Culture, Process and Technology
Members of the primary care innovation panel agreed that the health care system needs to move away for the traditional fee for service model. Their discussion brought up three immediate challenges to doing that: innovations around technology are essential, but they’re not enough; in the end, reforming the system isn’t going to change anything if patients aren’t on board; and it’s hard to get people, especially physicians, to adopt new ways of thinking.
It sounded ambitious, but CEO of Essence Healthcare Frank Ingari
predicted that practices can complete the transition from fee for services to outcomes based care in two to three years. What this will take, in part, is a change in the doctor’s role.
“Our model today is a reactive patient presentment mode. The doctor sits and patients present. There’s a ton of people who don’t present until they show up at the ER. We need a model that flips that around where the provider community is outreaching,” Ignari said.
There is a lot of talk at the Innovation Summit at how new technologies might inspire this kind of engagement. Dr. Brian Prestwich of the University of Southern California said population management software now allows him to walk into his office in the morning and zero in on which the 3,000 patients in his system he’ll be taking care of.
Chief Medical Officer of Aetna Lonny Reisman gave an example of how these technologies give doctors the capability to identify groups of patients who need certain treatments ― but they don’t guarantee that patients will get those treatments. He told a story of how a group of providers identified patients who were in need of drugs after suffering a heart attack. They ordered the drugs and gave them to the patients for free. They later found that half of those patients didn’t take those drugs.
“Without community, without support with other sorts of incentives that are frankly beyond what I’m able to conceive of, there are clearly more partnerships, more levels of collaboration that are going to be needed in order for us to optimize the value that theses technologies can ultimately bring,”Reisman said.
A change in culture is needed on the patient side. But it’s also needed on the provider side as they move from thinking in terms of transactions to thinking in terms of outcomes. CEO of ChenMed Christopher Chen said that over the years his company has been able to scale culture relatively effectively. But there’s a worry that the culture change won’t be in sync with the policy changes that will come in the next few years with the Affordable Care Act.
“You have a doctor today practicing in a fee for service environment and he is engrained to think in a fee for service pattern. It’s amazing,” Chen said. “A lot of them say the idea is great, but I can’t wrap my entire head around it because I’ve stuck in a specific way of practicing for a number of years.”
Moderator Chief Strategy Officer of West Wireless Health Institute Mohit Kaushal ended on an optimistic note saying he thinks these efforts to innovate around technology and change culture will work. All we have to do is do the things we say we’re going to.