Our perfectly designed healthcare delivery system

In the United States, we have a perfectly designed $2.7 trillion healthcare delivery system. It’s perfectly designed to deliver more and more healthcare, but not well-designed to “deliver” more health. And when you start asking the question, “How do you deliver more health, not just more healthcare services?” the answers are very different. As the proliferation of shared risk, accountable care and capitated payment arrangements has made clear, this will be an important area of focus for hospital executives in the coming decade.
In New York, Montefiore Medical Center can tell you — almost to the penny — how much an investment it takes to set up a school-based health center. They model how many pediatric asthma admissions will be prevented, how many days of school attendance can be saved, and how many teenage pregnancies will be averted. Ultimately, this data translates into more money for the school district with better attendance, better educational outcomes for children and in a capitated environment, savings from reduced ambulatory sensitive admissions to Montefiore. Most importantly, an “upstream” investment keeps kids healthier in the first place, with ancillary benefit to the community.
In California, Dr. Preston Maring at Kaiser Permanente noticed that there were vast differences among patients being readmitted for congestive heart failure, with low readmission rates in Richmond, and high rates in Oakland. He observed that many patients he sent home to Richmond were going home with families, while those living in Oakland were going home alone. Digging deeper, patients home alone were eating frozen meals, and these high sodium, low nutritional meals were leading to readmission. Based on these geospatial analysis results, Kaiser Permanente was able to contract with a private vendor to deliver high-quality, fresh meals at low cost to these members. Problem solved!
While I’m not suggesting that every hospital needs to start school based clinics or engage in geospatial analysis, understanding your patients’ needs — sometimes better than they know themselves — will allow the “mass customization” that differentiates the highest performers in an era of retail healthcare. Whether you call it managing population health, addressing the social determinants, or the worst name — the “social non-medical needs” of patients, these skills and strategies are essential today.