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Fixing healthcare requires Netflix-like disruption

Brian Eastwood | Dec. 10, 2013
There's no shortage of ideas about how to fix what the Institute of Medicine deemed the quality chasm back in 2001. However initiatives taken so far aren't yet working.

It costs a lot of money, too. Recurrent hospitalizations for predictable complications relate to chronic health bring aggregated costs to the system, says Dr. Robert J. Master, CEO of the Boston-based Commonwealth Care Alliance. Put another way, $11,000 for a hospitalization represents the "cost of a missed opportunity."

Fixing this means transferring risk to a clinical body that's help accountable for patient care, Master continues. This, in turn, means redesigning the healthcare delivery system into one with interdisciplinary clinical teams who provide care in multiple locations; individualized care plans that promote home and community care; an attitude that views "primary care" as a concept, not a facility, and 24-7 availability in all settings, at all times.

Yes, it's hard - but since 2004, the Commonwealth Care Alliance's senior care program, with 100 interdisciplinary teams working across 33 facilities, has seen half as many "expected hospitalizations" as similar fee-for-service organizations, Master says. "If it works right, the perception is more services, but costs are mitigated."

'Locked Knowledge Base' Leave Costly Healthcare Routines in Place
In today's environment, though, Kaiser and Commonwealth Care are the exception and not the rule. By providing greater incentives for treating sickness than not preventing it, and by doing so for so long, healthcare has made it increasingly difficult to challenge the cultural, political and financial forces that stifle innovation, says Dr. Heidi L. Behforouz, director of the Prevention and Access to Care and Treatment (PACT) Project at Boston's Brigham and Women's Hospital. "We have a lot of innovations," she says. "The problem is finding the systems that accommodate them."

Partners HealthCare is another such system, having rolled out an iPad app that asks patients a variety of health, wellness and quality of life questions. Patients see the data as a gauge, like a speedometer, highlighting their values or scores and comparing them to the norm. On the back end, the data is normalized, helping Partners quantify, trend, aggregate and compare data sets, says Dr. Gary L. Gottlieb, president and CEO of Partners HealthCare.

But most of modern medicine is defined by the "locked knowledge base," with information of all kinds - training, educational, clinical and financial - kept in silos, says Lincoln C. Chen, president of the China Medical Board.

With no link between knowledge and the training cost associated with gaining it, restrictions on task shifting remain in place. That means receptionists can't recommend a preventive screening, health coaches can't call a patient at home and stitches cost more than $500 apiece.

Until this change happens, Chen says, patients will continue to say, "I need to see a doctor" - and the healthcare system will intuitively respond without acknowledging that each appointment only exacerbates the imbalances in the system.


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