BJC HealthCare CEO lays out recommendations for improving direction of US healthcare

To address the evolving needs of the U.S. healthcare system, Steven Lipstein, president and CEO of St. Louis-based BJC HealthCare, and Arthur Kellermann, MD, dean of the F. Edward Hébert School of Medicine at the Uniformed Services University of the Health Sciences in Bethesda, Md., published a paper in JAMA outlining the recommendations for restructuring healthcare to support more efficient, targeted healthcare delivery.

The paper, called "Workforce for 21st Century Health and Health Care," summarizes the recommendations of a National Academy of Medicine writing team comprised of healthcare leaders and chaired by Mr. Lipstein and Dr. Kellermann.

"Today, the healthcare system is transitioning from the traditional fee-for-service approach toward value-based models of care delivery," the authors wrote. "Within these models, care delivery and management are intended to be more patient- and person-centric and made more efficient by keeping people healthy and reducing duplicative or unnecessary services." For a successful transition, Mr. Lipstein and Dr. Kellermann point to the need for seamless coordination between healthcare providers, integrated approaches to care and segmenting the population by health conditions.

Here are five recommendations for improving U.S. healthcare delivery, according to the article.

1. Encourage front-line healthcare providers to act as stewards of population health. According to Mr. Lipstein and Dr. Kellermann, expanding the healthy population could have significant trickle-down effects on healthcare spending in the U.S., as healthy people utilize far fewer healthcare services than those who are seriously ill or injured. Strong population health management initiatives will require a diverse and multidisciplinary workforce comprised of physicians, physician assistants, registered nurses, social workers, nutritionists, exercise physiologists, public health professionals and other healthcare workers.

2. Utilize telehealth. "Various examples of telehealth services have demonstrated that patients do not need to travel long distances to realize optimal primary care outcomes," the authors wrote. "With appropriate training and access for health professionals and the people they serve, many patients will no longer be limited to receiving needed services at fixed sites of practice." The best candidates for telehealth include patients who incur minor episodes of illness or injury and who do not need a clinical procedure or diagnostic tests.

3. Reduce costs by better targeting services. Caring for patients who experience major episodes of illness or injury often requires expensive technology, medicine and prolonged periods of treatment and recovery, according to the report. By regionalizing and better targeting these services, healthcare providers can achieve greater efficiency and lower spending. "Abundant evidence exists indicating that there is demonstrable value associated with quickly and efficiently bringing patients to the right place at the right time for the right reason, particularly when treating patients with malignancies, stroke, and cardiac conditions," wrote Mr. Lipstein and Dr. Kellermann.

4. Better train the healthcare workforce to treat patients with chronic conditions. The challenges healthcare providers face when treating patients with chronic conditions become more complicated when those conditions are combined with obesity, substance abuse, mental health disorders or physical disability. "Chronic care management and individual life circumstances are inextricably linked," the authors wrote. "To better serve patients effectively and to achieve optimal health outcomes, the workforce must have the education, skills and capacity to help patients live with their chronic conditions."

5. Invest in better end-of-life care. Nearly 3 million Americans die each year. Many of those people's healthcare services at the end of their lives are provided by clinicians that are primarily there to care for patients with advanced illness. According to Mr. Lipstein and Dr. Kellerman, investing in and training more palliative and hospice care professionals would lessen the dependence on healthcare providers whose skills are best suited to care for individuals with chronic disease or other acute conditions.

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