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Transforming Health Care Strategy

Today, healthcare sector is undergoing a major makeover globally. The world is moving towards better quality of health care at affordable costs. Business oriented healthcare facilities and private profits in medical services are going to face a sure death in near future. The vast irregularity in healthcare service between private and public sectors, erratic pricings, poor quality and practically no measurement of success and failure of care provided, has now crossed the threshold.

Decision makers in healthcare sectors and government leaders have tried innumerable strategies ranging from increasing number of healthcare units to enforcing practice guidelines to providing incentives and insurance to the people. None of these seemed to have actually addressed the real problem.

The real problem lies with providing the right value of care at the right price. Maximizing the quality at lowest cost for the patients forms the crux of a successful healthcare strategy. The current situation demands a fundamentally new strategy that moves the healthcare sector from being supply-driven to patient-centered in terms of the needs and quality of care. Instead of increasing the number of outlets that provide care, the focus must now move on integrated disbursal of high-value care and quality service to the patients such that the outcomes improve dramatically.

The noble profession that it once was, it is time to re-visit the real meaning of this highest service to mankind – health care service and design strategies that revolve around this fulcrum.

It is time that the fragmented medical system in the country where general physician visits, secondary care, hospitalization and tests all demand patient’s time and compromise on the quality shifts to an integrated system where every health provider offers the full range of services.

While it may mean to some that with reducing costs and profits the income for healthcare providers may be marred. But in reality, medical systems that have made these changes are seen to have actually bettered their profits with this system. Value-based care is the future of healthcare system in any country throughout the world.

This transformation is not a single step but a systematic, step-wise change in the organization, provision, measurement and cost reimbursement of healthcare delivery. If healthcare providers can improve patient outcomes and provide efficient care, they can sustain. Organizations failing to improve in value of service provided are likely to fade out in coming years. The strategic agenda of value-based care has six key points as discussed below:

  1. Consolidate Integrated Practice Units (IPUs)

The first step in structuring the healthcare organization is forming it around patients’ needs. A siloed organization or segregation of specific services to particular organization has to be broken. Integrated Practice Units are dedicated teams that provide the full spectrum of clinical and nonclinical services for complete patient care. That means, IPUs must not only treat a disease but also related conditions that the patient is likely to suffer. For example, if a patient is being treated for diabetes, the IPU must also be equipped to treat related kidney and eye disorders and other diabetic conditions. They must provide counseling as well as educate patients and their families on disease prophylaxis in addition to health support.

The team must work together to maximize patient’s overall health outcome and provide care as efficiently as possible.

  1. Measure patient care outcome and success of treatment

Almost always, healthcare provision in a hospital ends with the stay at hospital. Most hospitals in the country have no measure of the outcome of their care or success rate of a particular treatment or surgery at their hospital. Majority healthcare providers fail to track patient condition. Even if they do, it is mostly restricted to just a few areas like mortality or safety.

A systematic measurement of the patient health outcome post-treatment is critical. “Quality measurement” is essential. It is important to measure the patient’s quality of life in addition to lifespan or mobility. For example, in diabetic patients, most healthcare providers check for just the LDL cholesterol or HbA1c levels. However, most patients really want to know how long their vision will last or if they would need dialysis in future or if they might face a heart attack etc. The true measure of quality must be patient centered and what matters to them in their everyday quality of life. Patients do care about mortality rates, but they also have concerns about functional outcomes like incontinence, fertility etc.

Another important measurement to be made is the cost of the service and its comparison with actual quality of outcomes achieved.

  1. Shift towards bundled payments

A shift to value-based care cannot be made without revising the payment structures in the healthcare organization. Cost of healthcare is a major concern to a patient. Charges of service vary a lot from the actual cost of service and payment methods too see a lot of disparities.

The “bundled payment” model allows the patient to make a single payment for all the services taken under a particular episode of care. A major shift from traditional payment system where the hospital, surgeon, anesthetist etc. needed to be paid separately for their services in the treatment; bundled payment system allows the patient to collectively pay a set price for the entire episode of care.

Bundled payment model encourages better fixations of cost of treatments and lowering overall cost of a treatment. It is successfully being practiced by major hospitals in the U.S. and has tremendously helped in cutting healthcare costs for patients while ensuring the providers are paid as per their role in the treatment.

  1. Integration of healthcare delivery organizations

Multi-site health organizations are growing in size and proportions over the past few years. However, these multisite organizations my not truly be improving the quality of care. Instead of increasing the organizations in numbers, these multisite organizations can actually improve their quality by concentrating services the team specializes in, in a particular site rather than duplicating services.

For example, if a particular organization at one site has a team with great experience in cardiac surgeries and other in cancer care, they must rather stick to providing particularly those services rather than trying to provide below-average quality of all kinds of care. Such facilities may also benefit with integrating with community centers that take care of basic care while they take care of more sophisticated treatments. Multisite organizations must choose to concentrate volume to fewer locations and excel in their quality of treatments rather. This strategy is seen to be game-changing and one of the finest examples is in London where six well-known hospitals have boosted their reputation and business by integrating their specializations and expertise and vastly improving the quality of their care.

Concentrate volume and improve value are the new keywords in healthcare transformation.

  1. Spreading out further

Healthcare delivery at even the best of hospitals and academic medical centers still remains restricted to the geographic location. It is important that highly skilled personnel and experts of particular medical conditions try to reach out further and extend their reach to the patients through IPUs. Such geographic expansion helps in not just increasing volume but also improving the quality vastly.

As is being re-iterated throughout the article, the focus has to shift on improving quality of care provided. Bigger parent organizations must have facilities to spread out their expertise further in patient treatments throughout the country and must collaborate with regional IPUs and other health centers to improve quality of deliverance.

  1. Creating a sound support technology platform

While all the above points are effective actions, what will actually drive them to successful establishment is a powerful supporting information technology platform. IT systems have enormous capability of supporting this strategic agenda of value-based care as discussed above. It is a tool that can beautifully make this entire integration of healthcare systems, patient history record-keeping, establishing and sharing medical costs and improving patient care possible. The right value-enhancing IT platform can prove to be a game-changer in revolutionizing the healthcare sector of the country. It can be developed further for better deliverance of healthcare services, hospitalizations, appointments, tests etc. and store massive amounts of data pertaining to patient records. It can also ease treatment delivery by making medical record accessible to all parties involved in providing care.

IT can boost the performance of this healthcare strategy and make it a reality.

Step-by-step application of the points mentioned above can give greater transparency to the system and increase patient satisfaction. This value-based agenda, if mastered, can reward the nation with excellence in healthcare services and better quality of life for its citizens.