This week I’m writing about the search for The Holy Grail of the new healthcare market … integrated delivery systems (IDSs) such as ours lowering the cost of an office visit, while simultaneously improving patient outcomes. This is to be differentiated from the soon-to-be old IDS economy in which lowering the number of units (e.g., fewer hospital days for a population of patients) paid for the higher cost of an office visit (which commonly includes the cost of integration [e.g., EMR], plus space and personnel). I’ve written about the Why and the What of such a Holy Grail, now it’s time to imagine The How.
#1 Optimize the scope of practice for all clinical personnel: let’s face it, highly compensated surgeons and other interventionists are most efficiently used (a) determining what needs to be done, and then (b) doing it. Highly complex decision analysis, sequential probability equations, and shared decision making discussions are the work of cognitive specialists, or at least should be. And real population care … matching each of 2,200 individuals to best-practice “prevention intervention”, along with prompt, effective resolution of straight-forward clinical problems, is the domain of Primary Care, 100% of the time. We need our nursing teammates and associate practitioner colleagues and practice / process advisors to tell us how best to distribute the remainder of clinical work.
#2 Better match patient demand to clinician supply: historically, we’ve “permanently planted” our physicians and associate practitioners at a single site, despite the ebb and flow of patient volume and complexity. More than occasionally, we have a full complement of nursing staff in the office when the surgeon is in the operating room. We must use PMG Medical Economics (Analytics and Modeling) to better match supply and demand.
#3 Do more with the space we have, rather than replicate space we already have: we have relatively low patient flow in our exam rooms if viewed over the course of a year. Each of us knows a particular day, month, season or department that the office was busting at the seams, but overall, across all 35 departments and 29 offices and 12 months, we use our exam rooms only ~60% of their maximal capacity, and that capacity is not evenly distributed across our delivery system. We’ll have to enlist the help of you, our process engineers, and department administrators to help us solve this puzzle. The new Kaiser Permanente ACC/CDU at Southwood, scheduled to open sometime in 1Q2014, provides new functionality for patients using that MOB – functionality that could not be created repurposing the current space.
#4 Better activate patients to work harder on their behalf, during the 99.9% of their lives spent not in the exam room. Imagine your practice delivering to the patient technically relevant, emotionally compelling information in the precise moment of decision-making … choosing food, exercise, self-monitoring activity … that reliably and repeatedly led to the behavior you both want. What would happen to control rates for hyperglycemia, hypertension, hyperlipidemia, depression/anxiety, obesity, and so on? Using motivational psychology, Big Data, patient preferences and personalities, genetic information, we could craft a series of well-timed electronic communications and data uploads to activate and empower patients in ways that words, spoken by a doctor in 20 minutes every three months, can’t. I believe someone will figure this out, why not us? Of course “laying on of the hands” will always be a critical part of the clinical sacrament, but as a specific healing intervention in itself, rather than a perfunctory ceremony.
Together, we’ll figure out the specifics, led by the clinicians doing the work, and our “rocket-scientist” practice and process engineers. Our members will be thankful … thankful they can enjoy the benefits of KP Integrated Care, at a price they can afford.
Click here to read the next post in the series, “In Search of the Holy Grail – Being Successful”