We already know our country’s healthcare system pales in comparison to every other nation with a similar socio-economic status. It is well accepted that the United States has the most expensive healthcare system in the world. Starbucks spends more money on healthcare benefits than coffee beans and GM spends more on healthcare benefits than steel. The fact is, we have the most expensive system rendering some of the worst health outcomes and consistently land dead last on annual comparative reports among similar nations. And to add another dose of reality: The third leading cause of death in the U.S. is medical errors!
It’s easy to spot problems within our system, they pop up just like the Whack-A-Mole game you see at the arcade. As soon as you think you’ve solved one problem, another one pops up. Our healthcare system is like a Whack-A-Mole game gone awry.
Population health and interoperability are getting increasing amounts of attention and media exposure because they provide a way to address problems in our healthcare system – namely, fragmented communication. When communication breaks down it compromises any system, whether it be a family, an organization, or a nation’s healthcare delivery system. Effective interoperability provides the ability to open up the lines of communication.
A patient arrives at the ER on a Saturday night with a badly injured leg. X-rays are taken, a fracture is diagnosed, and the leg is set in a cast in order for the bone to properly heal. However, no one addressed the reason the patient broke his leg, which was directly related to substance use from years of self-medicating severe and persistent depression. The patient, a childhood trauma survivor, is in active addiction to opioids and did not want to admit or explain his illness or history. The treating physician, without access to the patients complete medical records, prescribed a narcotic for pain associated with the broken leg. The physician went about solving one problem (whack!), and another one will soon pop up as the patient in active addiction left the office with a prescription for a powerful narcotic.
On the surface it may be easy to find fault with the physician and claim that he is distracted, inattentive, or unskilled. However, it would be far more accurate to dig a little deeper and understand that the physician lacked information. Without access to a patient’s complete health record, it is unlikely the physician could accurately know that the young man with the broken leg has a history of depression and substance use disorder. When a member of the healthcare team has a limited view, treatment is also limited.
Scenarios like the one above play out every day and compromise treatment outcomes. Services are duplicated, tests and assessments are unnecessarily performed, and errors are commonplace. Even the timing of a patient’s healthcare needs plays an unfortunate role. An ER physician treating a patient with a broken leg during a weekday may have access to more comprehensive records than he would on an evening or weekend when other provider’s offices are closed. All of these add to the nation’s healthcare excessive expenditures yet render results that do not meet the standards of other nations.
Population health, the aggregation of data across multiple technology resources in order to access a patient’s holistic history, is an approach that aims to improve the health outcomes of a population – in this case, American citizens. When a patient’s general medical records are accessible to a behavioral healthcare provider, and vice-versa, we begin to take control in the Whack-A-Mole game.
Historically, our system has been encounter-based – up pops the mole, we whack it and wait for the next one. An encounter-based approach may be fun for arcade games but not when it comes to effectively managing acute and chronic health across patient populations. We are beginning to move toward a holistic, population management approach which will give the U.S. an opportunity to catch up to other nations. A pay-for-value approach is on the horizon and will arm treatment providers with complete medical records and the ability to access a patient’s entire history, resulting in an informed decision-making process.
Population health and comprehensive pay-for-value approaches will give providers the ability to deliver best practice methods, improve treatment outcomes, and help contain the rising healthcare costs. We can no longer afford to be reactionary with encounter-based medicine. It’s time to leave the games in the arcade’s.
Haven Lindsey works for MAP Health Management, LLC., and lives in Austin, Texas.