The healthcare sector faces a vexing dichotomy. Experts agree that patient-centric care is the key to improving outcomes and reducing costs. At the same time, many providers face challenges in delivering patient-centric care across the entirety of the traditional care continuum, especially in an environment of value-based healthcare. For providers to deliver the best possible care and to thrive in this environment, provider-facing challenges must be addressed.
Becker’s Hospital Review recently spoke with Harry Reddy, CEO of Allm USA, about innovative approaches to integrating patient-centricity throughout the care continuum. He discussed how new technologies and systems thinking are enhancing transparency and real-time visibility in healthcare, resulting in greater empowerment of all stakeholders across the patient journey.
Patient-centric care: The promise of value-based healthcare has been elusive
In the early 2000s, it became clear that traditional strategy frameworks simply don’t work in healthcare. Unlike market-based businesses, healthcare providers can’t demand any price for products or services, and they can’t refuse to serve customers who are unable to pay. The concept of value-based care emerged from this debate. To improve patient outcomes, strategy experts and healthcare policymakers suggested that all stakeholders needed to work more collaboratively throughout the care continuum.
“The Bush and Obama administrations invested billions of dollars in value-based care,” Mr. Reddy said. “Private payers and medical centers developed quality contracts, CMS embraced the idea of accountable care organizations, and equipment and device makers created better tools and precision diagnostics. Everyone expected quality to increase and costs to decrease. Instead, healthcare spending has grown, and life expectancy hasn’t improved. Under Trump administration, CMS has created new innovative models such as ET3 (emergency triage, treat and transfer). Despite these efforts, after 20 years of value-based healthcare, the net result is still a work in progress.”
Care is rarely delivered in a single setting and even today, few providers have visibility into the total continuum of care for their patients. The patient may experience a medical event at home, on the street or in the primary care setting. From there, the patient may be transferred to a hospital. Once the patient is discharged from the hospital, their journey doesn’t end. Many transition to a rehab center, skilled nursing facility or back home for in-home care. Even after a patient’s condition is stabilized, they may not be fully recovered. Recuperation, therapy and follow-up appointments often continue.
Although the patient’s total care experience doesn’t necessarily begin or end in the physician’s office or hospital, many providers default to this myopic view of the patient journey. “Providers focus on what they were trained to do, which is providing specialty services,” Mr. Reddy said. “They are acting in the best interest of the patient based on their specialty, but they don’t necessarily have a patient-centered perspective because they don’t have total visibility and are not accountable for the total continuum of care. Furthermore, they don’t know patient’s social needs, which oftentimes equally important in improving outcomes.”
New technologies are transforming the patient journey for all stakeholders
Patient-centricity can be defined as putting oneself in the shoes of the patient. This means looking beyond medical symptoms and gathering information about social determinants of health, such as patients’ home and family situations, economic conditions and other factors that may affect their well-being. For example, patients without close family members may be unable to make decisions in the hospital if they are unconscious. After discharge, some people also may struggle with medication adherence and follow-ups for their treatment plan.
Trusted digital companions that shadow the patient journey throughout the care continuum could help make decisions for individuals without family. They could also help family or loved ones provide support to patients remotely.
“When value-based healthcare first emerged 20 years ago, we didn’t have these types of tools,” Mr. Reddy said. “Thanks to a new generation of technologies, we can develop digital health smart apps and solutions. Digital companions that are easy to adopt are now possible.”
New technologies that support patient-centric care can also promote provider safety and well-being. For example, clinicians can now monitor patients in intensive care units remotely via live camera feeds. Over the past year, this has been valuable to minimize provider exposure to COVID-19.
Each care setting has its own needs, priorities and time sensitivities. As a result, it has been difficult historically to find one tool, app or solution that addresses the needs of different players across the patient care continuum, from the onset of a health condition to recovery.
“What happens at home is different from what happens in an ambulance, emergency room, or in the primary care physician’s office,” Mr. Reddy said. “Yet EMR systems force everyone to use one system. Providers are often unsure whether they are missing a critical piece of clinical or background information.”
Fortunately, today it’s possible to leverage modern technology fluidly across discrete settings. This enables healthcare organizations to focus on the needs of the patient and each care setting, while simultaneously optimizing for both efficiency and effectiveness. True patient-centric care
means handing off data seamlessly from one care setting to another via apps and solutions that work interoperably. Although different tools exist for different providers, they are all connected from a patient-centricity standpoint.
“Patient outcomes and quality are improved, and you also see systemic savings because costs are reduced,” Mr. Reddy said. “Everyone is a winner, but you can’t achieve this goal without paying attention to both patient-centricity and the needs of different care settings.”
On top of new technologies, it’s also beneficial to apply systems thinking to the challenge of patient-centric care. Traditionally, systems thinking has been applied to complex systems composed of interdependent elements, such as airplanes. Every element works in its own silo, but they also work collaboratively with one another. Feedback loops support the system overall.
“There’s no question that healthcare is complex, with payers, policymakers, providers and patients,” Mr. Reddy said. “In aviation, the outcome of systems thinking is a safe journey and reaching a destination on time. In the healthcare context, the goal of systems thinking is to get patients back home and to support their complete recovery.”
COVID-19 may accelerate the evolution to patient-centric care
The COVID-19 pandemic has opened the nation’s eyes to health equity issues, and it has also opened the door for healthcare innovation. “Prior to COVID-19, public health and patient care were seen as two different things,” Mr. Reddy said. “Now, the lines have blurred, and they’ve become one and the same, as it should have been all along.”
At the same time, healthcare stakeholders have recognized that greater flexibility is one way to address barriers to care. Payers, including government agencies like CMS, have loosened restrictions on the use of telehealth. In response, provider adoption of telehealth solutions has increased.
“COVID-19 has created a platform for healthcare transformation and the realization of value-based care,” Mr. Reddy said. “There is increased awareness on the part of policymakers and payers, better provider receptivity and greater involvement from patients and family members. New technologies and solutions will make patient-centric care a reality. In COVID-19 era, the systems thinking once again proved that sociology concept of individual empowerment and trusting technology with built-in feedback loops would perform much better in complex environment such as healthcare. Further, it allows new knowledge creation among all stakeholders, which is a paramount for continually innovating and improving the healthcare delivery. For example, when a paramedic receives a feedback from surgeon after dropping off a stroke patient, the paramedic not only comforts him/her but also learns on the fly and may create a new knowledge in the field for even more better patient care next time.“
Patient-centric care eliminates silos in favor of empowerment
Traditional healthcare silos are a poor foundation for a patientcentric care continuum. Instead, healthcare organizations must break down these silos by focusing simultaneously on patient-centricity and the needs of the different provider participants in the care continuum. Thanks to the fluidity of modern technology, it’s now possible to design solutions for each care setting with the proper data interoperability and seamless integration.
With this approach, every stakeholder is empowered, including patients, family members and different care providers ranging from physicians to specialists to nurses to paramedics. They have total information at their fingertips when needed, which leads to more effective decision making and more efficient communication in the patientcentered way.
“As we think about healthcare from a value-based care perspective, we want to improve patient outcomes from onset of symptoms to complete recovery, and even prevent problems before they arise,” Mr. Reddy said. “When coordination across the care continuum happens efficiently and thoughtfully, it empowers people and lets everyone play their role with total transparency.”