Bold vision and risk tolerance: Key ingredients for success in care-delivery innovation

Care-delivery innovation is a necessity for healthcare organizations aiming to move away from fee-for-service models and toward patient-centric, value-based care.

During Becker's Hospital Review's 12th Annual Meeting, in a session sponsored by Vituity, two Vituity leaders — Denise Brown, MD, chief growth officer, and Theo Koury, MD, president — led a roundtable discussion about drivers and barriers to care-delivery innovations.

Four key insights:

  1. To stay relevant, healthcare must drastically change. Historically, health systems have been designed for the convenience of physicians, not patients. This is especially evident in primary care's gatekeeping function. Patients often must see a primary care doctor in person to get a referral to a specialist.

    "The house of medicine is clinging on to antiquated notions of what an interaction is," a physician at an academic hospital in the Northeast said, commenting on the unnecessary division between in-person and digital health services. "In healthcare we talk about telehealth versus health, and that's fundamentally wrong. [Digital] is an extension of the care process, and we need to start thinking of healthcare as a continuum, part of which is digital."

  2. Care-delivery models that promote the concept of patient as consumer are on the rise. Alternative models that are more patient-centric have the added benefit that they can also increase clinician satisfaction. For this to occur, though, such models must be leveraged through the right process and ensure that the people implementing them are working at their highest license level. "Historically, we've shoved a lot of new work processes onto highly paid individuals that they aren’t necessarily trained to do," Dr. Koury said.

    Still, some new roles may be a good fit for seasoned professionals looking for a career pivot. A digital healthcare consultant for a large West Coast academic health system said this has been the case for some ICU doctors and nurses who no longer want to work at the bedside. "If we can put them into a remote-monitoring scenario, then we don't lose all that critical care for patients," she said.

    "Once they get used to the technology, our providers find it very satisfying because they can see their patients' satisfaction when they don't have to leave their home to get care," another participant said. "What we're seeing is this newfound energy behind the idea of changing the way we care for patients."

  3. Insurance-related barriers are holding back adoption of innovative care models. One of the main reasons care-delivery innovation has been slow is a lack of clarity around reimbursement. "We would be willing to do a lot of this change, but we're not sure if and how we can get paid for it," one participant said.

    Another attendee said pandemic-triggered telemedicine has accelerated innovation through remote patient monitoring and home care and, with that, has begun to loosen regulations and mindsets about reimbursement. "We were forced to [be innovative], but now need to not backslide," another attendee said. In all, a common view was that the healthcare industry must advocate more forcefully for the evolution of payment models.

  4. Taking on higher levels of risk is a way for health systems to meet payers halfway. To convince insurers to take a chance on alternative care models, healthcare organizations must be willing to share downside risk. Yet they must also innovate fast enough to compete with "cherry-picking" new entrants, such as retail clinics and apps. "Retail picks off the most lucrative aspects [of one-off care delivery], while tech companies have apps that are picking everybody off who can pay a subscription," Dr. Brown said.

As health systems work their way through care-delivery innovation, they must both modernize their patient-facing processes and increase their tolerance for risk. It's what thriving as a highly competitive industry requires.

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