Hospitals and health systems have been under the gun. The pressure is real. They accepted the healthcare models that were presented to them all those years ago. They played by the rules and delivered fee-for-service care.
And then with healthcare costs rising, patient outcomes being questioned, and readmission rates and penalties increasing, the rules were changed. Value-based care entered the arena, ushered out the old ways of doing things, and now there are new rules to follow.
We know there are problems in U.S. healthcare – that’s nothing new. We also know that other countries enjoy far more successful systems. But how do we make ours work? We can’t change it overnight even if we all agreed to do so.
Part of the rule change includes care coordination. On the surface, it may sound like more healthcare jargon. It’s not. It’s the real deal and it’s making a lot of providers step outside their comfort zone.
Value-based care is founded in the conviction that delivering value to patients carries more weight than the cheapest, fastest, or jazziest. Value rises above all that, and more doesn’t mean better. When an individual enters the hospital to have her hip replaced, she is focused on getting through the surgery, returning home, and recovering so she can return to her lifestyle.
Spending time with her children or grandchildren, walking her dog, gardening, maintaining her independence – these are the real-life scenarios that patients care about. Yet for many, being able to feed their family and pay for prescriptions is a very real concern. Taking off work (again), to go through rehab may not be an option for everyone. What happens when a patient leaves the hospital will often dictate their level of success in recovery and their potential to return to the hospital.
When delivering value, having the knowledge of who patients are as people, understanding what they are experiencing, and knowing what is important to them is crucial. Care coordination focuses on the patient. Her diagnosis. Her prognosis. Her lifestyle, and the Social Determinants of Health she experiences.
Care coordination requires providers to recognize and remove their own barriers and silos. Not only must they communicate with other providers, but they also need to fully collaborate with a patient’s entire treatment team – including family members or loved ones. Solving a patients Social Determinants of Health is now front and center – value based care demands it.
Providers have begun to discover the benefits of using new, empathically developed software that helps them maintain a connection with their patient and their family. Learning and tracking details about a patient’s obstacles and lifestyles allows the provider to deliver individualized care while connecting them with the resources they need. This cross-functional approach challenges the entire care team to communicate, collaborate, and learn about each patient and connect them with community resources and social services when necessary.
When everyone is involved, providers begin to truly know who they are treating. A person emerges from the diagnosis and the obstacles to health and well-being are identified. She can’t afford to fill the prescription. He doesn’t a have a way to get to therapy three times a week. She’s struggling with depression and isn’t motivated to get better. These are critical pieces of the puzzle that care coordination unveils and it does not stop when a patient leaves the hospital – connections are maintained when a patient has returned home and their risk is highest.
Care coordination means that the:
- Quality of care is improved
- Duplication of services are reduced
- Hospital readmissions decline
- Emergency room visits decrease
- Overall costs are lower
- The patient experience is improved
In value-based care, providers answer to those they serve: their patients. Payers may dictate, or implement policy, but if we step back to look at it as an economic model of supply and demand – this involves the provider serving the patient.
Care coordination addresses that demand and it looks a lot different than the fee-for-service model that was expected, and delivered, for so long.
Jamo Rubin, M.D. is founder and CEO of TAVHealth. Headquartered in San Antonio, TAVHealth’s community collaboration platform connects providers, payers, human service agencies, and community partners to help solve the social determinants of health.
Jamo founded and led Medical Present Value, a revenue cycle company (now Experian Healthcare [EXPN]) and PTRX, a pharmacy benefit management company (now UnitedHealth Group [UNH]). Jamo also co-founded and led Tenzing Health, a division of Vanguard Health Systems.
Prior to his entrepreneurial career, Jamo practiced as a cardiac anesthesiologist. He currently serves as Chairman of the Texas Biomedical Research Institute, and is the former chairman of the Texas Property and Casualty Insurance Guaranty Association. He received his MD from UT Southwestern, trained at Harvard’s Massachusetts General Hospital, and received an MBA from UT Austin.
