Healthcare delivery costs and care quality care continue to be hurdles in the US healthcare system. There are various contributors to this problem: lack of standardization of systems and processes, process and system integration gaps between care providers, deficiencies in care management across patient care continuum, legacy payment models, are some. While the system suffers as a whole, it is the patient who bears the most impact with gaps in care management, quality of care, complexity of care navigation, quality of life, and unforeseen bills. The effect of Covid-19 also seems ominous: it is unknown how the entire human body will be affected in the years to come for those afflicted with the disease. So, how should care delivery best prepare itself to face this potentially significant uncertainty.
A well orchestrated integrated care delivery (ICD) model and application can vastly improve patient care. What is ICD? ICD is the coordination of care between providers, payors, policy makers, regulators, the community, and the patient across the patient care continuum, combining medical and non-medical attributes. For example, a patient may be treated for diabetes, but what else is known about the patients life style and living conditions, mental health, and other medical and non-medical factors? These other factors greatly impact the patient’s health. What is the coordination and delivery of care for such dependent medical and non-medical conditions? Another example is that of the obgyn treatment of a pregnant woman and her baby; but how could this treatment be extended if it became known that she suffers from depression? Additional cases of gaps in care management occur between hospital discharges, nursing care, acute care, homecare, long-term care, and between provider treatments. This lack of care coordination between providers and health and wellness services lead to rapid hospital re-admissions, unnecessary treatment, loss of health, and loss of economic well-being. ICD has a promise to alleviate many of these gaps.
What should be done towards developing and delivering an ICD healthcare model? The following are some thoughts:
- Incorporate social and behavioral needs in basic and specialized treatment and re-define and expand eligibility criteria. Payors and providers should aggressively integrate social and behavioral needs in their care models. This is a very complex undertaking, but necessary.
- Integrating processes and systems to extensively use medical, payor, and population health data for proactive and predictive monitoring of patient demographic groups. For example, claims data can be analyzed to develop and deliver precise location, disease state, demographics, and other attributes-based health and wellness community programs.
- Providing patient-centered innovative technology based care coordination and care management programs. These could be further enhanced by the use of population health services discussed above. The whole idea is to enable: (i) a smooth transition between care facilities and care management services with necessary medical and non-medical patient information sharing; and, (ii) provide appropriate care in the transitioned setting. Available remote monitoring medical device capabilities should be used whenever applicable. Needless to say, this requires a robust internet infrastructure.
- Drive new payment models for care coordination, quality, and efficiency. This includes a holistic approach to patient care and not for single treatment cases. For example, using a community healthcare service to check various ancillary disease triggers, such as, food and exercise counselling for diabetics. These payment models should also explore medical cost sharing, risk shared reimbursement, pricing transparency, between payors and providers.
At the basic level this entails four levels of integration: (i) organizational, to form a collective of coordinated and supporting provider networks; (ii) functional, to integrate front, middle, and back-office functions with the appropriate technology, such as EMR/EHR; (iii) service, where different complementary services are stitched together; and (iv) clinical, where care is delivered coherently across multiple care specialties. Needless to say, this is very complex, but must be done to improve patient health, be prepared for the next pandemic, and improve cost and care quality.