Health care leaders gathered at an FMCNA-Financial Times event to discuss challenges and opportunities
In a way, the U.S. healthcare system has been a victim of its own success: advances in medicine and the accessibility of primary care have more than doubled the life expectancy of an average person. Yet, this achievement has created an increasingly older population prone to more long-term, chronic conditions. Therefore, treating chronic illnesses presents one of the biggest challenges to our healthcare system, and society as a whole. In fact, the Fresenius Medical Care North America (FMCNA) 2015 Health Indicator Survey issued on November 4 makes clear that the country desperately needs to put the same focus on the unique needs of chronically ill people as it does on acute and primary care needs.
There are no easy answers for improving chronic illness care in America, but FMCNA and the Financial Times co-hosted a panel of healthcare industry leaders who convened at the Metropolitan Club in New York City to share insights and discuss solutions. The panelists offered ideas based on real-life experience about how to improve care for chronically ill people. They discussed a range of issues confronting the healthcare system today and gave insights into coordinated care models, clinical information systems, delivery system design, value enhancement and other ways to treat patients with chronic conditions.
Below are five key takeaways from the discussion about what we need to be doing at all levels of healthcare – provider, payers, government regulators, etc. – to improve care for those with chronic illnesses
1. We Need More Than Great Ideas; We Need To Build Better Health Processes and Systems to Support Them.
Addressing the needs of chronically ill patients will take more than just innovative programs or breakthrough ideas and technologies, according to the panelists. It also will require developing new processes and systems to support those initiatives. According to FMCNA CEO Ron Kuerbitz, there are lessons to be learned from the care of patients with chronic kidney disease – most of whom have multiple chronic conditions – about reorganizing care delivery systems to make sure new breakthroughs achieve better outcomes.
Kuerbitz cited as an example, the company’s Crit-Line technology, which enables clinicians to more accurately determine if a kidney patient is holding excessive fluid. The retention of excess fluid which results from non-functioning kidneys can lead to congestive heart failure and other health complications that require hospitalizations. Before this new technology could be useful, however, it had to be seamlessly integrated into the company’s everyday care process, requiring coordination across a number of different teams both inside and outside the clinic.
“It’s not enough to have a great idea. You have to have a system to implement it,” Kuerbitz said. “We know what technically can be done, but now we must organize the system to achieve those outcomes.”
2. Don’t Just Collect Big Data, Figure Out How to Use It to Benefit Patients
The sheer volume of medical data available to health care providers and payers today is staggering, but panel members agreed that simply having the data does not translate to better patient care.
Mike Weissel, Executive Vice President of Optum, said his company is pursuing several avenues to put big data at the fingertips of both physicians and patients in a way that will inspire constructive action. Optum uses algorithms to pore over huge amounts of patient data every day, and its system determines who needs a communication—such as an alert to patients and their pharmacists that combining their prescriptions may cause complications.
“How do you get to actual behavior change?” asked Weissel. “Like anything else in life, actual change is hard to do and we’re working on that.”
Susan Devore, President and CEO of Premier, Inc., a healthcare performance improvement alliance of approximately 3,600 U.S. hospitals and 120,000 other providers, said that simple solutions gleaned from the data can often provide the best results. For example, one of the most successful Accountable Care Organizations in Premier’s PACT™ population health management collaborative used data to identify the 500 most expensive patients in its system, and then gave them simple tools like sensor cuffs, scales and iPads to keep better track of their health and weight, resulting in a staggering 40% reduction in hospital readmissions.
3. Provide Incentives for Providers and Payers That Are Aligned
Bending the cost curve to treat chronic illness more efficiently and effectively entails changing the way we pay for that treatment, several panel members agreed. That means continuing to align reimbursement models with the notion of value-based care – a payment system that rewards achieving better quality and outcomes at sustainable cost – and giving payers and providers incentives to offer more coordinated care.
“This has to be financially sustainable. No one is going to develop a system without it.
How do we participate in the savings that we generate?” Kuerbitz posed.
Thomas Scully, General Partner, Welsh, Carson, Anderson & Stowe and former Administrator of the Centers for Medicare & Medicaid Services (CMS), said that financial incentives were necessary to ensure the health care industry adopts new models for care. Getting the payment structure right is critically important to keeping patients and providers involved in the new ACOs that are a key piece to the puzzle, he added.
“Money drives behavior, and we can’t have coordinated care in a fee-for-service world,” Scully said.
In fact, using alternative delivery and payment models like Accountable Care Organizations, Patient-Centered Medical Home models and bundled payments, the Department of Health and Human Services is committed to tying 50% of fee-for-service Medicare payments to quality and value by the end of 2018. Several of the nation’s largest health systems and insurers formed a task force earlier this year with the goal of shifting 75% of their business to contracts with incentives for quality and lower-cost health care.
4. Create Broad, Integrated Networks to Specialize in High Cost, Chronically Ill Patients
Several panel members believed that the needs of chronically ill patients are best met through larger, consolidated health care networks, which can achieve the scale necessary to invest in integrated, evidence-based care. Many of the new tools and systems that are successful with chronically ill populations – such as predictive modeling and other analytics-driven practices – require a large investment in infrastructure, such as the IT systems used to track the aforementioned healthcare data. These types of investments are only economically feasible if the scale is large enough to service a broad population of patients.
“We simply can’t move the needle on chronically ill one hospital or practitioner at a time,” said John Birkmeyer, Executive Vice President, Integrated Delivery System and Chief Academic Officer of Dartmouth-Hitchcock Health.
However, such networks should also be built with a specialized focus on particularly high cost, chronically ill patients. The primary care system is not as equipped, medically or culturally, to handle the specific, multifaceted needs of these patients. Instead, we need networks with the expertise and resources to be able to address the needs of each particular population, while remaining scalable across the broader system.
“Treatment objectives of chronic populations are fundamentally different than the rest of the healthcare system,” said Kuerbitz, adding that no one player can do it alone and emphasizing the importance of partnerships among health care providers, payers, data & analytics firms and other health system participants.
5. Help Patients Manage Their Own Health and Surround Them with Support
In FMCNA’s 2015 Health Indicator Survey, 90% of patients said they are prepared to take care of needs arising from their disease. Because lifestyle factors are so critical to preventing and managing chronic illness, the panel discussed the need for patients to become engaged in their own health. While wellness programs have had inconclusive results, providers and payers continue to use other creative means to incentivize people to take better care of themselves, such as reward programs and interactive games.
In addition, panelists discussed the need for more programs that individualize care and support plans for each patient and involve collaborative care teams consisting of physicians and nurses, social workers, behavioral therapists and others. The health care industry is increasingly exploring the possibility of entering or engaging businesses such as food or transportation to provide a more complete ecosystem of care to help meet patients’ basic needs. These include social services, as patients who do better in their everyday lives tend to do better with their illnesses.
“In primary care, you’re talking about preventing acute episodes or a cure. In chronic conditions, you’re talking about helping people to manage, to live with a condition they’ve got, and still live the lives they want to live,” said Kuerbitz.