Keeping Perspective Is Challenging Because of Turbulent Health Care Design

Rapid chaotic change is what foundations and government and payers have promoted most in health care over the last decade. In the attempt to shake up health care and promote value, core values have been disrupted. Cost, quality, and access have not significantly improved. Costs have increased substantially. Outcomes have not improved. Access has not improved where most Americans need access. Even worse, people have been taught that access is about insurance - not much help when workforce is not available. In many ways what has been done via innovation has been distraction from actually addressing cost, quality, and access. 

Keeping Perspective During Turbulent Times was a recent post by Commonwealth. It is quite interesting that those who have engineered turbulent times would craft such a post. The following is a representation from the perspective of basic health access.

The Innovation Bandwagon Takes No Prisoners

There is no stopping this train as so many new players are excited about harvesting new dollars from health care. Each drives their own perspective and passes on their version of evidence basis, big data, and inflated claims. 

Innovation is the magic word, regardless of higher costs or other consequences. Those driving the innovation bandwagon appear to be oblivious to the changes. 

The team members that deliver the care have taken the most hits. This makes the side effects of declines in morale, declines in productivity, and increases in burnout most tragic.  Those most about the delivery of health care are impacted.

Why Disrupt Those Who Deliver the Care?

Relationships Are Important, But Are Inconvenient for Convenient Big Data
 
In particular the innovation efforts have disrupted important relationships. Behaviors, situations, environments, and local resources shape outcomes - but the data is collected for the purposes of billing and documentation. Numerous irrelevant study claims exist with more to come.

There is much talk about the problems of taking out ACA without a replacement.

• But what about taking out relationships without replacements? 
• Is this a necessary disruption?
• How do you replace trust, diminished by design?
• By focusing on "things" such as technology and big data, humanity has been marginalized or lost. It died without even the courtesy of open debate. 

There is much talk about team, but how can teams function best with divided loyalties and diminished support? How can health care function with fewer members with more duties and distractions?

Why Disrupt Those Who Deliver the Care Where Most Needed?

The new payments impact most needed providers directly and vulnerable populations indirectly as fewer dollars remain to circulate locally and impact the real determinants of health and other outcomes.What about the human subject experimentation called payment design with known consequences for providers caring for those most behind in so many dimensions that research consistently fails across the quality chasm?

Is it ethical to propose and promote treatments that delay real cures for access, cost, and quality? Treatments that delay cures for individual patients impact individuals. Treatments involving payment designs and regulations that force higher costs impact tens of millions.

Why Distract Those Who Deliver the Care Where Most Needed and Divert Funding?

Is health care better off with even more players seeking attention and more dollars or is this more distraction from those who have dedicated their lives to delivering care? 

If the health care pie is not growing, how can increased administrative and non-delivery costs do anything but shrink support for team members?

Case in Point - Primary Care

What does it take for optimal primary care?

• Can primary care be micromanaged to full effect or 
• Is optimal primary care about well supported team members kept in continuity with patients, practice, and community working over time

Which is the route to best accomplish higher primary care functions such as integration, coordination, and outreach?

My read is that the innovation bandwagon compromises primary care and especially care where needed in ways that increase discontinuity, make it difficult to practice, and make it even harder to do higher primary care functions.

Surely the literature is clear about the need for $105,000 more per primary care physician for Primary Care Medical Home and $40,000 more for MACRA not to mention tens of thousands more per year per physician to address the flood of chaotic changes for the past decade.

Volume Branded as Evil - Not Necessarily in Primary Care

The ragsheets decry volume in health care as waste or worse. But office primary care is different in many ways because it best represents access to care with 55% of US encounters.

• Is higher volume in primary care evil or 
• Is it called expanded access to care

The expansion in workforce can involve more team members supported, more productive team members, and team members in more places. These are all areas that cannot be addressed via expansions of low quality, inefficient, obstructive, low paying insurance coverage.

With Widespread Appreciation of Health Outcomes as Due to Patient, Local, Social, Community Factors then Why Clinical Interventions Known to Be Costly and Low Yield for Outcomes?

Why persist in the small change potential of clinical intervention, especially the costly digital subset?

Why not return the focus to populations in most need of changes in behaviors, environments, situations, nutrition, community resources, and social determinants - the real drivers of health, education, economic, and other outcomes?

Common Sense, SMART, Indicated, Evidence Based Solutions - Not Innovation Via Assumption

We know what we need to do. 

We need to facilitate investments in the people that invest in others - from the earliest ages.