The Best Care | info.rmatics

I’m at a conference at Harvard Medical School today, with various industry and policy luminaries. Federal CTO Aneesh Chopra and HHS CTO Todd Park were just speaking. Reginza Herzlinger is giving a talk right now. Clayton Christensen was here this morning. Gotta love Harvard, and I’ve got a number of thoughts which I’ll wrap into a set of posts over the next few days.

But until then, I wanted to draw out a single point that has recurred a lot in various conversations I’ve had over the last few days. Christensen brought it up again in his keynote this morning. It’s this: the best care for complex disease is delivered by groups of physicians who are coordinated with each other. That coordination comes from being in the same room.

Dr. Christensen’s example (from his book) is an acquaintance spent years looking for appropriate treatment for his asthma. Over several years he saw many different specialists, and they didn’t solve the problem. Then he saw the same set of specialists (different people, same expertise), all in the same room, after flying to Denver. And they figured it out in 30 minutes.

I saw something similar this winter after visiting a microvascular disease clinic at Massachusetts General Hospital. It was a volunteer effort, run on a Saturday morning, with 6 or 7 experience specialists and a few residents and fellows. They saw patient after patient, all of whom had been bouncing through the system – and more or less without exception, they knocked each problem down as fast as it came up.

So here’s a question for healthcare reformers and healthcare technology innovators. How can we create that same quality of care for everyone who has a difficult to diagnose condition?

2 thoughts on “The Best Care”

Will,

You bring out a critical flaw in our existing health care system — the lack of care coordination.

We clearly need better collaboration among care providers, but I’m not yet ready to conclude that we need to take it so far as care providers literallly “being in the same room”.

While Christensen is directionally correct — that more collaboration is good and needed — I think he is guilty of faulty inductive reasoning in generalizing from his specific circumstances to a broad generalized conclusion that care providers need to be physically in the same room.

In many cases, the transaction costs of making this happen will be exhorbitantly high.

A lot more can and will be accomplished through virtual collaboration — the blending of social and technical networks promises platforms and tools to enable these discussions among providers.

In some areas of medicine, getting people from multiple specialties in the same room to discuss a patient’s case is commonplace. For example, the multidisciplinary team approach is often seen in inpatient psychiatric and long term care facilities particularly around discharge planning. Having participated in these meetings as a clinical social worker, they are very helpful in understanding all aspects of a patients needs from both the medical and biopsychosocial perspectives.

These meetings are much easier to convene in an inpatient setting. They are often difficult in outpatient settings, however, have the same level of benefit. This is especially true for challenging cases.

One of the main reasons that these meetings are difficult to put together is compensation and billing. Clinical providers have certain productivity expectations they need to meet and collateral contacts (i.e. coordinating with other providers) often do not count towards that. In addition, whether or not a provider can bill for the time varies by the insurance carrier.

In order to change the paradigm from an individual provider approach to a case team approach, the economic incentives need to be aligned. Organizations AND payors will need to recognize that time spent coordinating care is as essential as a face-to-face encounter with a patient. As such, care coordination and team meetings should be universally billable and count towards a provider’s performance metrics.

While I haven’t formulated my formal opinion on a single payor system, it seems that this issue is one more way in which it may be better than the system we have now.

Vince Kuraitis on September 30, 2009 at 4:28 pm said:

Will,

You bring out a critical flaw in our existing health care system — the lack of care coordination.

We clearly need better collaboration among care providers, but I’m not yet ready to conclude that we need to take it so far as care providers literallly “being in the same room”.

While Christensen is directionally correct — that more collaboration is good and needed — I think he is guilty of faulty inductive reasoning in generalizing from his specific circumstances to a broad generalized conclusion that care providers need to be physically in the same room.

In many cases, the transaction costs of making this happen will be exhorbitantly high.

A lot more can and will be accomplished through virtual collaboration — the blending of social and technical networks promises platforms and tools to enable these discussions among providers.
Joanna Brownstein on October 1, 2009 at 10:53 am said:

In some areas of medicine, getting people from multiple specialties in the same room to discuss a patient’s case is commonplace. For example, the multidisciplinary team approach is often seen in inpatient psychiatric and long term care facilities particularly around discharge planning. Having participated in these meetings as a clinical social worker, they are very helpful in understanding all aspects of a patients needs from both the medical and biopsychosocial perspectives.

These meetings are much easier to convene in an inpatient setting. They are often difficult in outpatient settings, however, have the same level of benefit. This is especially true for challenging cases.

One of the main reasons that these meetings are difficult to put together is compensation and billing. Clinical providers have certain productivity expectations they need to meet and collateral contacts (i.e. coordinating with other providers) often do not count towards that. In addition, whether or not a provider can bill for the time varies by the insurance carrier.

In order to change the paradigm from an individual provider approach to a case team approach, the economic incentives need to be aligned. Organizations AND payors will need to recognize that time spent coordinating care is as essential as a face-to-face encounter with a patient. As such, care coordination and team meetings should be universally billable and count towards a provider’s performance metrics.

While I haven’t formulated my formal opinion on a single payor system, it seems that this issue is one more way in which it may be better than the system we have now.