ClickCare Café

Dramatic Videoconferencing Screw-Up Brings Up Telemedicine Questions

Posted by Lawrence Kerr on Wed, Mar 13, 2019 @ 06:00 AM

glenn-carstens-peters-210782-unsplashWe've all been blindsided by technology taking the place of a human, when and where it shouldn't. 

It's the labyrinthine customer service switchboard when we just want to ask a simple question of a real person. It's the app that sends us in circles when we really just want to pay a bill. 

But a recent technology screw-up touched a serious nerve for one family -- and even called into question whether and how telemedicine should be used. 

Mr. Ernest Quintana was in the hospital for the third time in 15 days, as the New York Times recently recounted. His lung cancer was beginning to get the best of him and he was struggling. His family remained hopeful, though, and they were all with him throughout the hospital stay. 

One afternoon, though, Mr. Quintana was surprised to find a machine with a video screen on it being wheeled into his room. With his granddaughter by his bedside, Mr. Quintana listened as a doctor in an undisclosed location, and whom he had never met, began to discuss his care. His surprise turned to sadness and dismay when the doctor shared that Mr. Quintana was likely not going to survive this hospital stay and prepared him for end-of-life care.

A prognosis of death is never easy news for a person or a family. But hearing the news from a doctor you have a relationship with, who brings compassion, presence, and leadership, can decrease the suffering and ease the way forward. In Mr. Quintana's case, the terrible news and challenging decisions were worsened by the impersonal and jarring way that they were broached. No one wants to have a conversation about death with a stranger on a video screen. 

So is this a condemnation of telemedicine? Of technology?

I don't think so. I believe that this sad turn of events simply points to positive and negative uses of telemedicine and positive and negative uses of technology. 

So many people default to videoconferencing as the go-to (or even default) form for telemedicine to take. We believe videoconferencing has severe limitations because it requires expensive hardware and circuitous scheduling coordination. Those are some of the reasons that we believe hybrid Store-and-Forward telemedicine is significantly more powerful of a tool.

But this story brings into focus an even more important and powerful reason that we believe telemedicine should be about team-based collaboration -- not videoconferencing between a doctor and a patient. When telemedicine is used for healthcare providers to collaborate among each other, the patient can interact primarily or exclusively with the providers that they have a relationship with -- and the "other opinions" on the team can be shared among the medical team. That way, the providers can be leaders, healers, and human beings FIRST -- but use telemedicine to consult with other people on the team as necessary, and without disruption to the care for that patient.

For instance, in Mr. Quintana's case, perhaps an outside opinion was necessary regarding his end-of-life care. But rather than that opinion being piped in through a video screen, we believe it would have been far better for his provider, obviously, to consult with the outside doctor -- and then have a conversation with Mr. Quintana in person, within the context of their existing relationship. 

Don't risk this kind of technology screw-up. Prioritize human relationships and let technology -- and telemedicine -- serve them. 

 

ClickCare Quick Guide to Hybrid Store-and-Forward

 

 

Tags: medical collaboration, hybrid store and forward medical collaboration, healthcare collaboration

Healthcare Travel and Wait Times Are Bad - But is That Our Problem?

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

andrik-langfield-266832-unsplashMy daughter recently signed her new baby up as a patient at a pediatric practice and had to choose one of the doctors in the group. “Dr. Salno,” they said, “is great. But you have to wait at least an hour to see him, every time.” She ended up choosing another doctor in the practice.

Her experience isn’t uncommon — so many of the very best healthcare providers we know have long wait times in their offices or are frequently running behind. Is that a problem for healthcare, or is it simply part of the reality?

 

In our experiences as medical providers, there is sometimes a sense that long wait times, doctors who are hours behind, and extensive travel to get medical care are all just facts of life in medicine. And that makes sense — there is a shortage of providers, especially physicians, and every healthcare provider I know has far more work to do each day than time to do it in. For some of us, long wait times and long travel times are practically badges of honor, showing just how in demand our practice is. 

In fact, those travel and wait times are long, and aren't decreasing. A recent study by Altarum shows that “Despite significant investments in the United States [from 2006 to 2017] in improving access to health care through better insurance, the use of innovative delivery systems, and advances in digitizing health care records and automating administrative processes, travel and wait times show no discernable improvements.”  These dynamics haven't been improving in decades.

The place that I see travel times really come into play are for patients with complex, chronic, or even acute but serious conditions. According to the Altarum study, patients who reported their health as “poor”, spent an average 26.4 hours per month on healthcare. That time may be transiting from provider to provider, from appointment to appointment, in addition to actually accessing care. 

But is this time that patients spend a bad thing? Is it something that should be decreased? And further, are travel and wait times something that healthcare providers should concern themselves with, or is it someone else’s problem?

Long travel times may not seem like the healthcare provider's problem until we consider the health cost of that time. Of course, there is the element of lost productivity and wages. But even just focusing on health itself, I believe that spending so much time accessing healthcare, as well as transit and waiting, has a severe and negative impact on our patients' health. Time spent at home with loved ones, hours invested in hobbies, focus at work, and rest in our own beds are all crucial elements of healing from disease. Every hour that a patient spends in a waiting room or driving to yet another appointment detracts from this healing time. 

So what can healthcare providers do? Most importantly, we can try to understand our patients' lives, travel times, wait times, and recovery and see it as "our problem." We can use medical collaboration tools to loop in other providers' input without the patient needing to trek across the state to gain that input when a picture and a discussion is actually all that is required (and this is reimbursable). When tools like iClickCare exist, that use telemedicine to dramatically decrease transit and wait times, there is the opportunity for health to truly improve, because the patients are able to spend more time healing and less time transporting or waiting 

 

ClickCare Quick Guide to Hybrid Store-and-Forward

 

Tags: hybrid store and forward medical collaboration, healthcare collaboration, medical collaboration tool

Why $5 of Supplies Can Prevent Thousands of Deaths

Posted by Lawrence Kerr on Thu, Feb 28, 2019 @ 06:00 AM

phuong-tran-1248347-unsplashIf there is one thing we all agree on, it’s that healthcare is complex.

The health of any individual is, of course, complex — with thousands of variables in the matrix of health, illness, and healing. Further, healthcare itself is complex, with so many challenges and opportunities that it’s easy to lose hope that things can change or improve.

So it’s deeply heartening when we stumble across a healthcare initiative that is outrageously simple, but with profound results.

Recently, I stumbled across two healthcare interventions that are deeply effective but very, very simple.

First, a group of California hospitals implemented a simple post-hospital educational initiative to reduce MRSA infections. 2000 patients were given either education on preventing infections via hygiene or that education plus antiseptic for bathing, antiseptic mouthwash, and antibiotic nasal ointment. The results? MRSA infections came down by 30%, with the education-plus-supplies group showing the most improvement. No new technologies were pioneered; nothing expensive was implemented. Just a simple “care package” to send home with patients from the hospital.

Second, a Virginia VA hospital had its nurses spend extra minutes with patients plus spend $5 on a toothbrush and toothpaste to encourage patients to brush their teeth. The results? Non-ventilator cases of hospital-acquired pneumonia have decreased by 90%. So far, they estimate that they’ve saved 21 lives and reduced costs by $4.69 million. Pretty phenomenal results for something as simple as a toothbrush and a helping hand.

So is there anything that we can conclude from these two studies, other than celebrate the ingenuity of their pioneers? I think there is. 

2 Key Learnings From These Pioneering (But Simple!) Studies: 

  • Simple and inexpensive can be best. 
    One thing that we love about iClickCare is that it's a simple, inexpensive way to do telemedicine -- no expensive new hardware or computers or huge software implementations required. Sadly, some in healthcare believe that complexity is always better -- so they'd almost prefer a more expensive, more difficult product. But these studies are yet another proof point of how misguided that approach is. 
  • Real life trumps theory. 
    In both of these studies, the initiatives were thoughtful about the reality that patients would face as people receiving care (one in the hospital, and one after the hospital stay.) It's easy for us in healthcare to focus on the glamorous treatment -- like a sophisticated surgery -- and forget that something as simple as nasal ointment or tooth-brushing can save lives. Similarly, we believe it's crucial to collaborate across the continuum of care -- not just between specialists -- since often, aides or nurses or others on the team will have a more "real life" perspective that can help.

The bottom line? Don't be afraid to do what is right for your patients, even if it doesn't sound fancy. It's possible that the deeply un-fancy is what's going to save healthcare -- and save lives. 

 

For more stories of smart collaboration, download our Quick Guide:

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Tags: telehealth, healthcare collaboration

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

Do Changes in Healthcare Payment Change Attitudes About Collaboration?

Posted by Lawrence Kerr on Thu, Jan 17, 2019 @ 06:00 AM

rawpixel-570908-unsplash (1)The New England Journal of Medicine's Catalyst blog has been doing a really strong job recently -- and their post on value-based care captures the challenging, difficult, and opportunity-filled place we're at in medicine, right now. 

If, as a healthcare provider, you've ever felt like the definition of "value," and how your organization pursues it, is a moving target... or if you've wondered what direction the whole reimbursement system is moving in... then this piece may have some fascinating insights for you, especially as we start 2019.

There has been a remarkable change in how reimbursement happens, even in the last couple of years. Now, a full 25% of healthcare is based on value-based reimbursement, as reported in JAMA (with the other 75% remaining fee-for-service.)

As you're likely aware, this value-based reimbursement is done in two ways: 

  • 1. Capitated Payments. Accountable Care Organizations ACOs use capitated payments (“subscription” per covered life per month)
  • 2.  Bundled payments. One payment, based on the patient's condition, which is split up among whatever services or providers treated that condition.

The mechanics of value-based payment models aren't complicated. But the perceptions of these models, the differing levels of support, and our diverse abilities to meet the models' challenges, all vary dramatically. So JAMA's New Marketplaces Insight Report, exploring the understanding and thoughts of different players in the healthcare system around these shifts, is fascinating.

First and foremost, the report suggests deep ambivalence: "Nearly half (46%) of respondents — who are clinical leaders, clinicians, and executives at U.S.-based organizations that deliver health care — say value-based contracts significantly improve the quality of care, and another 42% say value-based contracts significantly lower the cost of care."  In other words, half of us believe value-based contracts are great for quality and half of us believe that they're very bad for quality. Perhaps not surprisingly, healthcare providers tend to be more skeptical about the model than executives and administrators.

Also, many, across organizations and despite their roles, don't know their organization's stance on value-based care. The authors indicate that respondent answers may show a lack of consensus on what value-based care really means. "While there is broad agreement that value in health care is represented by the balance between the patient-centered outcomes of care achieved with the costs to reach those outcomes, many individuals do not completely understand that concept." For instance, one clinician asserts that "value" isn't really a term that is useful or has a broadly understood meaning: "Right now, [value is] a convenient term that means whatever the speaker wants it to mean.”

Payers and providers are not aligned. And the high rate of salaried employment by healthcare systems adds to the confusion. Many clinicians tend to have the starting point that, "I am morally obligated to my patient, but there is no real contract between the patient and myself." 

Regardless of current perceptions, there also remain practical barriers to full adoption of value-based care models. The primary barriers to the proliferation of value-based models are primarily related to infrastructure, including Information Technology. But regulatory issues, data integration, patient engagement, and others all play a role.

Of course, many of these barriers can be addressed by new tools, like iClickCare. But adoption is an interesting challenge when so many providers are ambivalent about whether value-based care is the right direction... or even how their organization is currently reimbursed.

To me, these shifts emphasize the crucial importance of healthcare collaboration. Wherever you or your organization falls regarding reimbursement, healthcare collaboration has become increasingly critical for doing the care coordination and achieving the outcomes that reimbursement shifts demand. I thought that an executive at a large nonprofit hospital in the South articulated the challenge -- and the opportunity -- of healthcare collaboration well: 

"Physicians had been taught for decades that they were the final arbiter of everything that happens to their patient. When, and until, we change the culture to one of team-based care where the patient belongs to the team, we will continue to struggle with adopting value-based care. As an example, a physician with a length of stay that is 10 days longer than his peer average once told me that the hospital has a length of stay problem because the hospital gets paid a single fee for the entirety of care.”

Clinicians are decreasingly able to bury their heads in the sand when it comes to the big picture of reimbursement. But rising to the challenge of what's to come in healthcare doesn't have to be complicated. Simply working effectively with your colleagues to provide the best, most coordinated, most efficient care possible will ultimately be the best approach -- now, and in the future. 

 

To learn more about how telemedicine can support value-based payment models, download our free Quick Guide: 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: healthcare collaboration, telemedicine reimbursement, value based care

What Helps Doctors Understand Patients' Stories?

Posted by Lawrence Kerr on Thu, Nov 08, 2018 @ 06:00 AM

vlad-bagacian-634061-unsplashStories are sewn into every part of medicine. 

The way we are trained to talk to patients is about drawing their story out of them. The way we share cases with colleagues is about describing the narrative of a patient. 

But modern medicine, especially in this age of EHRs and silos, tends to reduce patients to treatments and boils stories down to a series of interventions. And this weakness might feel more "efficient" at first but does tend to erode the quality of care our patients receive -- as well as the results they may experience from that care. 

That said, there are programs and tools that intend to reintegrate patient stories into our work. A recent article in the New York Times told of a program at Weill Cornell Medicine in New York. To combat ageist biases and practices, the program brings in older people to speak to medical students about their experience. Like all people, older patients have a diversity of experiences, strengths, and challenges. And for doctors to care for them well, they need to be able to understand this diversity, and create a care plan within that knowledge. 

As Dr. Adelman, the coordinator of the program, says, "Unfortunately, most education takes place within the hospital. If you’re only seeing the hospitalized elderly, you’re seeing the debilitated, the physically deteriorating, the demented. It’s easy to pick up ageist stereotypes.”  This program aims to complement this more hospital-based perspective with the other facets of patients' experiences. 

Unfortunately, this type of program is still rare. And rarer still are tools that support the full, holistic story of patients as the center of care -- especially once healthcare providers are outside of an academic setting and in the flow of practice. 

Electronic Medical Records, text messaging, and other intervention-focused tools only serve to create a further lack of "story" in patient care. But when you don't have the full story of a patient -- including their dreams, goals, daily habits, health goals and other "ancillary" aspects -- you don't necessarily have the full picture of how best to treat them. 

Certainly, many aspects of medicine pull us, as providers, away from stories and towards interventions. But when we use a telemedicine-based medical collaboration tool -- like iClickCare -- to have fulsome conversations with other providers about patients and share the holistic picture of whom the patient is, we provide better care and experience more satisfaction. So whatever our medical education provided or did not provide in this way, we always have the choice to use tools to practice medicine in the way that best fits our values. And for me, that has meant a tool that helps me do medical collaboration and see patients as full people. 

 

Tags: medical collaboration software, healthcare collaboration

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

Believe It or Not, There is a Human Behind Every Part of the Healthcare System

Posted by Lawrence Kerr on Fri, Oct 19, 2018 @ 06:00 AM

rawpixel-600792-unsplashMy daughter has a particular pet peeve. She’s noticed that in so many movies, when there is a doctor in the story line, he or she (usually he) tends to be arrogant, insensitive, and uncaring — in so many ways, inhuman.

As doctors ourselves, we tend to see our colleagues — whether doctors, nurses, or aides — as very much human because we know them and interact with them every day. But it’s easy to see insurance carriers or drug companies or other parts of the healthcare system as faceless monsters that make our patients’ lives difficult.

Which is why I was really interested to read a series of articles that turned all of that on its head, and definitely warmed my heart.

A couple of weeks ago, Gina Kolata wrote an article in the New York Times about the new class of drugs, PCSK9 inhibitors, that slash cholesterol levels for patients that aren’t seeing results on statins, or with diet or exercise, but have serious risk of early heart attack or stroke.

She told the story of the hyper-expensive drugs, the $14,000 price tag that the drug manufacturers have set, and the insurance carriers that create a byzantine maze for any patients trying to access the drug.

It’s a well-known story — evil drug companies and evil insurers make it impossible for patients to access the care they need. When I read it, I didn’t think much of it.

Then, about a week later, another story came out.  In this one, the New York times reporter tells a story that pretty much upends all of my assumptions about the players in the story.

The evening her story was published, the founders of Regeneron — the manufacturer of the PCSK9 inhibitors — emailed her.  Dr. George D. Yancopoulos and Dr. Leonard S. Schleifer wrote:

“If you can, please put Mackenzie and Rodney in touch with us, and we will try and help them get covered, or we can arrange to give them the drug for free… While we can’t give everyone free drugs, we can help Mackenzie and Rodney, especially as they had the courage to step forward and share their experiences.”

He then gave his personal phone number and asked the journalist to give it to the patients in the story, “explaining that he can be slow answering emails.” 

In her story detailing her conversations with Dr. Yancopoulos, Kolata told the story of Regeneron. It was founded by the two doctors in 1988. 20 years after that, Regeneron got its first drug approved. 5 years after that, they made a profit. 25 years of a business isn’t exactly a “get rich quick” scheme. The total cost to develop the drug was $1.6 billion and last year they made just $195 million (a tiny fraction of the total investment.) In reading the article, it's clear that Dr. Yancopoulos has battled for decades to create a drug that he truly believes will save lives -- and that his heart is very much invested in making sure people have access to it.

Certainly, it's great that these two patients got access to the drug -- although that doesn't change the challenges that most patients will encounter in obtaining it. That said, it's a fascinating article and shows that even the most "inhuman" elements of the healthcare system -- for instance, drug manufacturers -- may have real people behind them who are doing their best to chart a course forward in a challenging system. 

The truth is that none of us are as smart as all of us, working together, are. (We say that a lot.) And for us all to work together, we must continue to see everyone in the healthcare system as human. 

 

ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration, healthcare collaboration

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

5 Reasons Bundled Payment Programs May Not Be a Silver Bullet

Posted by Lawrence Kerr on Thu, Sep 27, 2018 @ 06:00 AM

jordan-rowland-716475-unsplashMost healthcare providers let “innovations around reimbursement” come and go.

The majority of us — whether we’re aides, nurses, specialists, or generalists — try to provide the best care possible, in as reasonable a way as possible. And we let the reimbursement and payment fall however it does, after the fact.

That said, there are certainly big shifts that affect how we care for patients — and certainly how we’re paid to do so. And “bundled payments” are one of those shifts that are big enough to pay attention to.

A New York Times article did a thoughtful review recently of Medicare’s bundled payments programs. Currently, these programs are effectively pilots, with hospitals able to opt into the program, rather than making them mandatory.

As I’m sure you’re aware, bundled payment programs create a single payment for every health care service associated with an event. (Rather than paying for the healthcare services individually.) The idea, of course, is that this approach would decrease costs: “In theory, if doctors and hospitals get one payment encompassing all this, they will better coordinate their efforts to limit waste and keep costs down.”

Of course, anyone who has ever gotten a “meal deal” because it was a better value — even though they weren’t originally planing on buying chips or a drink — understands why this may not be the best idea.

That said, some data shows that at least for hip and knee replacements, overall costs are slightly lower than with fee-for-service models. But different types of healthcare are different. And data on hip and knee replacements may not relate at all to other areas of healthcare — especially when the data is coming entirely from hospitals who have opted into the program (rather than taking part in it mandatorily.

But we have some broader concerns about programs like bundled payments.

5 Reasons Bundled Payment Programs May Not Be a Silver Bullet:

  • Most waste isn’t coming from doctors pursuing profit over smart care.
    One core concept in the formulation of this type of program is that providers are seeking profit first and safe, considerate care second. My honest take? This happens, but not very often. And so it's possible that one of the framing ideas is false.
  • Savings from bundled payments necessitate collaboration — and collaboration needs tools.
    Bundled payments benefit greatly from collaboration that can be empowered by healthcare collaboration tools like iClickCare. But simply changing how things are paid for may not provide the tools necessary to make that collaboration -- and thus the savings -- possible.
  • Savings from bundled payments necessitate care coordination — and care coordination demands support.
    This type of integrated payment depends on the interdependency of the providers. As with healthcare collaboration, however, providers are often attempting to coordinate care against all odds. And so it may make more sense to make care coordination more effortless than simply to change payment structures.
  • The “bundle” might not be the right combination of services.
    The bundling structure assumes that it is known what’s needed for a given healthcare event. The reality?  Healthcare “events” can be unpredictable and complex -- every patient is different.
  • Savings are good but rationing usually isn’t.
    The author of the Times article makes a point about steering patient access. While it certainly makes sense to guide patients towards the most appropriate treatments, I worry that this structure can raise the spectre of rationing -- which usually means that people with the least resources end up getting the worst care. Plus, in these programs, quality is generally not taken into account, at least not in very sophisticated ways — especially tracking quality across different groups.

 

All of the above isn’t to say that an overall shift to value-based care isn’t desirable (plus, it’s likely inevitable.) But we do think that it’s important to advocate for supports for shifts in care and reimbursement — not just change how doctors are paid.

 

Looking for ways to save costs in your hospital system? Hybrid Store-and-Forward may be the simplest way towards great ROI: 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: care coordination, healthcare collaboration, value based care

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