Healthcare: Answer 3 Questions

Healthcare is a challenge from many perspectives. It is possible to help think about healthcare from three of them. The perspective of a patient or their surrogate (family members or primary care physician). From the perspective of the care delivery team. And, from the perspective of the purchaser or payer for the services.

Each perspective has its own major goal which can be summarized by answering a key question. For the patient, the question is to answer 'how do I find the care that I seek (no matter what care may be) that is safe, affordable, good and equitable?' For the care delivery team, 'how do I have the knowledge I need to understand the outcomes from the care provided so that we can be aware of our results and improve?' And, for the purchaser, 'how do I have what is needed to determine where to direct and obtain care for my member and apply rewards or incentives for optimal care?'

What is implied in these questions are answers that would transform care away from the siloed transactional delivery of care we have today. We would focus more on defining patient goals of care and seeking to achieve those goals. For most primary care, patients want to take preventive measures, screen for early diagnoses, and apply prompt intervention for acute, self-limited outcomes. They want better chronic management of their conditions with clear objectives or targets that are shared with their care team. They want specialty medicine to intervene when the time is right for more experts to add to their care team. They want their personal wishes and culture to be first and foremost in defining their care - not the wishes or dreams of their employer, insurer or governing oversight bodies.

For specialty medicine, it is time to think in terms of service lines, the episodes of care within those service lines which represent a patient's care journey, and the interrelationships of the care team. TEAM. The business model in fee for service is a very narrowed view of the team. It is a small, transactional unit of analysis that represents a single service, with its associated fee. If you take the patient's view, their care is a sum of multiple services - office visits, labs, imaging, path reviews, consultant opinions, procedures and their teams, etc. Their care journey and team as they see it is over days, weeks and months. It is multiple clinicians working in concert to achieve a goal. Our fragments, transactional system makes it challenging to see the full set of contributors to a care team. This fragmentation disperses efforts to create shared knowledge, shared therapeutics and share accountability. Without a proper linkage, leaks in the system lead to gaps, failures and potentially call for rescue efforts to avoid harms.

If we are to find the answer to the question around care teams and our ability to optimize knowledge to inform optimal care and drive improvement, we need to elevate teams to a new level - and that comes from aligning the business model that generates the accountability needed to drive transformation.

Finally, the purchasers want safe, affordable good and equitable care as much as anyone. To acheive this means they have to take the necessary steps to capitalize the transformation. We have to purchase care differently, in episodes. We have to generate knowledge about the episode that informs patients about where to find the care they seek. And generate knowledge that builds the care teams in such a way that they are informed about the outcomes of care and are rewarded for their efforts to deliver on those outcomes and improve.

If patients have transparency to find the care they seek; if care teams take shape and have knowledge of outcomes and affordability; if purchasers capitalize the transformation to an informed, transparent and reward-based, team-based care, we will see transformation in healthcare. It comes down to answering three questions - completely!