Redesigning the Delivery of Common Health Care

For a long time, health care system analysts have struggled with how to make health care less costly and more effective.  Meanwhile, the private market has created a number of innovations toward those ends, including the overall concept of managed care, retail clinics, online visits, and medical home-type primary care.  A study sponsored by the Commonwealth Fund focuses on the work of Stanford University’s Clinical Excellence Research Center, which works on identifying new care designs for treating diseases on which spending could be lowered by 30% of more, while improving outcomes.  (Commonwealth Fund Study)   The Center studies existing high-performing clinical teams to see if what they do can be replicable and it applies general system design principles to health care.  Among the disease areas it identified for focused redesign were cancer care, chronic kidney disease, colorectal cancer screening, severe obesity, chronic musculoskeletal care and critical care.  In kidney disease for example, the Center believes that home dialysis and better management of early disease stages could save as much as $63 billion a year.  The Center has developed a series of partnerships with health care systems and health plans across the country to collaborate on and pilot its work.   Two systems are working on the chronic kidney disease model.  The advanced cancer care model is being piloted in four systems and centers around health coaches who talk to patients and their family about goals for treatment and quality of life, as well as emphasizing chemotherapy at home.  The Center estimates $37 billion could be saved annually if this model was widely adopted.

Another project of the Center involved looking at data to identify primary care practices that had very high scores on quality measures and also were in the lowest 25% of annual per patient spending.  They further studies the practices that met these criteria and identified ten characteristics of high-performing groups:  the clinicians are always available in some manner, including items like same-day appointments and extended hours; clinicians adhere to quality guidelines and use tests and treatments appropriately; patient complaints are taken seriously and used as an improvement opportunity; more tests and procedures are done within the practice; referrals are made carefully and followed very closely; hospitalization discharges are immediately followed up with re-integration into the care plan; physician extenders are used to the maximum of their licensure and skills; the work environment for the care team is open and collaborative; compensation reflects quality of care, patient satisfaction and other factors; and capital equipment and facility spending is low.  The work on elements of primary care effectiveness is now being extended to some common specialties.