MedCity Influencers, Providers

Orchestrating Care in the New World of Distributive Access

The challenge with the emerging model of “distributive access” is that there isn’t any one individual or entity coordinating everything; patients are left to navigate their own care journeys. And while health systems invested billions of dollars in technology, little of it is well-coordinated or well-orchestrated for the health system, for healthcare workers, or for patients.

We’re at a fascinating time in healthcare as it relates to patient access and flow. Healthcare is coming out of that period of change and disruption from the pandemic, which made us realize we weren’t quite as ready with our infrastructure and ability to communicate and collaborate as we – and most Americans – thought we were.

Healthcare professionals try so hard to take care of all of us, and they do an excellent job. But our healthcare system doesn’t make it easier for them because everything is siloed. There are multiple departments, with many steps and hand-offs with varying levels of streamlined communications and data. Along a patient’s journey, without systemness the flow of information could get lost. It’s like an apprenticeship; I’m a nurse, and I pass on what I’ve learned to the next nurse, who does the same, and so on.

And while healthcare workers are afforded various tools and technology, providers have done a poor job of streamlining and optimizing the operational flow to ensure a quality patient journey throughout the health system. Rather, the patient journey has become super-transactional. For example, patients who don’t have any place to go end up at the emergency department (ED), where they’ll be treated and then just sent on their way with discharge instructions. Patients end up having to figure everything out from there, including where to go for follow-up, and even how they’ll pay for services.

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A Deep-dive Into Specialty Pharma

A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.

If you look at our healthcare ecosystem over the course of decades, we evolved from where people had primary care physicians who they knew and trusted and who coordinated their care. Now we have easy accessibility to care just about anywhere; I can pop into a CVS MinuteClinic or a Walmart Health clinic to receive care, or I could schedule a telehealth visit.

The challenge with this emerging model of “distributive access” is that there isn’t any one individual or entity coordinating everything; patients are left to navigate their own care journeys. And while health systems invested billions of dollars in technology, little of it is well-coordinated or well-orchestrated for the health system, for healthcare workers, or for patients.

Predictably, this lack of coordination leads to poor clinical outcomes because patients may misunderstand something in their discharge instructions or fail to follow up in a timely manner because they didn’t log into their patient portal. But some patients may have 10 or more patient portals, each for a different provider. It’s hardly surprising that people become so overwhelmed that they may avoid interacting with the healthcare system until they suffer a major health emergency. And then they’re back at the ED.

Such a transactional approach is bad for both the patient and our healthcare system. Lack of efficiency is hurting margins to the point that health systems are in the worst financial shape ever. We’ve invested billions of dollars in electronic medical records and haven’t pulled it all together to coordinate and deliver care where and when it’s needed.

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Barriers to orchestrated care

How do we align payers and providers to support care and access and reimbursement in a way that drives better outcomes for the patient? How do we get to where we can coordinate and deliver care everywhere, where we can operate without boundaries, in a world where access to healthcare is so widely distributed?

During the pandemic, health systems that operated in a siloed manner felt the costs of the inability to coordinate operations and share resources in the forms of compressed margins, frustrated staff, and suboptimal patient outcomes – particularly as care expanded outside of traditional settings. As health systems grow and expand to meet the changing needs of patients and providers, they must reimagine patient flow to measure and improve coordination across disparate settings. When they start thinking about care orchestration more holistically, they can then create the operational scale that will trigger better utilization of their resources and optimal patient outcomes.

Technology alone is not going to solve the problem. In fact, technology is just the starting point and exists in every one of our systems. We can all talk to each other, and we can share data, however it’s the inability – and sometimes unwillingness – of solution providers that sometimes gets in the way. As technology innovation continues to drive digital transformation, providers will need to implement controls that proactively guide patients to the optimal care setting rather than just dealing with them when they arrive at a facility.

The second barrier to orchestrated care in an increasingly distributed care system is the overwhelming responsibility we put on patients to sort through and evaluate the unlimited options they have for accessing care. That’s bad for patients, and it’s bad for our health system.

Unfortunately, the health system is structured around financial incentives. We’re constantly asking more of healthcare workers – when to bill a patient, asking patients to take a survey, gathering data, adding multiple codes to the patient’s medical records, and much more. The mechanisms aren’t yet in place to enable financial incentives to support clinical outcomes. As a result, patients end up getting sick and have medical crises that require a highly acute level of services.

Data shows that 60% of the population is healthy, 30% have a chronic disease, and 10% are sick. Both the cost of care and revenue per patient are much higher for populations with acute conditions, even though these patients comprise a small percentage of the total population. Health systems must get control over this.

With laser focus on healthy and chronic patient populations, disruptors are aggressively moving into the healthcare space in ways that may threaten the survival of health systems, despite the massive amounts of money invested in primary care infrastructure and urgent care. Consumer expectations regarding care access have evolved. People don’t want to get bogged down in an inefficient healthcare system when they have a routine health issue; they just want someone to take care of their problem. And health systems never will be as good as CVS, Walmart, Walgreens, or Amazon/One Medical in providing this type of convenient, concierge-style service.

For health systems to survive and thrive, they must manage demand, capacity, and throughput for acute care, an area that nontraditional care providers are ill-equipped to serve. They must ensure they are capturing market share and acquiring patients in support of the service lines they’re strong at and invested in. Further, they must treat those patients efficiently and move them to the next post-acute care setting, and they must utilize all their capacity. When the boundaries to care are no longer limited to a specific hospital or health system, healthcare becomes more ubiquitous, and providers can ensure prompt access to care at every stage of the patient journey.

The right tools and a trusted data source

Health systems also will need to form partnerships with stakeholders across the entire care continuum. These systems will do more with patients who have chronic conditions, but they’ll still have to partner with Walmart and Walgreens and share information and exchange data when a sick patient leaves the acute setting to go home. Some information about that patient will need to follow along with the patient.

If health systems are looking for their electronic health records (EHR) platforms to improve patient flow, they will be disappointed. While EHRs are suitable for billing and collections, they are not the right tool for optimizing care access because lack of interoperability creates data siloes that undermine care decisions. Optimizing access by re-imagining patient flow requires using the right tools to get the right care at the right location at the right time.

Patients aren’t always equipped with the knowledge and judgment to make safe and informed decisions regarding their care. They need a complete, trusted data source and technology to connect disparate organizations and help orchestrate care.

Automation technology can smooth the flow of patients and ensure prompt access to the appropriate level of care at every stage of their care journeys. However, technology alone isn’t enough; processes must work effectively in concert with digital tools. A well-designed access and orchestration center will efficiently find capacity and staff for the patients they want to admit or transfer.

Access centers can play a critical role in increasing healthcare consumer loyalty by serving as a hub to help providers facilitate patients’ care journeys. When access centers enable and improve their patients’ care access, it allows clinicians and caregivers to focus on treating the patient and to practice at the top of their licenses. This in turn drives more efficiency in our health system, which is better for clinical, financial, and operational outcomes.

Photo: MicroStockHub, Getty Images

Jonathan Shoemaker joined ABOUT in 2023 as Chief Executive Officer, bringing more than 25 years of health system and information systems experience with a proven track record of transforming and delivering initiatives and solutions that improve healthcare delivery, operations, and growth.

Before joining ABOUT, Jonathan most recently was senior vice president of operations and chief integration officer as well as a member of the senior executive team leading Allina Health’s Performance Transformation Office. Before his most recent role at Allina, Shoemaker spent six years as Allina Health’s chief information officer and chief improvement officer. Prior to Jonathan’s tenure at Allina, he held leadership positions at prominent IT & healthcare firms, including NorthPoint Health and Wellness Center, BORN Consulting, and Hennepin County Medical Center.

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