For the past 30 years, environmentalists have used the term “sustainability” to describe finding that perfect balance between developments that meet the needs of the present without compromising the ability of future generations to enjoy our planet. But sustainability is also a call to action, a task or “journey” that implies responsible and proactive decision making and innovation.
Sustainability has a role in healthcare as well. Though not a term commonly associated with the industry on either the macro or micro level, the fact remains that the ecologists’ notion of “sustainable development” is a concept that the healthcare industry would be wise to embrace.
On the macro level, “healthcare sustainability” is only achieved if the system works as it should and that means that the revenue that providers and payers receive needs to be commensurate with the care delivered. Only then will appropriate and adequate dollars be flowing through the system and thus assure sustainability from the business perspective. Without such dollars the system will crumble under its own weight, and the loser will be not just the system itself but the people it is meant to serve.
The challenge therefore becomes how to make sure that sustainability from the business perspective is occurring. The answer is found in data. Providers and health plans need to know the health status of their patients/members so they can determine what conditions should be treated and where there are gaps in care … and then be properly reimbursed for the services they provide. Through the use of advanced data-pursuit algorithms to target and obtain missing data, programs exist today that not only give health plans and providers the ability to correct inaccuracies or gaps in care reported, but also provide early warning indicators that lead to better quality management.
Sustainability on the micro level – as it applies to the individual – means sustaining the health and well-being of Americans so the system can properly use its precious resources to care for those in greatest need. This is particularly true with the Medicare population and “dual eligibles” as Medicare represents approximately 20 percent – or $572 billion – of all national healthcare spending. Each year about one in five seniors is being admitted to a hospital at a collective cost of more than $100 billion. Not only are Medicare beneficiaries with multiple chronic conditions the heaviest utilizers, but the 14 percent of all seniors who have six or more chronic conditions account for 55 percent of total Medicare spending on hospitalizations.
For this population the answer can best be found in care coordination as repeated studies from Avalere Health and others have shown that an integrated care model results in fewer hospital stays and readmissions – and that saves the system money. Again, data is the key for everything from early detection to care management, but organizations need to have the systems, training and discipline in place to maximize the benefits that data can bring.
Just as ecologists have established “pillars of sustainability” as they look to build a more eco-friendly society, so, too, the healthcare system needs to establish its own pillars of sustainability. Let us start with four:
- The importance of the accurate collection and sharing of data among all of the participants in the healthcare process.
- The careful tracking of the health status of a defined population, with a particular focus on wellness initiatives, gaps in care, and ongoing monitoring of chronic conditions.
- The significance of care coordination as it pertains to, in particular, the senior population whose many needs if unattended can overly consume the healthcare system of resources it needs to serve entire communities.
- The acknowledgement that the flow of adequate dollars is essential to the sustainability of the system and that is dependent, most of all, on rich data that is accurate, current and complete.
The word sustainability is derived from “sustain,” which means to “maintain, support or endure.” To maintain, support and endure the healthcare system so it can serve the needs of all is the greatest thing that we in the industry can do.
Tom Peterson is president and CEO of Clear Vision Information Systems, one of the healthcare industry’s leading companies in helping Medicare Advantage health plans and the physicians who work with them improve their own profitability as well as the health and quality of life of their patients. www.cvinfosys.com.