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No Patient Left Behind: Patient-Centered Healthcare Reform

2016; Mary Ann Liebert, Inc.; Volume: 1; Issue: 2 Linguagem: Inglês

10.1089/heat.2016.29016.hrc

2639-4340

Judd E. Hollander, Megan L. Ranney, Brendan G. Carr,

Healthcare Systems and Technology

Healthcare TransformationVol. 1, No. 2 Open AccessNo Patient Left Behind: Patient-Centered Healthcare ReformJudd E. Hollander, Megan L. Ranney, and Brendan G. CarrJudd E. HollanderProfessor, Vice Chair of Finance and Healthcare Enterprises, Department of Emergency Medicine; Associate Dean for Strategic Health Initiatives, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.Search for more papers by this author, Megan L. RanneyAssistant Professor, Department of Emergency Medicine; Director, Emergency Digital Health Innovation Program, Alpert Medical School, Brown University, Providence, Rhode Island.Search for more papers by this author, and Brendan G. CarrDirector, Emergency Care Coordination Center, Office of the Assistant Secretary for Preparedness & Response, U.S. Department of Health and Human Services; Associate Professor, Department of Emergency Medicine; Associate Dean for Healthcare Delivery Innovation, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.Search for more papers by this authorPublished Online:15 Jun 2016https://doi.org/10.1089/heat.2016.29016.hrcAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail The Secretary of Health and Human Services recently outlined a powerful vision for transformation of the healthcare system.1 The Center for Medicare & Medicaid Services (CMS) plans to move 50% of spending to alternative payment models (i.e., Accountable Care Organizations [ACO]) by 2018. While policy makers debate ways to reduce healthcare expenditures, and industry searches for ways to increase profit, we must remember that from the patient perspective, the most important aspect of healthcare is easy access to care at an affordable cost.2 Patients have demonstrated their priorities and preferences with their feet and their wallets. While primary care visits are falling, patients made more than 130 million emergency department and 160 million urgent care visits last year; retail pharmacies have entered the healthcare space; and telemedicine is expected to grow to a $30 billion industry by 2020.3–5Let's Move Past the "Appropriateness" DebateThis growth of "convenience care," in which undifferentiated or infrequent patients are opting out of the traditional primary care system, coincides with increasing attention to reducing "inappropriate" use. Payors have expanded their focus from the individual (e.g., targeting those with high-cost conditions or utilization patterns) to the care setting (e.g., discouraging the use of high-cost settings, such as the emergency department, for anyone with noncritical illness or injury). Developing novel tools to manage patients with complex and costly conditions, however, fails to increase healthcare's accessibility for the majority of Americans.Conceptual Model for the Path ForwardIn an ideal world, medical advice and healthcare would be available whenever and wherever patients are sick, injured, or scared. We present one conceptual model that provides patient-centered, easily accessible care throughout the whole continuum of health (see Figure 1). Although this model originated at a single hospital system, we feel that it has wide applications. Nationally, most efforts focus on the right side of the model—areas that are high cost for payors, but that are less common for patients. The left side has the potential to make a larger impact on day-to-day life and healthcare experience for the majority of Americans.Figure 1: Model of patient-centered care across the care continuum. Patients previously well or at their baseline begin to feel a little sick. Solutions to enhance the likelihood of patients receiving earlier interventions exist throughout the continuum. ED, emergency department.The Left Side of the WheelThe "little sick"In this conceptual model, individuals are usually at their baseline (bottom of Fig. 1). Patients who fall off their baseline and become "a little sick"—a sore throat, a new pain—can be treated either by (a) their own provider, through asynchronous communication, telephone consultation, or scheduled e-visit; or (b) an on-demand physician who is available 24/7 to provide virtual care. To avoid fragmenting care, these "available-ists" should coordinate care with a patient's other providers, and should have access to the patient's medical record regardless of where they typically receive their healthcare. In theory, patients who utilize the emergency department or urgent care because of the convenience may choose less costly options if these options were as convenient. Adding imaging and laboratory testing onto on-demand video visits (thereby creating a virtual emergency department[ED]) could further align patient and payor goals. Easy availability of evidence-based expert care when patients are afraid or uncertain is more likely to shift patient behavior than focusing solely on financial disincentives for health systems.Emergency department careDespite innovation in the approach to caring for those who are "a little sick," some patients will have acute exacerbations of their chronic condition or suffer an acute injury, and will require treatment in an emergency department. The majority of these patients, even under this new model, likely will not require admission. For these patients, particularly those with multiple chronic conditions or behavioral health problems, physicians need tools to help coordinate outpatient care and to improve transition plans. Patients who understand their discharge instructions and are connected to outpatient services are more likely to return to their baseline. Mobile tools to integrate healthcare can both encourage medication compliance and behavior change after a visit, and can link patients back to their usual source of care.Some acutely ill or injured patients will need highly specialized care (i.e., stroke care). When critical care capabilities are not available at the hospital closest to the patient, physician-to-physician telemedicine consultation through remote monitoring enables more patients to stay in their community. Regional care coordination exchanges, in which networks connect patients to needed resources across health systems, can assist patients who require admission as well as those who will go home.6The Right Side of the WheelHospital-based careIn the acute care setting, patients can benefit from improved engagement of their families and caregivers. The timing of physician rounds may not be conducive to having family members physically present. "Virtual rounds," which connect caregivers and family members with patients and their providers real time through a secure video platform, increases patient and family engagement while also increasing care coordination and communication.Transitions of careTo improve patients' transition home after an acute healthcare visit, communication options include videoconferencing, ideally with all providers, the patient, and their family at the time of discharge or shortly thereafter. Utilization of telemedicine solutions by transition of care coordinators prior to scheduled outpatient visits provides the opportunity to re-engage and enhances understanding and compliance with discharge recommendations.When not a patientLastly, we need to empower people to take care of their own health during the time that they aren't "patients."7 Mobile apps and on-demand virtual consults can enhance medication compliance, behavior change, and health and wellness.ConclusionUltimately, whether the ACA remains the law, regardless of CMS policies, regardless of whether ACOs are mandated, in order to improve the health of Americans, the focus cannot be on technology, payment, or the provider. It must be on the patient. We need to allow patients to get the care they want, when they want it, in the manner they want it. Technology cannot replace empathy, human interaction, or thoughtful care coordination, but the proposed model incorporates innovative solutions into a traditional framework, while acknowledging patients' and families' individual preferences and needs, so that we don't leave any patients behind.Author Disclosure StatementNo financial conflicts of interest exist.References1 Burwell SM. Setting value-based payment goals—HHS efforts to improve U.S. health care. New England Journal of Medicine. March 2015. 372 (10): 897–899. Crossref, Medline, Google Scholar2 The Advisory Board Company. What do consumers want from primary care? 10 insights from the Primary Care Consumer Choice Survey. Google Scholar3 Monegain B. Telemedicine market to soar past 30 billion. August 4, 2015. Available at www.healthcareitnews.com/news/telemedicine-poised-grow-big-time (last accessed November 24, 2015). Google Scholar4 Ritchie A. Why primary care physicians are seeing fewer patients. Available at http://medicaleconomics.modernmedicine.com/medical-economics/news/why-primary-care-physicians-are-seeing-fewer-patients?page=full (last accessed November 24, 2015). Google Scholar5 National Center for Health Statistics. Health, United States, 2014: With special feature on adults aged 55–64. Hyattsville, MD. 2015. Available at www.cdc.gov/nchs/data/hus/hus14.pdf#083 (last accessed November 24, 2015). Google Scholar6 Martinez R, Carr B. Creating integrate networks of emergency care: from vision to value. Health Affairs. December 2013. 32 (12): 2082–2090. Crossref, Google Scholar7 Asch DA, Muller RW, Volpp KG. Automated hovering in health care—watching over the other 5000 hours. New England Journal of Medicine. July 2012. 367 (1): 1–3. Crossref, Medline, Google ScholarFiguresReferencesRelatedDetailsCited byMore silver linings of the COVID pandemic: Uplifting effects continue15 March 2022 | Academic Emergency Medicine, Vol. 29, No. 7Role of nursing in telehealthNursing, Vol. 52, No. 6Telemedicine Research and Quality Assessment12 November 2020Recommendations from the First National Academic Consortium of Telehealth Judd E. Hollander, Theresa M. Davis, Charles Doarn, Jason C. Goldwater, Stephen Klasko, Curtis Lowery, Dimitrios Papanagnou, Peter Rasmussen, Frank D. Sites, Danica Stone, and Brendan G. Carr1 August 2018 | Population Health Management, Vol. 21, No. 4 Volume 1Issue 2Jun 2016 Information© Judd E. Hollander et al. 2016; Published by Mary Ann Liebert, Inc.To cite this article:Judd E. Hollander, Megan L. Ranney, and Brendan G. Carr.No Patient Left Behind: Patient-Centered Healthcare Reform.Healthcare Transformation.Jun 2016.114-119.http://doi.org/10.1089/heat.2016.29016.hrccreative commons licensePublished in Volume: 1 Issue 2: June 15, 2016Open accessThis Open Access article is distributed under the terms of the Creative Commons Attribution Noncommercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.PDF download