Reimagine, then reinvent health care delivery

March 1, 2021 / By Carole Cusack

Dealing with a pandemic this past year turned everything we thought we knew about life upside down, including health care. An already challenged industry was exposed for what it has become—a disjointed, overutilized and fragile system of treatment. The COVID-19 pandemic further exposed what researchers have been highlighting for nearly a decade, that is, there are access and outcome disparities between populations based upon racial, ethnic, and socioeconomic factors. Now is the time to examine the breaks in the system, reimagine and reinvent health care in this country, with the goal of creating a model of patient-centered, directed, high-value care delivery.

The United States does not currently have a national repository for public health information across all populations. This omission created a lag in identifying COVID-19 vulnerable populations and redirecting resources. There has been progress in the effort to build platforms for sharing data in localized geographies, but until data has been enriched and put to work, these platforms will still be only data warehouses. 

Sharing patient data across the continuum of care facilitates identification of co-morbidities and social barriers and, in a new model of care delivery, the combination of these factors—clinical and social—can be used to individualize treatment at the patient level. Analysis of client data has highlighted the correlation between social risk and greater levels of health risk (as measured by the presence and intensity of co-morbidities). We have also seen higher use of low-value services (such as emergency department usage and readmissions) in these populations because of barriers to a patient’s ability to participate in his/her own treatment. Stratification of populations using the combination of clinical and social factors would facilitate future responses to public health emergencies. More importantly, these types of data provide value every day in the hands of frontline health care workers who seek to develop personalized approaches to patient management.

Our data show that patients who have a strong relationship with their primary care team cost less compared to similar patients without the same level of directed care. The difference can be as much as 45 percent lower cost. The new health care delivery model needs to incent the use of the primary care team as directors of a patient’s health and applicable social needs. 

Many years ago, we surveyed our clients’ medical directors regarding the degree of influence primary care had on expenditures. We concluded that primary care had influenced 60-70 percent of health care spend. If the new model expects the primary care team to direct patients toward high value outcomes, then it should also include a greater investment toward that effort. A 2019 study by the Primary Care Collaborative reported that only 5-7 percent of the health care dollar was spent on primary care compared to an average 14 percent in other industrialized nations. We need to reconsider the investment in primary care given the predicted future shortage. 

The new health care model may need to broaden its definition on who can direct care beyond the traditional brick and mortar health care setting. The pandemic forced a wary industry into adopting telehealth. We know that large national organizations are moving toward telehealth for primary care.  Is this the solution to the growing shortage of health care providers? We are closely monitoring the data on this topic, primarily to answer the question on whether this model can or will produce the degree of patient direction that we need to realize the high value outcomes that we desire. A JAMA article, published in October 2020, found that telehealth visits were less likely to contain preventive screenings.  These are the data points that we are watching closely in our own datasets. We are also monitoring data on the use of specialists as patient directors. While we know that not all specialties fit the criteria, we are watching the critical few that might because of the nature and frequency of patient interactions. The goal of the new model is to get as many patients aligned with care directors as possible.

I’ve mentioned “value” a few times in this blog. What does value mean in health care? There isn’t a consistent definition. A new model for care delivery should have a standard for measurement and achievement of high value care. There are standards for measuring the processes of care delivery, but the industry has sent mixed messages on whether these metrics, while important in developing treatment protocols, produce value in patient outcomes. 

The new model also needs to build standards that remove low value services from care delivery. Examples of such services are emergency department visits for care that could have been delivered effectively and safely in a physician’s office or avoided with better access and more directed treatment plans, avoidable inpatient admissions and readmissions, and excessive use of high cost ancillary services. These services can be easily monitored and organized into feedback highlighting variation and outliers. This type of information will help us build a common language around value in health care delivery, help our medical professionals understand their patients in greater detail and offer a pathway to improving outcomes in both cost and quality.

In 2021, 3M Health Information Systems is sponsoring a webinar series that will address the challenges I’ve outlined in this blog and help you reimagine and reinvent your role in health care delivery. View the March webinar here. The following is a brief description of the series:

  • Q1: Insights for Success:Sign up for webinar series Use social determinants of health and risk adjustment to uncover vulnerable populations, unmet needs and deploy care management tactics.
  • Q2: Measures that Matter: Move beyond traditional process measures to help primary care providers understand their patient relationships and build stronger ties.
  • Q3: A Patient First Approach: Analyze the “whole person” to identify patterns of care access and new approaches to measuring outcomes.
  • Q4: One Community: Create a single source of truth for data sharing and care management within the medical community.

We hope you will join us on this journey!

Carole Cusack is the Director of Client Engagement & Strategy with 3M Health Information Systems.