Hospitals have developed a high-touch model of clinical care to foster a connection between healthcare providers and ensure expert oversight every step of the way.
But with workforce shortages and increased demand for care straining providers, hospitals need to reimagine what the care process could look like. Intermountain is taking steps in that direction by focusing on the system-patient relationship instead of the physician-patient relationship.
"Labor is scarce and getting scarcer. The model we've known has been unsustainable for a long time, and is starting to fracture and break. It's doing that before our eyes," said Dan Liljenquiest, chief strategy officer of Salt Lake City-based Intermountain Healthcare, during an episode of the "Becker's Healthcare Podcast."
Mr. Liljenquist said workforce shortages are getting worse. After examining the health system's data, he anticipates a quarter of the system's physicians and a quarter of nurses will retire over the next six years. Even if the system hired every physician and nurse out of every graduate program within its footprint, Intermountain would still be thousands of physicians and nurses short.
"We've got to figure out how to sever the traditional mindset that I have one doctor I go to and it's the same person because there's not enough of those doctors and so many are leaving the workforce that we are working to create a system-patient relationship," said Mr. Liljenquist.
The "system-patient relationship" for transactional healthcare delivery allows patients to access care more conveniently while alleviating the burden on clinicians.
Mr. Liljenquist said health systems will need to rely on technology to drive labor efficiency. Nurses at Intermountain spend around 30% of their time interacting with patients, and the rest is on documentation and administrative tasks driven by the fee-for-service pay model. The health system reported a decline in productivity when it has been essential for productivity to increase.
"The opportunity with technology and generative AI models being a really good example to streamline the actual administrative aspects of healthcare is really promising to us. We actually hope that one day we can get to an effective clinical use model as well, where care plans can be delivered and developed, referring, grounding and explainable clinical logic that frees up our nurses' time to actually care for patients rather than sitting down and typing out care plans for patients," he said.
Artificial intelligence and automation can alleviate some of the burden for clinicians. Many of the services provided by physicians in the fee-for-service model could be done by other clinicians and professionals, including pharmacists or advanced practice providers. In some cases, artificial intelligence chatbots could provide patients with valuable information about the next step for their treatment plans.
"Really thoughtful algorithms could say 'you've got high blood pressure, but you're on this medication, it seems stable. Let's continue that course of treatment and have somebody review it at the end' instead of making patients come in for an office visit, pay $300 and wait forever to see a doctor," said Mr. Liljenquist. "Those are the opportunities for us to create new models, and reality is not negotiable; it is upon us. "
Intermountain's medical group in Salt Lake City tested this approach in women's health. Traditionally, the physicians had all visits in-person, even visits that took five minutes to provide services, such as oral contraceptives, to establish the relationship in the hopes women would return if they decided to have babies. But the wait time to see physicians had ballooned to three months or more. Intermountain developed an easy questionnaire for the quick transactional appointments and saw more than 7,000 slots open up from patients who just wanted to refill their prescriptions.
"I do think patients are going to reach a point where they are on medication and stable and think, why do I need to go see a doctor to get it renewed? And that's why we're trying to create more of a system-patient relationships to say we're comfortable reviewing that and not requiring a doctor to have an office visit to do that type of thing," said Mr. Liljenquist. "
Healthcare's transition to value-based care is an opportunity to make big changes in clinician and patient expectations of how care is delivered as well. Intermountain has been testing a prepaid model to collect from patients upfront before services are delivered.