During the first round of the 2016 National Basketball Association (NBA) Championship, Stephen Curry, star point guard for the Golden State Warriors, slipped on a wet patch of court and sprained his medial collateral ligament in his right knee. Two weeks and one day later, Curry was back on the court, and displayed an astonishing performance against the Portland Trailblazers, setting an NBA record for points scored in overtime.
Typical recovery time for such an injury can be six weeks or more — and Curry was out just 15 days. Although Curry has access to the highest-caliber medical experts, the newest medical technologies, all paid for by the deep pockets of a well-moneyed sports franchise, it's just too easy to attribute his, or any pro athletes' speedy recovery from a career-threatening injury to healthcare that is qualitatively "better." Even when you account for the above factors, the pivotal difference between value-based healthcare for professional athletes and for the general population lies in diverging care philosophies when it comes to treating the two groups.
Discrepancies in value-based healthcare philosophies
The basic philosophy of value-based healthcare comes down to two intertwining ideas: outcomes and alignment. In the sports world, everyone, from the players to the fans, is focused on outcomes; so if a surgery or a treatment of any kind is delivered to an athlete, the success of that intervention is judged by when that athlete can return to play, at what level and how quickly. Thus, outcomes are of utmost importance, and they are fairly easy to define because of a well-defined baseline of performance before and after the injury.
The second component is alignment — between the party paying for the care (who also pays the salary of the athlete), the medical professional as the deliverer of care, and the athlete. The deliverer of care knows he or she is being judged by the outcome of the treatment, and the athlete is concerned with returning to the sport as quickly, and at the highest caliber, as possible. All three parties have their incentives aligned in the successful delivery of that outcome.
If we look outside of the elite athlete's healthcare, to the typical patient, we see a different picture. Typically, patients don't have a firm grasp on what is wrong or what type of experience and outcome to expect. Of course, we all want to go back to the way we were before we recognized a particular symptom; unfortunately, that kind of outcome is not always possible, and it can be difficult to determine what success really looks like. Further, clinicians are often incentivized to see as many people as possible, and do as many procedures as reasonable. They aren't always incentivized to fully understand a patient's context and success metrics, or to precisely tailor treatment so the outcome that most closely aligns with those metrics is achieved. Adding to this complex web, oftentimes payors (e.g., insurance carriers and health plan sponsors) are left to rely on cost data, with no reliable way to directly gauge the efficiency or effectiveness of care. Also, the payor has a responsibility for restraining costs.
Tactics for proactive care and long-term wellness strategies
In order for care teams to be able to engage patients and develop proactive, long-term health planning and wellness strategies, they require two key elements: information and communication. To get the right information, clinicians must have the right data they need to analyze the information in a credible, deep, and actionable way, and they must deliver the information at the right time. This requires that care teams have a reliable way to aggregate all of the relevant data, use different analytic techniques for extracting the insights from the data, and be able deliver that data at the point of care and the point of decision-making.
The next piece of the equation is real communication -- the exchange of ideas, information and values. The clinician needs to have time and space to engage with the information gleaned from data and analytics and also to engage in dialogue with the patient. The physician-patient relationship is critical here, so that patients can not only understand the desired outcome but also understand what's involved in achieving this outcome. Expectations should be set appropriately and care delivered according to those expectations.
Tools for optimizing outcomes
Technological tools are some of the most critical components of a clinician's 21st century medicine bag, but in order for the technology to be truly useful, a physician must have a firm understanding of data science: the ability to understand what insights are necessary to guide care, to engage patients, and to maximize health and well-being. Specifically, the most important tools a physician can use to optimize outcomes include:
- The data itself (e.g., clinical, claims and wellness data);
- Clinical analytics to help physicians understand the data;
- Interoperability, to help the data flow through the system so that a single, comprehensive view of a patient's health history is available; and
- Performance measurement tools to gauge how well care is being delivered and how fully patients are engaged in their health.
- Further, we need to ensure that we have appropriate mobile health solutions to help support patient engagement efforts, from apps to telemedicine, and other ways clinicians can contact and stay in touch with our patients.
Going the extra mile
In terms of comparing the healthcare received by professional athletes to the care received by the general population, the analogy is powerful for its illustrative quality, primarily as it provides us a way to talk to patients about how they should manage and think about their health and care. This means focusing on outcomes, rather than passively engaging the healthcare system; finding systems that align incentives to outcomes and patients' needs with the outcome he or she wants to achieve; and leveraging the right technological tools necessary to go the extra mile—to achieve a value-based system that allows for optimal health and long-term wellness.
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