More than anything else, healthcare providers now need to learn how to deliver less expensive healthcare. It's what I have been calling cheaper, faster, better care. This goal cannot be achieved successfully by requiring nurses and physicians to work harder and faster or squeezing hospital suppliers for better prices. This has generally been the strategy in the past when profit margins have slipped. No, a substantial part of the answer lies in the development and practice of new models of healthcare delivery. All of this was succinctly stated in a recent article quoting George Halvorson, chairman and CEO of Kaiser Permanente. The following paragraph was embedded in a longer article about the future of healthcare (see: The Face of Future Health Care):
Yet even with all of its effort, [Kaiser's] chairman and chief executive, George C. Halvorson, acknowledges Kaiser has yet to achieve the holy grail of delivering that care at a low enough cost. He says he and other health systems must fundamentally rethink what they do or risk having cost controls imposed on them either by the government or by employers, who are absorbing the bulk of health insurance costs. “We think the future of health care is going to be rationing or re-engineering,” he said.Mr. Halvorson is convinced that Kaiser’s improvements in the quality of care save money. But he also says that the way to get costs lower is to move care farther and farther from the hospital setting — and even out of doctors’ offices. Kaiser is experimenting with ways to provide care at home or over the Internet, without the need for a physical office visit at all. He also argues that lower costs are going to be about finding ways to get people to take more responsibility for their health — for losing weight, for example, or bringing their blood pressure down.“The obesity work is incredibly difficult,” he said. “It’s very, very hard to move the needle.”Other health care experts say that while Kaiser has a place in the future, whether it is the best model for the country’s health care remains unclear. “They have not translated some of their strengths into better prices,” said David Lansky, the president and chief executive of the Pacific Business Group on Health, which represents employers on the West Coast, many of whom purchase coverage from Kaiser for their workers.
That's right. Here's the shorter version of what Halvorson, at least, has decided what we now need to do:
- Start delivering healthcare "farther and farther" from the hospital setting and "even out of doctor's offices."
- Find ways to "get people to "take more responsibility for their [own] health."
In my opinion, there's only one way to deliver healthcare at a distance outside of our physical facilities. The answer is virtual visits with the physician or nurse sitting in front of a PC or holding a tablet and the patient at home using the same type of technology (see: OptumHealth, a Division of UnitedHealth, to Offer Virtual Patient Visits Nationwide; Health Insurance Companies to Reimburse for "On-Line" Physician Services; Pfizer Integrating Telemedicine into Its Clinical Trials).
How do we get patients to take responsibility for their own health? For me, the first step is to identify patients with significant chronic health problems (e.g., diabetes, obesity, chronic lung disease) and select those who are ready and able to help themselves achieve better health. These patients then need to be assigned a health coach (nurse, physician, or both) who will work with the patients to achieve measurable, concrete improvements in their health.
All of this constitutes a shift away from our current health delivery model. We have built expensive physical plants that will become more and more obsolete in the future. Such a model also assumes that patients must travel to our facilities. We also need to learn how to promote wellness and healthy habits among patients and not just treat disease. We need to start developing new delivery models now because it's going to take years to refine them. For a variation on this new delivery model theme, Dark Daily just posted a piece on bedless hospitals and their impact on the clinical labs (see: New Outpatient Treatment Paradigm Spurs Construction of ‘Bedless Hospitals;’ Trend May Reshape Clinical Pathology Laboratory Testing).