ClickCare Café

Cutting Edge Prenatal Programs Demand Telemedicine & Care Coordination

Posted by Lawrence Kerr on Wed, Jun 05, 2019 @ 06:00 AM

carlo-navarro-219810-unsplashPrenatal care in the United States is a bit of a crucible for issues related to rising health costs, telemedicine, and medical collaboration. 

Maternity and prenatal care are at the nexus of high-pressure healthcare, patients with often-routine but occasionally hyper-sophisticated care, and the high cost of care. For instance, OB-Gyn providers consistently have the highest rates of malpractice law suits in all of medicine. 

As the leading edge of healthcare, prenatal care is an interesting lens through which to see common dynamics in the rest of medicine. So two new articles are relevant to all of us, even though they're focused on prenatal medicine. 

First, UnitedHealthcare is launching bundled payments for maternity care. It will roll out the program to 20 provider groups by the end of the year. Under this program, providers will be paid a lump sum for prenatal, delivery and postpartum care. 

While a small percentage of all maternity care in this country, I believe that the impact of this program will be outsized. As a huge cost center within healthcare, insurers have a keen interest in shaving prenatal costs in any way they can. And a bundled payments system is, potentially, a way to do that. In a hypothetical kind of way, this program makes a lot of sense for everyone involved. In practice, the onus of doing the care coordination and medical collaboration that is demanded by a bundled payments system is huge. It requires that providers manage the diversity of providers across the continuum of care, and across the length and breadth of prenatal scenarios -- from the most simple to the most complex. 

I do think that eventually, this kind of integrated payment system is what we need for healthcare. But in the short and medium term, I think it's unwise to just pay in  a bundle without giving providers the appropriate tools to make sure the requisite care coordination happens. It's a "sink or swim" model, without giving providers the tools they need to swim.

Related to this is a study done to see whether a prenatal app could complement in-person visits effectively. Prenatal care has a notoriously intensive visit schedule -- which can be burdensome on both the patient and on the providers. But, as Fierce Healthcare reports, “providers say visits are hard to cut back on due to decreased patient satisfaction, the need for weight and blood pressure monitoring as well as the importance of providing educational information around pregnancy health.” So a new study looked at whether an app providing weight and blood pressure monitoring, as well as timed education for expectant moms, could be as effective as in-person visits for lower risk patients. The results? Patients were able to use the app to decrease their number of prenatal visits by about 20% without a decrease in patient or provider satisfaction. That said, it was a very small study size of less than 100 patients and perhaps more investigation is needed.

 

 

On one hand, I was excited to see the study of the use of the prenatal app -- as it's an example of actually providing a tool, rather than just changing how payments happen. On the other hand, I wonder whether it's the best tool we can come up with. I'd like to see more communication and coordination, and a more holistic approach -- rather than simply remote monitoring and one-size-fits-all education. 

I applaud any effort to improve healthcare and to use technology to evolve how we communicate and care for our patients. That said, I also think that it's important that we continue finding ways to care for our patients better -- not just less or more cheaply. 

 

ClickCare Quick Guide to Hybrid Store-and-Forward

 

Tags: care coordination, medical collaboration tool

Why We Need “More Than Medicine” to Keep Patients Alive

Posted by Lawrence Kerr on Thu, May 23, 2019 @ 06:00 AM

 

blubel-103318-unsplashWhen we became doctors, we did so because we wanted to help patients live longer, healthier lives. Not because we wanted to "provide healthcare."

That said, as days get more hectic, as visits with patients get shorter, and as demands on us get more intense, it's not easy to keep our sights on that vision of health. 

But a recent study reminded me of the very real difference between healthcare and true health -- and I bet it's a reminder that most of you need, too. 

A recent article in Fierce Healthcare looks at a study by The Stanford University School of Medicine's Clinical Excellence Research Center in California, which explored what role healthcare plays in avoiding premature death.

This question about the role of healthcare almost feels like a contradiction in terms -- our knee-jerk reaction is to say, "Of course healthcare plays the primary role in preventing premature death!"  But the results of the study contradicts that intuitive response. In fact, although healthcare plays a role in longevity, behavioral and social factors have much more influence on the longevity of people in the United States

 

Healthcare is estimated to prevent 5-15% of premature deaths. Behavioral and social factors, on the other hand, account for between 16% and 65% of premature deaths in the United States. As Robert Kaplan, research director of the Clinical Excellence Research Center (CERC) said, “in order to bring the U.S. health back in line with other rich countries, we need more than medicine.”

So what is that "more than medicine" that our patients need?

Dr. Steven Woolf, MD, Virginia Commonwealth University explains, “Healthcare systems need to do their part, such as paying attention to the social needs of their patients in order to help lower emergency department visits and hospital admissions.”  In other words, we need to: 

  • Take a holistic view of our patients' health, including their social, environmental, financial, and behavioral realities. 
  • Coordinate care and do medical collaboration so that we can actually attend to the full picture of our patients' health, rather than just "providing care."

That might mean realizing that a patient can't take time off work -- so using iClickCare to collaborate with a colleague on the case, rather than sending the patient for a consult. It might mean coordinating with a patient's care team across the continuum of care, including all of the aides and nurses that will care for that patient when they are discharged. It might mean doing medical collaboration with our young patient's teachers, social worker, pediatrician, and family -- rather than performing a procedure in isolation. 

We've said it before and we'll say it again: medical collaboration is not an optional flourish -- it's the foundation of caring for our patients in a truly effective way. 

Get our Quick Guide to Medical Collaboration for free, here: 

ClickCare Quick Guide to Medical Collaboration

 

Tags: hybrid store and forward medical collaboration, care coordination, medical collaboration tool

The Unstoppable Trend in Medicine That’s Here to Stay

Posted by Lawrence Kerr on Thu, May 09, 2019 @ 06:00 AM

jeremy-bishop-335002-unsplashSome things in medicine come and go.

Many trends — demands on our time or our practice  start off as the trend du jour but eventually get abandoned for new trends on the horizon.

But there is one trend in medicine that appears to be here to stay— and it’s coming to your state and town, whether you are ready or not.

That trend that’s here to stay?  Value-based payment in medicine.

As Fierce Healthcare summarizes, in just 5 years, 700% more states have adopted value-based payment (VBP) systems. Currently, only 4 states have yet to launch a value-based model.

What does that mean for most healthcare providers?  It means that it's not enough to simply put our heads down and provide good care for the patient in front of us. In a value-based model, it becomes very much "our problem" whether care coordination happens, whether we need to do medical collaboration, and what "non-medical" things are affecting our patients.

For instance, in a value-based model, there are concrete consequences to referring a patient to a doctor 3 hours away and hoping the patient gets an appointment and that they actually go. The patient may not make it to the appointment, end up with a bad outcome, and ultimately  in addition to the subpar care  it becomes a financial hit for the doctor and her organization.  Far better?  Use a system like iClickCare to get a 2-minute consult from that provider, while the patient is in front of you. 

For a long time, healthcare providers felt that medical collaboration and care coordination were altruistic things they would do "when they had time."  In a VBP world, collaboration and coordination are the most practical, incentivized activities in healthcare. Coordinating a medical team means that followup care happens and readmissions drop. Medical collaboration means that you can efficiently pull in providers across the continuum of care to determine the best possible course of treatment  decreasing length of stay.

It's not always the case that the right thing to do and the selfish thing to do are the same. But in a VBP world, the right thing and the selfish thing are the same  use medical collaboration, telemedicine, and care coordination to care for our patients. 

 

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Tags: care coordination, value based care, medical collaboration tool

Do Hospitals Hide Data that Could Help with Care Coordination?

Posted by Lawrence Kerr on Thu, Apr 18, 2019 @ 06:00 AM

daan-stevens-282446-unsplashI’ve always said that it’s better to stay out of the hospital.

When confronted with risks of infection, error, or complications — it’s of course better to stay healthy and stay home.

But sometimes an elective surgery is wise or an emergency hospital stay is necessary. And in those cases, all of us want to be sure that our patients are safe.

But recent data and evidence has begged the question — are hospitals incentivized to hide infections when they occur?

I have to believe that almost all hospitals across the country prioritize patient well-being above any concerns about reputation or profitability.

But when antibiotic resistance combines with age-old concerns about infection and sickness in hospitals, things get serious. And even good intentions  for instance, to thoroughly investigate an outbreak without alarming people  can end up hiding data and information that could keep people safe. 

And the reality is that we all depend on hospitals sharing this information on their own behalf because there aren't agencies that will do so for them. In fact, as the New York Times reports, "under its agreement with states, the CDC is barred from publicly identifying hospitals that are battling to contain the spread of dangerous pathogens."  For instance in 2016, there was an outbreak of a drug-resistant pathogen in a Kentucky hospital  but it was not until 2018 that the CDC issued a report on the outbreak. And, of course, hospitals themselves have often "circled the wagons" when an outbreak occurs, looking into the infections themselves rather than sharing information more broadly. 

I completely understand wanting to limit public disclosure, especially in cases when public perception could be misinformed and reactive. Infection is complex and hospitals are often so big, they're like miniature cities, with outbreaks affecting a small minority of people.

But I do wonder whether the instinct to limit information about drug resistant infectious outbreaks within the medical community make sense. In fact, the tendency to limit information in this way is common in medicine, both at the level of the institution and at the level of the individual provider. We're under such immense pressure and scrutiny in the medical community  with such devastating consequences if mistakes are made  that many providers and organizations learn that it's better to keep information to yourself. The medical community often notices that "silos" keep excellent care, medical collaboration, and greater efficiency from happening  but the reality is that many of us have incentives to maintain those silos. So when an outbreak of an infection occurs, hospitals try to limit misinformation or panic  and in so doing, may limit information that could help other providers do care coordination or support them in solving the problem. 

I hope that hospitals are doing the best they possibly can to prevent outbreaks, as well as sharing information when the outbreaks occur. But I also know that all of us in medicine should learn to share information more freely, collaborate more effectively, and put our patients' care well above our own instinct to hide missteps or needs for support. And we hope that iClickCare can play a role in helping providers share information securely, safely, and without risking negative consequences. 

 

Try iClickCare for sharing information among the medical community members and within your medical team  safely and securely:  

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Tags: medical collaboration, care coordination

Why Opioid Overdoses Spotlight Care Coordination Failures

Posted by Lawrence Kerr on Thu, Feb 21, 2019 @ 06:00 AM

tom-parsons-426898-unsplashThe US opioid epidemic is reaching unprecedented levels. Almost 48,000 people died of an overdose in 2017 and millions of people are affected by opioid abuse. 

One challenge in the treatment of opioid abuse and overdose is that they lie at the intersection of multiple disciplines, providers, and dynamics. Mental health, public policy, law enforcement, social work, housing, emergency care, and medication all play a role. But too often, only the immediate problem is addressed -- and care coordination fails -- which means that patients end up experiencing chronic repetition of that problem. 

A recent study looks at why opioid overdoses reveal the significant cracks in the care coordination that exist -- and endanger all patients.

You could say that West Virginia is Ground Zero for the opioid epidemic. The state has an opioid overdose rate more than three times the national average and the highest death rate from drug overdoses in the country. So the challenges that patients and providers face there are instructive for providers in states with less severely affected populations but who face similar dynamics.

In an effort to understand the trajectory of care for these patients, Fierce HealthCare looked at a recent West Virginia study of Medicaid claims. Researchers followed the treatment of patients after the overdose code to see whether follow-up care was billed. For instance, checking to see whether mental health visits, opioid counseling visits or prescriptions for psychiatric and substance abuse medications were billed after the initial Emergency Room care. 

Following ER care for an overdose, less than 10% of patients received a substance abuse drug and fewer than 15% received mental health counseling. Of course, it’s possible that the rate of referrals was higher and that many patients didn’t access the counseling. But realistically, follow-up may be as crucial a part of the care as the initial care itself. As one patient who was treated for an overdoes in the ER said, “There were a lot of times I could have gone down a better path, and I fell through the cracks."

I noticed several key insights from this study that I think are meaningful for any provider, regardless of how relevant opioid abuse in particular feels to them. 

4 key learnings from opioid overdose and care coordination failures:

  • The more complex the disease, the greater the risks for coordination.
    But "complexity" doesn't just come from the details of the disease itself. In opioid abuse, multiple parties, including healthcare providers and social services all need to come together to care for the patient effectively. And these providers must collaborate across institutional lines, across the continuum of care, and across a long time horizon. This complexity is where we start to see care coordination fall apart -- but really it just reveals the weakness in care coordination that exists for all patients.
  • Some diseases are associated with less sympathy than others. 
    The reality is that with drug overdoses, there may be an aspect of moral condemnation in the ways that healthcare approaches the problem. As healthcare providers, we know that opioid abuse is really a complex disease. But it's very possible that bias sneaks in and the complex coordination of providers, services, and care falls short because providers may feel less sympathetic about the particular aspects of this disease. Some of our most vulnerable populations may have healthcare challenges that are frustrating or overwhelming to providers -- and it's important that providers are able to collaborate with social services and colleagues that can support these patients in ensuring appropriate care.
  • All good care goes beyond acute care. 
    It’s never enough to simply treat the acute illness that is right in front of us. But as providers, we need the tools and collaboration to care for patients more broadly than that. Most emergencies require more than simply treating the situation in front of us. A baby's stitches in the ER require follow-up with the pediatrician. An overdose necessitates counseling and substance abuse drugs.

Our EHRs and systems simply don't support this more broad understanding of what it means to provide care in complex situations. And that means our patients are receiving subpar care, due to the limitations of our tools and workflows. Each healthcare provider is doing his or her job to the best of his or her ability. But the demands of caring for our patients mean that sometimes just "doing our job" isn't good enough -- we must also look at the big picture of that care. And we must demand tools to help us act well and care appropriately within that big picture. 

 

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Tags: care coordination, healthcare collaboration

The 3 EMR Interoperability Blindspots Your Hospital Has

Posted by Lawrence Kerr on Thu, Feb 14, 2019 @ 06:00 AM

rawpixel-782046-unsplashRecently, seven major hospital systems put out a bold call.

It is crucial, they contend, to improve data sharing and interoperability among EMRs and EHRs. As Fierce Healthcare reports, "In a 2017 AHA survey, 57% of respondents had experienced challenges sending the proper information to a different vendor platform. And 37% ran into challenges just matching patient identities between systems."

Any healthcare provider who works with Electronic Medical Records won't dispute that data sharing is lacking with these tools. But despite the importance of this report, I see 3 crucial blindspots that it has -- and that your hospital may have, too.

I agree that interoperability among EMRs and EHRs is something that we should all demand. The simple access to data about your patient is as fundamental as having a clean and private exam room to see that patient in... or as having the ability to record your own notes about that patient. 

So I was glad to see this hospital report come out. That said, I believe there are three crucial shortcomings to this report. And identifying them isn't so much to undermine the findings or importance of the report itself -- but to identify blindspots that your hospital may have as it begins to pursue interoperability of EMRs and EHRs.

 

3 crucial shortcomings to focusing on EMR interoperability:

  • EMRs / EHRs will never be true healthcare collaboration tools.
    No matter how sophisticated interoperability among medical records becomes, the truth is that these systems will never be true healthcare collaboration tools. The records simply aren't made to easily facilitate multidirectional care coordination and medical collaboration among all members of a care team. And so it's a mistake to believe that by solving interoperability, we might have improved care coordination or collaboration. 
  • Providers need better tools now. 
    The reality is that even if EMRs and EHRs become more interoperable, healthcare providers need better communication and collaboration in the meantime. The reality is that today, EMRs and EHRs consistently get in the way of sharing data and patient information. Until the day that EMRs/EHRs are interoperable, healthcare providers must take the burden on themselves of making sure that other members of the care team have HIPPA-secure access to patient information. 
  • We need collaboration among people, not computers. 
    The AHA report emphasized that "there is an urgent need to coalesce around improved standards that overcome the significant gaps making communication difficult between systems." In other words: we need our computers to communicate better. But the harder truth is that allowing computer systems to share data is just Step One. What is really needed in medicine is the ability of providers to collaborate and coordinate care. The data-sharing is just the foundation -- it doesn't necessarily facilitate the profound collaboration that needs to occur for good care to happen. 

As always, these organization-level initiatives -- like those to improve interoperability -- are crucial. They are long-term projects that affect key foundational aspects of what we do as providers. But these projects are often uni-dimensional and may not affect our work in the holistic ways we need them to. So even as hospital-level and nation-level work occurs, we as providers must create and demand tools that are immediate and holistic enough to support excellent care for our patients. 

 

ClickCare Quick Guide to Medical Collaboration

 

 

Tags: care coordination, EHR, EMR, medical collaboration tool

Why Balls Get Dropped in Discharge to Skilled Nursing Facilities

Posted by Lawrence Kerr on Wed, Feb 06, 2019 @ 06:00 AM

 

hush-naidoo-1170845-unsplashThe United Hospital Fund is a nonprofit that is embarking on an important initiative. Their Difficult Decisions series explores the challenges that hospital staff personnel face in planning discharge.

The third in the series looks at the transition to post-acute care, usually to a Skilled Nursing Facility (SNF). And the study itself brought to light important insights for all providers, in understanding discharge planning, as well as patient transitions, more generally.

The most salient point in the study is, as Fierce Healthcare summarizes, that discharge planning presents profound obstacles for the hospital staff personnel who carry it out. Both administrators and staff very much have a goal of continuity of care. But the tools and structures that staff personnel encounter make the outcome of discharge planning fall short, many times. 

For any of us who work in hospitals every day, none of this comes as a surprise. That said, there were several nuances in the study that were enlightening in exploring when balls get dropped in discharge planning -- and how we might improve that process. 

Why Balls Get Dropped in Discharge to Skilled Nursing Facilities: 

  1. Discharge plans are made without real input from the people carrying them out. 
    One thing that I loved about this study is that it was carried out by talking directly to the people who are actually doing the work, in order to understand the real challenges and opportunities they face. For that reason, I think the insights carry more weight than a study solely based on administrators, or findings from a think tank or conference. Similarly, discharge plans are sometimes coordinated "at the top" rather than allowing them to be shaped and reshaped by the medical team, across the continuum of care.
  2. Discharge plans are often static. 
    The status of a particular patient changes quickly and often without warning, which means that the discharge plan must change and evolve, too. A static plan won’t work. And one that’s created once and then executed by members of the care team, in their offices or even across institutions won’t work. That’s why a tool like iClickCare -- which uses telemedicine to support medical collaboration for care coordination -- is so crucial. As the patient's situation changes, the entire care team can continue to influence the discharge plan, communicate about status changes, and get multiple perspectives.
  3. There is little communication across institutions. 
    Although, in theory, a nurse at a Skilled Nursing Facility, or a doctor at a hospital can always "pick up the phone,"  the pace of medicine and the realities of scheduling makes telephone tag nearly impossible to do successfully. For that reason, there is often little communicate across institutions -- for instance, from a hospital to a Skilled Nursing Facility, or vice versa. That means that information is often fractured and things can get missed, not to mention that crucial nuances of patient care fall by the wayside altogether. 
  4. Patients are given information, not guidance. 
    In theory, patients are given the information they need (for instance, a list of skilled nursing facilities). But realistically, they’re not being given the guidance or support necessary to make high-quality decisions about "next steps" in their care. True guidance and support means their whole care team working with the patient collaboratively -- throughout the duration of their illness.

In exploring the findings of this study, it was so clear to me that "trying harder" is not the answer when it comes to healthcare providers doing care coordination and discharge planning effectively. Teams need excellent tools and strong processes to support them in actually creating the continuity of care they intend to. And telemedicine-based medical collaboration is one of those crucial tools. 

 

You can try iClickCare today to support your organization in doing care coordination as effectively as it intends:

 

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Tags: care coordination, medical collaboration tool, skilled nursing facility, telehealth in skilled nursing facilities

A Surprisingly Simple Way to Improve Birth Outcomes

Posted by Lawrence Kerr on Tue, Jan 29, 2019 @ 06:00 AM

julie-johnson-692218-unsplashIn Sweden, 28% of women who give birth were born in another country.

These women may be Syrian refugees or arrivals from Africa, or France, or Spain. They speak countless languages and may not be familiar with the medical protocols and cultural norms of their new home. 

And this reality is not without its challenges. Sweden has good rates of maternal complications and mortality, but immigrants face outcomes six times worse than their native-born counterparts. 

That said, a simple new initiative has been changing that for immigrant women giving birth -- and the practice is rooted very much in medical collaboration and care coordination.

A recent article in the New York times explores Sweden's immigrant maternal health challenge -- in which foreign-born women face outcomes six times worse than Sweden-born women. Of course, these women may have significant linguistic and cultural barriers, keeping them from accessing the same standard of care.

Interestingly, the solution to this problem isn't intensive prenatal interventions or better technologies -- it's simply improving collaboration and communication.

This collaboration intervention comes in the form of "doula culture interpreters" -- trained women who assist a pregnant woman in her labor, supporting her in communicating with her midwife or doctor as well as helping her understand the norms and practices in the birthing process. These doulas translate from the immigrant’s home language and culture into their adopted language and culture. But they also translate the medical system, culture, and jargon. 

Sometimes the participation of the doula is as simple as literally translating from Swedish to, say, Arabic. Other times, the "translation" is from medical-speak to plain language. “Good communication is listed as one of the best ways to improve outcomes,” Dr. Esscher, a Swedish obstetrician, said in an interview. And, indeed, the doulas' support of good communication, has been having an effect on outcomes. 

I found this doula project inspiring in its simplicity. It's an intervention that doesn't involve displacing or dramatically changing any current practices or providers. It simply improves communication, collaboration, and coordination with the assistance of one of the doula interpreters. I also think that this kind of approach spotlights the importance of having collaboration tools that are flexible enough to involve multiple kinds of collaborators.

For instance, the old telemedicine paradigm of a one-to-one videoconference or text message thread between two doctors simply isn't enough to support this kind of approach. Rather, a truly team-based approach in which, perhaps, the doula interpreter, the obstetrician, and the midwife could all collaborate on postpartum or antenatal care, that is the approach that is truly necessary. Knowing this need generally, iClickCare has been structured to enable medical collaboration among multiple members of the care team, regardless of medical training, across the continuum of care. In an age when our care team includes a range of providers, offering a range of perspectives, this kind of tool is not only helpful, it's indispensable. 

To me, this program brings up questions that apply to all of us in medicine. First: We’re in a time where immigration and refugees are one of the challenges and opportunities that many countries face. How might we ensure that all people in our country experience the same quality of care and outcomes? And perhaps even more crucially: we're in a time when medical care is increasingly team-based, with a diversity of training levels and perspectives. How might we make sure that all members are engaged to provide the most coordinated, nuanced care possible?

 

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Tags: telemedicine solutions, care coordination, medical collaboration tool

Health Care Power-Users Point to Collaboration as Key to Care

Posted by Lawrence Kerr on Tue, Nov 06, 2018 @ 06:00 AM

rawpixel-577480-unsplash (1)

Frequently, “power users” of healthcare are seen negatively.

Whether because they are seen as more “demanding” patients or because of their relatively larger “burden” on the healthcare system, there is often a bias against these patients.

But a recent study — a collaboration among the New York Times, The Commonwealth Fund, and the Harvard TH Chan School of Public Health — looked in depth at these patients, both putting a spotlight on their behavior and experience, as well as sharing the wisdom they have about how to interact effectively with the healthcare system. Interestingly, much of what they shared advocated for a more collaborative, connective way of doing medicine.

In this study, “power users” of healthcare are defined as “people who have been hospitalized multiple times and are seeing multiple physicians, related to a serious illness, medical condition, injury, or disability.”

Of course, their perspective holds a lot of important insights for healthcare providers, for a few reasons. They: 

  • Have experienced more facets of the healthcare system. 
  • Necessarily developed skills and habits to deal with the shortcomings and strengths of the system. 
  • Are sicker and so may tax the system more, revealing faults that go less noticed otherwise. 

So this study of their experience, problems, and advice is enlightening. Among the findings: 

  • 30% say they were sent for duplicate tests by different healthcare providers.
  • 23% have had to wait too long for appointments, treatments, and tests.
  • Overall, they offer the following advice for navigating the medical system:
    • Show your doctor a list of medications you are taking (78%)
    • Bring a list of things to discuss with your doctor (70%)
    • Bring a family member, friend or someone else to all of your medical appointments to serve as a coordinator (55%)
    • Seek advice or help from a family member or friend who is a doctor, nurse or other health professional (34%)
    • Seek advice or help from a former patient who had a similar health condition (23%)

 

Our take on these results? People who use the medical system a lot experience the delays, confusion, and duplication caused by healthcare providers that aren't able to coordinate care or do healthcare collaboration. For that reason, the advice these patients offer tends to revolve around creating their own solutions to ensure care coordination on their behalf.  

Instead of patients trusting doctors and other providers to coordinate care, they do it themselves or involve friends or relatives to support them in doing it. This behavior certainly makes sense. And it's a wise way to approach a well-intentioned system that doesn't always work. But it does concern us, since patients have only a limited ability to truly coordinate care on their own behalf. For instance, a patient can bring a list of medications they are taking, but they can't bring a list of providers who should collaborate on a case. They can ask a friend to offer advice, but they can't necessarily facilitate meaningful conversations among all of the members of their care team. 

That's why we believe it's necessary for healthcare providers to have the tools they need to truly effect care coordination and healthcare collaboration. Sure, patients may fill in the gaps. But their ability to identify all of the possible gaps and truly fill them effectively is limited.

 

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Tags: care coordination, healthcare collaboration, medical collaboration tool

Why Overall Well-Being is as Important as Medical Intervention for Cost Savings

Posted by Lawrence Kerr on Tue, Oct 02, 2018 @ 06:00 AM

rawpixel-678092-unsplashHealthcare is such a potent combination of art, science, social work, and hard economics. And where these varying approaches touch each other, there can be friction.

So many healthcare providers view what they do as a combination of art, science, and social work — with hard economics never (or rarely) entering their mind.

But many times, healthcare economists come from a perspective that assumes something very different about how healthcare functions and how providers make decisions. Many times, healthcare economists use as a fundamental premise the idea that: providers are self-interested and will bill for as many services as they can; and it’s crucial to focus on hard outcomes of services, not on overall well-being of patients. Their perspective tends to be that hard economics reign and that these other approaches are dreamy intangibles.

A new study in JAMA challenges all of that.

JAMA published a study described as a “US national, population-based cross-sectional study [examining] the association between county well-being and Medicare fee-for-service (FFS) spending.”

In other words, researchers looked at whether Medicare spending was lower when people’s overall (non-medical) well-being was better. The results?  Medicare spent almost $1,000 less per patient for those in the 20% of well-being scores, compared to the bottom. And this is after adjusting for independent factors like income, urbanity, educational level, etc.

As the JAMA study explained, “Well-being is a positive state of being beyond the absence of disease, measured by not only physical health but also other dimensions, such as emotional, social, and economic health. Well-being may be modifiable by a broad range of interventions across different sectors.”  It’s all the stuff that we tend to see as “outside the scope” of a given medical intervention.

We think this is an incredibly important insight and study highlighting something not commonly spotlighted. Certainly, new models have gone up one level to reward fee-for-performance rather than fee-for-service. But the truth is that this measure of overall well-being is up several levels beyond that. And to capture the economic value of our patient's overall health and happiness is important. 

The whole goal of what we do as doctors is to support our patient’s well-being. But if you really needed another reason to pursue that measure, this is evidence that a broader view, a more holistic approach, is cost-effective too.

One of the challenges that we get into with iClickCare utilization is that it might be more efficient to just allow secure text-messaging, rather than having a fulsome, team-based, archivable healthcare collaboration system. The very reason we do what we do is because we believe that this kind of more holistic, team-based approach may not be the fastest way to get a simple, discrete answer — but it is the most efficient, effective, and cost-conscious way of approaching the whole patient. The "whole patient" includes all aspects of their medical condition as well as the other factors in their life that interrelate with that condition. 

The components of well-being in the study that decreased cost-per-patient so dramatically were largely non-medical. That means that any collaboration system that doesn’t allow non-medical caregivers and providers (social workers, teachers, caregivers, etc) to collaborate is misguided and ultimately wasteful in terms of ROI. 

We're glad that this kind of study is being done. And we continue to applaud the efforts of all of those healthcare providers who take the holistic view of their patient's well-being -- rather than simply addressing the malady in front of them. 

 

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Tags: medical collaboration, care coordination, healthcare collaboration

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