. For example, over here they might see an inability to access transportation to and from their physician or physical therapy appointments. Over there, they might see difficulties paying for their medicine and diabetic test strips. And in every direction they often see few social connections that could help them achieve better health.

And while success or failure in battling the challenges that the provider sees can be an important indicator of success, it really doesn't tell the whole story. In fact, it can fall far short of solving the entire problem and producing the greatest value. A growing body of evidence shows that providers who embrace and solve the nonclinical healthcare challenges of their patients improve their own overall patient care and financial goals. Eliminating obstacles to care like lack of transportation, treatment affordability and social isolation has several tangible results: treatment compliance increases, hospital and ED admission/readmission rates decrease; outcomes improve and healthcare delivery costs drop.

To cite just one example, from a joint-replacement program at a major hospital in the Midwest, the total costs inside and outside of the 30-day bundle period dropped some 80 percent, from $60,000 to $12,000. Only about 20 percent of the healthcare organization's reimbursements, moreover, came from costs under its direct control - products, nurse staffing ratios, and other clinical activities. Fully 80 percent of the savings came back as a direct result of the hospital's efforts to address non-clinical patient barriers to care that previously went unaddressed - transportation issues, affordability of prescriptions, access to supplies, connection to community resources, and social isolation.

Such issues historically have never been on private healthcare's radar, and why would they be? There is no way to get compensated for them; there are no CPT codes for "treating" issues like these. Nevertheless, patients want and need help navigating this new healthcare world, and as pressure grows to achieve the Triple Aim, partnering with organizations that can supply resources to address these needs will become increasingly important to hospitals.

The bottom line is that changing the way people care for each other helps everyone: patients and their families, nurses and physicians, even entire health systems. To truly improve all aspects of care, providers must place themselves on their patient's hilltop and understand what they see. There's a person inside every patient, and taking the time to know someone as an individual reveals important information to inform the care delivered by healthcare providers. Transforming the way people care for each other generates measurable benefits for patients and providers alike.

Jamo founded and led Medical Present Value, a contract management and revenue cycle company (now Experian Healthcare (EXPN), and PTRX, a consumer-oriented pharmacy benefits manager (now Catamran (CTRX). Jamo also co-founded and led Tenzing Health, a division of Vanguard Health Systems. Prior to his entrepreneurial career, Jamo practiced as a cardiac anesthesiologist. He received his MD from UT Southwestern, trained at Harvard's Massachusetts General Hospital, and received an MBA from UT Austin.

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