Most efforts to move to value in healthcare fail. The link goes into some detail about the reasons for the failure and then there’s this. Expensive parallel disease management systems are not integrated into the primary care practice. The disease management system and the practice may have pieces of what is needed, but very few have a comprehensive solution that combines teams focused on a related set of priority chronic conditions with robust clinical and financial data analytics, protocols, automatic identification of high-risk, high cost patients, and an effective population health tool. That is what it takes. If the disease management program is not giving the same advice as the practice, it just confuses the patient. Value-based care is a huge undertaking and it requires bringing together the stakeholders to accomplish it.
We have still made very little progress in moving to value in most parts of the United States. No individual or single organization can do this. I have been working to make progress for 20 years and I have enjoyed only limited success. Early on, it occurred to me that we were attempting to change a technical or scientific paradigm. Our system has never been focused on chronic disease. We rescue patients late in the disease process. We must change that if we are to create value. I knew of a man in our town who had been very successful in leading the change from the old rotary phone technology to the new cell phones. I asked him to have lunch.
When I asked him about his success, he said that he was an executive in a leading land line company. He told the rest of the leadership team that cell phones were coming and they would be the next new thing. He told them he wanted to lead the move to cell phones in the land line company and they laughed in his face. “Why would we do that, we are dominant in this space and we are very successful. No, that makes no sense.” He told the rest of the team, “I would like to do this here. If you don’t agree, I will leave the company and do it with others.” He left the company and the rest is history.
His main advice stuck with me. “If you are working to move to a new system, identify people who ‘get it’. When you are discussing the topic with others, you will be able to tell easily who these people are. If they light up and become engaged in the discussion, this is a person who may help. If they show little interest and look around the room, you will waste time and wear yourself out trying to convince them. Be polite, but just move on. You will make progress when you bring together enough leaders who get it.”
The Moving to Value Alliance is bringing together stakeholders who “get it.” It started in Connecticut, but it has expanded its reach nationally and internationally. They are making good progress in moving to value in their state. By my count there are over 250 community and healthcare leaders who are part of this alliance. If you are serious about moving to value, you need the help of other stakeholders to get there. You can’t do it on your own. Your organization cannot do it alone. This is the best group of leaders who are serious about moving to value that I have found. Save yourself some time and effort. Join us. Let’s accelerate the move to value!
Thank you Dr Besterman for you ongoing commitment to the transformation and for your support for the MTVA movement. We tend to question whether as individuals we can make a difference - yes we can, as we come together, collaborate/connect and create a tsunami for urgently needed change in this out of control healthcare system.