Innovative Health Care Delivery Model

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Innovative Health Care Delivery Model

With the ongoing transformation of health care delivery, care models which partner physicians and hospitals as co-leaders of the clinical enterprise are rapidly emerging. More than 100 physician and hospital executives gathered for this half-day complimentary program to learn about two care models that ease transitions across the continuum of care: the perioperative surgical home and the Hospital at Home®.

The program, a collaboration between the AHA’s Physician Alliance and the American Society of Anesthesiologists (ASA), highlighted real-world examples of innovative care delivery models. See below for the video shared by presenter Kathy Davis, RN, MBA, NEA-BC, of Presbyterian Healthcare Services featuring the Hospital at Home® model.

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Abstract

Although the health care reform movement has brought about positive changes, lingering inefficiencies and communication gaps continue to hamper system-wide progress toward achieving the overarching goal—higher quality health care and improved population health outcomes at a lower cost. The multiple interrelated barriers to improvement are most evident in care for the population of patients with multiple chronic conditions. During transitions of care, the lack of integration among various silos and inadequate communication among providers cause delays in delivering appropriate health care services to these vulnerable patients and their caregivers, diminishing positive health outcomes and driving costs ever higher. Long-entrenched acute care-focused treatment and reimbursement paradigms hamper more effective deployment of existing resources to improve the ongoing care of these patients. New models for care coordination during transitions, longitudinal high-risk care management, and unplanned acute episodic care have been conceived and piloted with promising results. Utilizing existing resources, Mobile Integrated Healthcare is an emerging model focused on closing these care gaps by means of a round-the-clock, technologically sophisticated, physician-led interprofessional team to manage care transitions and chronic care services on-site in patients’ homes or workplaces. Innovative Health Care Delivery Model

Introduction

Since its implementation in 2010, the Patient Protection and Affordable Care Act (ACA) has succeeded in providing more people with access to care and improving value on a number of fronts (eg, banning preexisting conditions as a reason to deny health insurance coverage, instituting exchanges that enable consumers to comparison shop for health insurance plans, allowing adult children up to age 26 coverage under their parents’ health insurance). However, the complexity of the large, fragmented, and uncoordinated US health care system continues to prove challenging, despite ongoing efforts to address escalating health care costs and suboptimal quality outcomes.

The problem

Persistent inefficiencies, resistance to change, and multiple interrelated issues across the system prevent critical information and resources from reaching providers and patients in a timely manner. Strategic vision, coupled with the ability to mobilize and deliver appropriate resources to patients in the community, is needed so that health care professionals can provide accessible, safe, well-coordinated, cost-effective, high-quality care. Innovative Health Care Delivery Model

Access to healthcare services

Continued barriers to access range from lack of availability to high prices to lack of insurance coverage. In the nation’s  largest states, 12%–30% of residents lacked health insurance coverage or experienced problems getting needed care in 2014.1 In many rural areas, an inadequate supply of health care professionals restricts access to needed services, challenging the health care system to utilize and deploy clinical and material resources in different ways. A major weakness in typical outpatient and inpatient care delivery systems is that primary care professionals, paramedics, emergency physicians, and hospitalists function in unintegrated silos that impede care coordination, inhibit communication, compromise quality, and raise costs. These and other modifiable barriers to access lead invariably to unmet health needs, delays in receiving appropriate care, and preventable hospitalizations.

Cost of care issues

Although the rate of escalation has diminished recently, health care costs remain high. In a recent Gallup survey, 42% of Americans named either the cost of health care or access to health care as the top US health issues. According to one recent projection, the rate of increase in the cost of employer-sponsored health care benefits in 2015 will equal about 4.1%.4 Equally troubling are estimates that up to one third of the more than $2.8 trillion spent on health in the United States each year may be classified as waste—waste that is related largely to failures of care delivery, care coordination, and overuse. Innovative Health Care Delivery Model

Health care quality and safety issues

Serious gaps in care guidelines and processes continue to have an adverse impact on the quality and safety of care, particularly in outpatient settings. Specifically, poor care coordination processes lead to failures in transmitting critical patient information, adverse drug interactions, conflicting treatment plans, and/or lapses in necessary treatment. Failures in patient communication and patient education were among the root causes of 197 sentinel events (eg, suicide, falls, wrong-side surgery) compiled by The Joint Commission from January 2014 to October 2015.

Health information technology (HIT) issues

Although health care communities across the country have made some strides in adopting, implementing, and using HIT to share relevant patient information, the lack of widespread adoption of a reliable system that can share and integrate communication across institutional and organizational boundaries is a significant hindrance to efforts to improve care coordination.

Chief among these issues that hamper progress are persistent inefficiencies and wasted resources that compromise access, health outcomes, and value. These interrelated problems occur with alarming regularity:

  •  during transitions of care,

  •  in the longitudinal management of medically complex patients, and

  •  when individuals with chronic disease have clinical episodes that require acute intervention.

Clearly, there is a critical need for innovative solutions that improve care coordination and communication among clinicians, patients, and their families/caregivers during these high-risk intervals, facilitating medically appropriate just-in-time care delivery by interprofessional teams. Innovative Health Care Delivery Model