High-per­for­mance health­care is sim­ple to de­scribe, yet hard to de­liver. To­gether we can change that

Modern Healthcare - - COMMENT - By Jef­frey D. Sel­berg

For the most vul­ner­a­ble, chron­i­cally ill among us—many of whom cope with be­hav­ioral health chal­lenges and strug­gle to se­cure hous­ing, food or trans­porta­tion—the jour­ney to re­ceive the care they need can be daunt­ing.

All too of­ten, these high-need pa­tients—who make up about 5% of the pop­u­la­tion but ac­count for roughly half of all health­care spend­ing—are let down by the sys­tem. They en­counter a be­fud­dling lack of co­or­di­na­tion among providers, which can be both harm­ful to their health and un­nec­es­sar­ily costly. And their med­i­cal care is al­most al­ways com­pletely walled off from the com­mu­nity-based services that also im­pact their health and qual­ity of life.

Yet, the vari­a­tion that ex­ists in care de­liv­ery and out­comes within this pop­u­la­tion sug­gest that there are high-per­for­mance mod­els that ex­ist and, if widely used, pro­vide a great op­por­tu­nity for sys­temic im­prove­ment.

High-per­for­mance care is sim­ple to de­scribe, but hard to de­liver. It should be ac­ces­si­ble, holis­tic and co­or­di­nated care that bet­ter in­te­grates med­i­cal, be­hav­ioral and so­cial services to meet in­di­vid­ual pa­tients’ needs. It should re­ward bet­ter out­comes and lower costs, rather than the amount of care pro­vided.

While we’ve made some nec­es­sary progress in shift­ing to­ward in­cen­tives that re­ward out­comes and not vol­ume, it isn’t enough. We also need to un­der­stand which mod­els of care work re­li­ably for which high-need pa­tients and de­velop the know-how for ac­cel­er­at­ing their adop­tion na­tion­wide.

In­deed, many bright spots have emerged over the last decade. At the Peter­son Cen­ter for Health­care, we’ve been work­ing closely with ex­perts from the Har­vard T.H. Chan School of Pub­lic Health, the Na­tional Academy of Med- icine and the Bi­par­ti­san Pol­icy Cen­ter to bet­ter un­der­stand seg­ments within the high-need pop­u­la­tion, match ex­ist­ing care mod­els to these seg­ments and iden­tify pol­icy con­structs that can fa­cil­i­tate their spread. This work presents a mean­ing­ful op­por­tu­nity to spread care that de­liv­ers bet­ter clin­i­cal and func­tional out­comes, an im­proved pa­tient ex­pe­ri­ence and in­spires more “joy in work” for the peo­ple who pro­vide the care—all at lower cost.

For­tu­nately, many lead­ing or­ga­ni­za­tions, in­clud­ing ac­count­able care or­ga­ni­za­tions and Medi­care Ad­van­tage plans, are de­liv­er­ing more ap­pro­pri­ate, co­or­di­nated care. Medi­care Ad­van­tage plans, with their fo­cus on serv­ing Amer­i­cans over the age of 65, have a spe­cial op­por­tu­nity to help treat the in­creas­ing num­ber of se­nior cit­i­zens with com­plex health and so­cial needs. As we iden­tify promis­ing care mod­els, these or­ga­ni­za­tions will be well-po­si­tioned to test and spread these ef­forts. For in­stance, the Bos­ton-based Com­mon­wealth Care Al­liance has em­ployed new mo­bile care teams to visit and care for vul­ner­a­ble, low-in­come pa­tients in their homes or in their com­mu­ni­ties. Af­ter the first year, en­rolled plan mem­bers had 7.5% fewer hos­pi­tal ad­mis­sions and 6.4% fewer emer­gency depart­ment vis­its com­pared to the pre­vi­ous year.

The need to iden­tify, test and spread promis­ing ap­proaches like the ef­forts in Bos­ton is in­form­ing our new col­lab­o­ra­tion with four other ma­jor health foun­da­tions—the Com­mon­wealth Fund, John A. Hart­ford Foun­da­tion, Robert Wood John­son Foun­da­tion and SCAN Foun­da­tion. Over the years, our or­ga­ni­za­tions have be­come deeply in­vested in solv­ing this chal­lenge. To­gether, we be­lieve we can iden­tify what is and isn’t known about ef­fec­tively pre­vent­ing, de­lay­ing and treat­ing the in­ci­dence of chronic ill­ness. As we do, we are tar­get­ing in­no­va­tive ways to ad­dress gaps, re­duce du­pli­ca­tion and ac­cel­er­ate the adop­tion of what works.

We re­cently launched our ef­forts with the Play­book—cre­ated in part­ner­ship with the In­sti­tute for Health­care Im­prove­ment—which cu­rated case stud­ies and ev­i­dence on promis­ing de­liv­ery mod­els that could po­ten­tially be adopted by provider or­ga­ni­za­tions. Read more about it at bet­ter­care­play­book.org.

This is just the be­gin­ning. We all need to be open to shar­ing new ideas so that to­gether we can re­al­ize the vi­tal goal of im­prov­ing how high-need pa­tients are cared for in this coun­try.

Jef­frey D. Sel­berg is ex­ec­u­tive di­rec­tor of the Peter­son Cen­ter on Health­care.

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