Healthcare is now a Team Sport
By: Dr. Mark Kestner, Chief Innovation Officer at MediGuru
The financial model of medicine until recently drove members of the care team to their respective silos. The workflows were not integrated. Patients were admitted to the hospital, and hospital operations were rewarded by “heads in beds”. The cost of care was a non-issue. Barriers to discharge were not effectively addressed. Is this a hospital issue (waiting for a study or test)? Is this a physician issue (waiting for a specialist or an order)? Or is this a community issue (waiting for placement or a supply home delivery)? While we could ask the question, it infrequently was effectively acted upon.
This wasn’t just an inpatient issue. As an example, patients were often referred to specialists without the appropriate accompanying tests, studies, documentation, or justification. This could reflect a problem with timing, sequencing, or appropriateness. The bottom line was that there was little care coordination.
The Electronic Health Record helped reinforce the model of a time in which each discipline was documenting in their own silo on the inpatient side and was rarely coordinated with outpatient documentation. The notification of hospitalization was spotty at best. On discharge, there may have been a dictated summary of care but there rarely was a handoff from the other disciplines. Thus, because of a lack of communication, individuals on the team did not know each other.
With the introduction of the hospitalist function, physicians increasingly became aware of hospital operations and each team member’s function. The team was beginning to talk to each other. The financial model though continued to reinforce and reward delays and poor coordination of care.
One learning from the recent pandemic is that we can’t sustain the financial model. We can’t continue to reward inefficiency, and we can’t rely on the patient to coordinate their own care by navigating our fragmented system. The system must reward value and thus care needs to be coordinated. The players surrounding the patient need to be introduced to each other, and their participation needs to be reinforced.
As we increasingly move to value-based care, the team will be rewarded for efficiency and outcomes. The cost of care will have to be controlled due to the capitated nature of the financial model. We can’t rely on patients to navigate and determine their care. The team will have to take on that function and finally, the financial model will reward them.