Disconnects in Transforming Health Care Delivery

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A new report from the NEJM Catalyst Insights Council showcases results from a survey of Council members, including executives, clinical leaders, and clinicians, about critical issues in the current medical landscape, such as patient engagement, market disruptors, and value-based payment models.  The survey results demonstrate that while there is some agreement on how these issues are being handled, there is also a disconnect about their effectiveness.

For example, when it comes to patient engagement, 60 percent of clinical leaders believe efforts are having a moderate or major impact on outcomes, whereas only 43 percent of clinicians feel the same. Similarly, 62 percent of executives believe care quality is a top advantage of value-based care, compared to just 47 percent of clinicians.

DCHI board and committee member Alan Greenglass, MD, former Senior Vice President of Network Development at Christiana Care Health System, is featured throughout the report. Greenglass, who was previously a primary care physician, articulates the challenges many medical systems and providers are up against in this new world of healthcare. For example, when discussing market disrupters, Greenglass states “Leaders are looking for alternatives that seem decentralized to the consumer but that actually allow for more standardization, replace or supplement limited physician resources, and help drive business to the ‘mothership’...Clinicians see these initiatives as competitive to, and lower quality than, their practices. They’ve also seen the various waves of this type of innovation (urgent care centers, then retail clinics) and see themselves as being left with the sickest part of the population, those with chronic disease, who probably should be in a continuity, team-based (and not physician-only) model.”

In addition, when it comes to value-based care, the report notes that 74 percent of executives and 67 percent of clinical leaders believe that shifts in payment models are a critical driver of changes; however this belief is reflected in only 58 percent of clinician’s responses. Greenglass says “To me, it’s moving to population-based reimbursement that is the game-changer...I’ve lived in that environment and see how it changes how a clinician thinks. For example, I don’t need to say, ‘make an appointment for me to recheck you in three weeks.’ I can say, ‘my nurse will call you in three weeks to hear how your blood pressure (or success with smoking cessation, etc.) is going...I think we need to put into effect the new payment models, protect clinicians from downside risks over a period of time, and support them in learning new ways of practicing.”

Practice transformation is critical to the future of health care, but it requires buy-in from everyone involved, from the top down and bottom up. Disconnects in Transforming Health Care Delivery illustrates the challenges we are up against in our rapidly changing world, but also highlights opportunities for more collaboration. DCHI believes that open conversations and cross collaboration are key to effective transformation, which is why we have developed our five working committees to address all aspects of this process. To learn more and stay updated with DCHI, please click the link below.

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