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INTEGRATED DELIVERY SYSTEMS AND PATIENT-CENTERED CARE

INTEGRATED DELIVERY SYSTEMS AND PATIENT-CENTERED CARE. PRESENTATION TO CIVITAS MAY 14, 2008. HALLMARKS OF INTEGRATED SYSTEMS I. SHARED VALUES & GOALS ALIGNMENT OF INCENTIVES; COMMON REVENUE STREAM PATIENT CENTERED CARE PHYSICIAN LEADERSHIP A MANAGEMENT STRUCTURE.

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INTEGRATED DELIVERY SYSTEMS AND PATIENT-CENTERED CARE

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  1. INTEGRATED DELIVERY SYSTEMS AND PATIENT-CENTERED CARE PRESENTATION TO CIVITAS MAY 14, 2008

  2. HALLMARKS OFINTEGRATED SYSTEMS I • SHARED VALUES & GOALS • ALIGNMENT OF INCENTIVES; COMMON REVENUE STREAM • PATIENT CENTERED CARE • PHYSICIAN LEADERSHIP • A MANAGEMENT STRUCTURE

  3. HALLMARKS OF INTEGRATED SYSTEMS II • COMPREHENSIVE RECORDS • SHARED PRACTICE GUIDELINES • ALL OR MOST OF A PATIENT’S CARE WITHIN A SYSTEM • CULTURE OF TEAMWORK

  4. HALLMARKS OFINTEGRATED SYSTEMS III • INTEGRATION ACROSS SETTINGS • POPULATION MEDICINE • PERSONAL AND PUBLIC HEALTH: EMPHASIZE HEALTH PROMOTION & DISEASE PREVENTION • SOMATIC AND MENTAL HEALTH

  5. BENEFITS OF INTEGRATED SYSTEMS • HEALTH PROMOTION, DISEASE PREVENTION • EFFICIENT RESOURCE USE • BETTER OUTCOMES • PATIENT CENTERED CARE

  6. BENEFITS OF INTEGRATION • ACCOUNTABILITY FOR QUALITY AND COST • LEADERSHIP IN PUBLICLY REPORTED QUALITY MEASURES • CONVENIENCE AS IN “ONE STOP SHOPPING” AND “SAME DAY” OPEN ACCESS. PATIENTS FEEL THE “SYSTEMNESS” • LEADING IN APPLICATION OF INFORMATION TECHNOLOGY FOR EHR, PATIENTS’ CONVENIENCE AND CAREGIVER SUPPORT TOOLS

  7. INTEGRATION IS A MATTER OF DEGREE • EVEN THE MOST INTEGRATED (KP IN CA) REFER SOME CARE TO SPECIALIZED REGIONAL CENTERS • SOME INTEGRATE CARE BUT NOT FINANCES

  8. WHY DON’T WE HAVE MORE INTEGRATED SYSTEMS IN THE USA? • ORGANIZED MEDICINE IN THE USA CONDUCTED A BITTER WAR AGAINST THEM UNTIL RECENT YEARS. • MOST EMPLOYERS DO NOT OFFER THEM AS COST CONSCIOUS CHOICES; THEY LOCK PEOPLE INTO FFS. • OFFERING CHOICES DOESN’T FIT MANY EMPLOYERS • INSURANCE COMPANIES RESIST CONSUMER CHOICE OF PLAN

  9. HOW COULD AMERICA GET MORE INTEGRATED CARE? • “OPEN THE MARKETS AND LEVEL THE PLAYING FIELD”; INDIVIDUAL CHOICE • UNIVERSAL COVERAGE BASED ON PRINCIPLES OF MANAGED COMPETITION • THE DUTCH HEALTH INSURANCE MARKET COMBINED WITH AMERICAN INTEGRATED DELIVERY SYSTEMS

  10. Elements of Managed Competition • “EXCHANGE” OR MARKET ORGANIZER • INFORMED, COST CONSCIOUS, CONSUMER CHOICE • INDIVIDUAL (NOT GROUP) CHOICE • RISK EQUALIZATION • GUARANTEED ISSUE, COMMUNITY RATING • LEVEL PLAYING FIELD • PRICE ELASTIC DEMAND

  11. HOW COULD THE NHS GET TO INTEGRATED CARE? • CHRIS HAM:“…POLICY MAKERS NEED TO RESIST THE TEMPTATION TO PRESCRIBE A SINGLE APPROACH AND TO FOCUS INSTEAD ON ENCOURAGING THE DEVELOPMENT OF INTEGRATED CARE USING THE MEANS THAT APPEAR MOST APPROPRIATE IN DIFFERENT CONTEXTS.”

  12. MORE WISDOM FROM CHRIS HAM • “ PRIMARILY [INTEGRATION] IS ABOUT RELATIONSHIPS BETWEEN PEOPLE. THESE RELATIONSHIPS ARE NOT INFORMAL FRIENDSHIPS. THEY HAVE TO BE WORKED ON AND BUILT PROFESSIONALLY IF CLINICAL INTEGRATION IS TO BE MEANINGFUL AND SUSTAINED THROUGH GOOD AND BAD TIMES.”

  13. IDS IN NHS? • Chris Ham: “ Encourage emergence of integrated systems, based on networks of like-minded GPs working together to provide and commission care for the populations they serve. This would be like the total purchasing pilots…but could go further…”

  14. IDS IN NHS? • TOTAL PURCHASING PILOTS WERE A GOOD DEVELOPMENT, GROWING ORGANICALLY AND VOLUNTARILY OUT OF INDIVIDUAL FUNDHOLDERS. I REGRET THEY WERE NOT ALLOWED TO CONTINUE AND GROW. • VOLUNTARY CHOICE BY DOCTORS AND PATIENTS IS IMPORTANT

  15. A FUTURE NHS? • LET DOCTORS AND PATIENTS CHOOSE THEIR PCT • LET PCTs COMPETE ON SERVICE • VOLUNTARY TRANSFORMATION TOWARD IDS. • LET GOVERNMENT HELP WITH INFRASTRUCTURE SUCH AS I.T.

  16. REGULATION? • CONSUMER PROTECTION • RICH SUITE OF PUBLIC REPORTING INCLUDING SURVEYS OF PATIENT SATISFACTION

  17. DUTCH MODEL • MANDATORY UNIVERSAL COVERAGE • PRICE SENSITIVE CHOICE; INSURERS COMPETE ON PRICE AND QUALITY • DUTCH HAVE PPI (FFS), NOT IDS • TO SUCCEED IN KEEPING CARE AFFORDABLE,THEY NEED IDS COMPETING ON PRICE

  18. DUTCH MODEL FOR UK? • THE IMPORTANT THING IS DELIVERY SYSTEMS, NOT INSURANCE COMPANIES • ORGANIZING CARE IS NOT A CORE COMPETENCE OF INSURANCE COs. • ADDING INSURANCE COMPANIES WILL NOT HELP. • FOR SUCCESS, INSURANCE COMPANIES MUST EVOLVE INTO DELIVERY SYSTEMS

  19. OUR EXPERIENCE • TOP DOWN IS BAD; BOTTOM UP ORGANIC GROWTH IS GOOD IF OVERALL INCENTIVES ARE RIGHT • VOLUNTARY IS BETTER THAN INVOLUNTARY WHEN WILLING COOPERATION IS NEEDED. • INTEGRATION TAKES YEARS TO GROW; DON’T BELIEVE IN QUICK FIXES.

  20. ON COMPETITION AND INTEGRATED CARE • KP LEADERS RECOGNIZE THEY ARE A COMPETITOR. THEY WELCOME COMPETITION • THEY ALL KNOW THEIR MONEY COMES FROM SATISFIED MEMBERS WHO HAVE A CHOICE • ROBUST COMPETITION DRIVES INNOVATION, AS IN I.T. ADOPTION • SERVICE IMPROVEMENTS WERE DRIVEN BY COMPETITION; WOULD NOT HAVE HAPPENED WITHOUT IT.

  21. ON PUBLIC REPORTING… • MOST PATIENTS DO NOT READ REPORTS; PEOPLE ASK FRIENDS. • MEDICAL GROUP LEADERS DO READ QUALITY REPORTS • CABG REPORTING IN NEW YORK • PUBLIC REPORTING OF QUALITY DOES MOTIVATE IMPROVEMENT

  22. ON INTERNAL MECHANISMS • PERMANENTE PAYS DOCTORS BONUSES FOR PATIENT SATISFACTION AND TEAMWORK: MARKET DRIVEN • PERMANENTE PAYS BONUSES FOR QUALITY: PUBLIC REPORTING DRIVEN, BUT THEY LED IN PUBLIC REPORTING IN CONFIDENCE THEY WOULD LOOK GOOD.

  23. MEDICAL PROFESSIONAL VALUES • DO NOT USUALLY INCLUDE GOOD CUSTOMER SERVICE WITHOUT COMPETITION • GOOD SERVICE AND PATIENT-CENTERED CARE WILL NOT HAPPEN WITHOUT CONSUMER CHOICE

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