Putting the Patient First Means Fixing a Fragmented Healthcare Ecosystem
By Terry Edwards
The New York Times recently shed light on one of healthcare’s worst-kept secrets: Fragmented care is the norm to the detriment of patients. Too many patients experience disconnected transitions as they move across a variety of care settings. Many patients complain about how each of their providers seem to ask the same questions. This repetition is more than an annoyance; it’s further proof of just how little each clinician knows about the patient’s medical history, and makes it difficult to ensure patients are sticking to the appropriate treatment plan. This disconnect between care settings has a negative impact on providers as well. According to the Institute of Medicine, fragmented care and other inefficiencies cost the healthcare system at least $130 billion annually. Moreover, a survey from the Agency for Healthcare Research and Quality reported that poor communication during care transitions can lead to duplicate testing, medication errors, and lack of follow through on referrals – all of which drain staff and resources.
As our healthcare ecosystem moves toward value-based care and population health management, it is becoming even more critical for providers to get on the same page about a patient and collaborate more efficiently and effectively.
Healthcare professionals understand how important this is to get right. My organization, PerfectServe, recently commissioned Harris Poll to conduct an online survey of 955 medical professionals. Ninety-eight percent of those surveyed (both clinical and administrative) indicated that improved communication with patients is critical to improving population health. While there is consensus that communication and collaboration are keys to success, I have a few theories on why this is still missing from day-to-day practice:
· Misdirected incentives. Much of the healthcare industry remains wedged firmly in fee-for-service. Coordinating care makes little financial sense for physicians, who are paid per task, not for improving patient care. Without the appropriate financial incentives in place, coordinated care is the exception, not the rule.
· Overreliance on the EHR. The EHR was heralded as the answer to everyone’s healthcare problems – from claims to improving the accuracy of patient records, creating greater care team access to relevant information, and better coordination of care. Our survey showed that only about half of hospital-based physicians and primary care physicians in large practice organizations believe the EHR is sufficient for care coordination and collaboration. The EHR has an important role to play in healthcare delivery, but, like most “miracle cures,” it can’t fix everything and needs to be considered in its proper perspective.
· Too little time. Clinicians in all roles are feeling crunched for time to treat patients and handle all of the administrative tasks required of them. According to a 2012 study by the Physicians Foundation, more than 57 percent of physicians report working more than 50 hours per week, and eight out of 10 (81 percent) physicians describe their practices as either over-extended or at full capacity. This makes it harder for clinicians to find the time to reach out to their colleagues to coordinate patient care.
· Gap between clinical and administrative teams. One of the challenges identified in our survey is a wide disparity in understanding between administrative (hospital administrators and office managers) and clinical (physicians, nurses, and case managers) respondents. For example, while 94 percent of hospital administrators say they are familiar with their organization’s population health management strategies, only 61 percent of hospitalists responded the same way. And while administrators might not be needed to coordinate a patient’s care, they’re absolutely critical to making sure clinicians understand organizational priorities in terms of coordinated care and population health. They also need to understand clinician workflow so that they can invest in tools and technologies that enhance rather than impede workflow.
Healthcare organizations are making great strides in tackling many of these issues. Value-based care will encourage clinicians to collaborate more with other care team members to help reduce inefficiencies and ensure smooth care transitions. The move to larger, integrated health systems may help create stronger relationships by connecting providers under a similar umbrella, facilitating referrals within the system. And many healthcare providers are looking at different tools to make sure their clinicians have what they need to collaborate with other care team members easily and through the appropriate channel.
Managing the health of patient populations is no easy task, but providers are rightfully focused on forging a path to get there. To accomplish this successfully, organizations need to create a strategy to transition their fragmented system to one which fosters true collaboration.
Terry Edwards is CEO and founder of PerfectServe in Knoxville, TN.