A vision of future health care

I have seen a vision of the future of health care and it looks like… well, I don’t know exactly what, because it hasn’t happened yet. But it’s intriguing for sure.

Local health providers were offered an opportunity last week to redesign the health care delivery system in ways that help lower costs, enhance quality and result in better outcomes for patients.

Concepts such as “accountable care community,” “episodes of care” and “patient-centered medical home” were a big part of the discussion. But I’m going to skip, for now, an exploration of what these mean and focus on a different issue.

The individuals at last week’s meeting – physicians, medical directors, clinic administrators, hospital executives, hospital board members – were given a glimpse of the view at 30,000 feet. What I want to know, and what I suspect many others want to know, is what the view looks like in a real, boots-on-the-ground kind of way. In other words, how it will affect the patient experience – because all too often, as policymakers start tinkering with the system, this is an element that’s overlooked or misunderstood.

There’s a lot to recommend the new care delivery models that are being talked about and implemented at various sites around the U.S. These models are moving away from the current fragmented, respond-to-the-patient’s-most-immediate-problem approach and moving toward more coordination, prevention and effective chronic disease management.

It would be hard to argue with these goals, yet in the real world something can be lost between theory and practice.

Take the patient-centered medical home. Part of this concept involves team care – physicians, nurse practitioners and other clinicians applying their unique skills on behalf of overall patient care. Sounds like a good idea, yes? But early results from medical practices that have implemented the medical home model found that at many of the pilot sites, patient satisfaction actually went down.

This doesn’t necessarily mean the model itself is fatally flawed or that patient satisfaction won’t improve once the transition phase is past. It suggests, however, that patients themselves aren’t sure they like the experience of belonging to a medical home. Some of it may be confusion or a lack of information on what the concept means. Some of it may be frustration with seeing clinicians other than the doctor at their appointments.

These early patient satisfaction findings could be shrugged off as unimportant or as evidence that patients are resistant to change or incapable of understanding the medical home model.

But they could also be looked at another way. If patients don’t understand why their clinic is turning into a “medical home,” what has been done to educate and prepare them for this change – and whose responsibility is this? If patients are uneasy at seeing multiple clinicians, perhaps it’s because they’re concerned – and rightly so – over the loss of continuity and the potential for lapses in communication, not to mention the disruption of one of the relationships that, for many patients, matters the most – the relationship with the doctor.

I’m not in a position to suggest to local health care providers what they ought to do. No doubt there’ll be many serious strategic discussions in the weeks and months ahead as they hash out their options.

On behalf of patients, though, I’m making a plea: At some point, preferably before final decisions are made, there should be community input – and not just from local movers and shakers but from a cross-section of patients with an honest, real-life perspective on what they want and what they value.

Among the important questions asked at the meeting last week was this: How do you motivate patients to do the right thing? Inevitably, patients are part of this and their buy-in will be critical.

However it shakes out, there’s an opportunity here to do something. Is it going to be done for patients or is it going to be done to them? Better yet, how about doing it with them? Now that would be transformational.

Image: “The Crystal Ball,” John William Waterhouse, 1902

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