The Next Generation of “Patient-Centered”

In In The News by Barbara Jacoby

LLH network pressBy Kameron Gifford, CPC
Imagine a sustainable model of healthcare that could “touch” and engage every consumer. A system created for the patient and delivered on their own terms; a continually evolving structure that could simultaneously satisfy all the needs of patients, providers and payers. A design in which each stake holder adds value to the next.  This next generation of care will continue to be centered around the patient’s individual needs, but directed by them as well.

Shifting From Patient Centered to Patient Directed

Every small business owner in America intimately understands the inherent connection between their customers and success. There is an art to successfully being able to predict and meet consumer needs. This consumer knowledge is powerful and history has proven that enough power in the right environment, will disrupt.
Close your eyes for a moment and think about the last time that you, a family member or friend was sick or injured. Do you remember trying to navigate through the current system? Perhaps you were seen in the Emergency Room or were admitted to the hospital. Either way, if you are eligible for Medicare, you were probably given strict instructions to follow up with your PCP and probably had an appointment before leaving the hospital.
Just as you were instructed (or your friend, or relative were), you made your follow up appointment and even remembered your discharge papers. When the nurse calls you in and asks, “What brings you in today?” You don’t tell her about how your son had to call in sick to bring you in because he will get fired if he misses another day; or about how you had to leave the house 2 hours early because you can only make it a few feet in your walker before having to take a quick break on the seat or about the stress of the medical bills that you won’t be able to pay.  Ten minutes later, when the Doctor finally comes in he tells you that he has no notes from the hospitalist and without those, he has nothing to reconcile.  After quickly scribbling a note for the girls to get records he says, “See you next week.”
Four hours after leaving you are finally back home. Exhausted and turned off by the system.
Managed Care plans attempt to reduce cost by “tightening” the network. This 3 day follow up rule is meant to reduce cost and improve outcomes through medication reconciliation. Great idea; in theory. Medicine is not one size fits all. This “72 hour rule” may work great for a 45 year old diabetic who is admitted for elective surgery, but what about the 96 year old who was just discharged from rehab after open heart surgery or the 73 year old that fractured their hip?
How will this negative experience influence the Consumer’s interaction with the system in the future? Will the patient feel up to making the journey again next week? Will transportation be an issue?
More times than not, this experience does have an effect on the consumer and when they do return, it won’t be for 2-3 weeks; thus perpetuating the cycle of readmissions.
Medication reconciliation is a great solution to reducing hospital readmissions, but if the solution is not meaningful to the patient then it will never be effective.
Now, close your eyes again and think about this same visit, but this time in the context of the future… directed by the patient.
This follow up visit could have taken place in the patient’s home, from their desk at the office, from their smart phone or in the PCP’s office. The consumer’s “personal” health team would already know the patient’s history because her admit to the hospital would have alerted the on-call “Transition Specialist” who worked with her PCP.  And if the patient still decided to go into the office, the visit would have included a live comprehensive follow up with the “whole team.” One where the cardiologist and the hospitalist would be included in the visit. Real time, shared decision making across the entire continuum of care – all in the presence of the patient.
The magic of all this does not lie in the LCD screens that vividly display the multiple specialist coordinating care in unison from around the world.
It doesn’t lie in the better outcomes, greater engagement or tremendous savings, but instead it is in the simplicity of the solution.
 This transparent care coordination translates to knowledge, and this knowledge then becomes the power that drives the system.  True Innovation.