The American healthcare system is broken. Patients are dissatisfied. Providers are unhappy. Costs are too high. Services with no value are far too common. I have pointed to the landmark book from the National Academy of Medicine (NAM) Crossing the Quality Chasm which lays out the problem in detail. The biggest problem? Chronic conditions are creating most disability, death, and costs. We have not brought together the new science, systems, and payment models to solve that challenge. The NAM did not just point out the problem. They created a very simple roadmap to solve it. “Carefully designed, evidence-based care processes, supported by automated clinical information and decision support systems, offer the greatest promise of achieving the best outcomes from care for chronic conditions.”
Steps for Crossing the Quality Chasm
Identify a limited number of priority conditions that affect many people and account for a sizable portion of the national health burden…..”the top 15 priority conditions are cancer, diabetes, emphysema, high cholesterol, HIV/AIDS, hypertension, ischemic heart disease, stroke, arthritis, asthma, gall bladder disease, stomach ulcers, back problems, Alzheimer's disease and other dementias, and depression and anxiety disorders.” Heart failure should be added.
Bring together the stakeholders. Improving chronic disease management is far too big a problem for any one entity. Stakeholder collaboration is critical. These entities include kealth care organizations, clinicians, purchasers, brokers, employers etc. These interested parties should work together to:
organize evidence-based care processes consistent with best practices
organize major prevention programs to target key health risk behaviors associated with the onset or progression of these conditions,
develop the information infrastructure needed to support the provision of care and the ongoing measurement of care processes and patient outcomes, and
align the incentives inherent in payment and accountability processes with the goal of quality improvement.
That’s it! That is all there is to it. This roadmap was created 21 years ago and we have done nothing with it. Let’s start together right now. You don’t need to reinvent the wheel. I have helped develop the evidence-based care processes consistent with best practices in collaboration with dozens of others. We have education programs to make self-management easier for patients. I am working on information infrastructure with Congruity Health that supports optimal medical therapy care provision and measurement in cardiovascular and related conditions. It is ready now. These first three steps fail if there is not a payment model that supports it. We have the roadmap. Care will not improve and costs will not come down until we follow it.
Cardiovascular and related conditions are the low hanging fruit. These include hypertension, diabetes, high cholesterol, heart attack, stroke, heart failure, chronic kidney disease, and vascular dementia. The advanced primary care medical home is the perfect instrument to bring these elements together. My colleagues and I can assist your organization in moving effectively to this model now in your value-based care contracts. Contact us.
whbester@gmail.com 423-782-0372
Hi, Bill. Great entry today. It’s not entirely correct that “we have done nothing” with the QI method. In the early to mid-90s Don Berwick and his colleagues at the IHI ran a number of collaborative QI projects, and these were very successful. One such success significantly lowered the amount of time patients were post-op on with breathing tubes and in the ICU when removal was clinically indicated. There were many other. Characteristically, these efforts involved multiple hospitals and small groups of clinicians working both independently and then comparing data and results. It was very exciting to see how easy it was to accomplish better outcomes when guided by a proven methodology and data. However, as hospital competition heated up and making profit became more and more the goal of health care, it was increasingly difficult to put the QI collaborative methodology to practice. I was personally involved in QI at this time as a trainer, and I remember that some hospital administrators became worried about lengths of stay decreasing for some patients, which decreased reimbursement. It all sort of died away.