Twenty-first-century health care in this country benefits from a wealth of medical resources, technology, advanced drugs and knowledge. Yet, despite spending more on health care than any other country, the United States continually ranks poorly on measures of efficiency and quality. Why is this?
The U.S. health care system suffers not from lack of investment in creating health care resources — training physicians, building hospitals, purchasing medical devices, etc. — but from a lack of access. Those working on the front lines of patient care know there's always a demand for resources that seem in short supply. As New York Times reporter Elisabeth Rosenthal put it in her article "The Health Care Waiting Game" this past summer: "There is emerging evidence that lengthy waits to get a doctor's appointment have become the norm in many parts of American medicine" [July 5, 2014].
Matching the right patient to the right resource at the right time is paramount to better efficiency, appropriate care and cost-management. Still, the limitations brought on by legacy processes and technology systems remain.
Opening Up Access
One way to mitigate the traffic jam and make health care work better for everyone is to apply a layer of intelligent analysis, connectivity and optimization to our existing systems. In doing so, we can free up doctors and nurses to provide better care to their patients. We can empower physicians to work together toward better health outcomes. We can dispense care not on a first-come, first-served basis, but with consideration of all the factors that determine a good fit, such as urgency of diagnosis, availability, medical history, insurance, quality metrics, patient choice and much more. We can reduce long wait times and create a better patient experience for everyone.
Technology has promised to "fix health care" before. Electronic health records were once hailed as the great savior in health care, promising to usher in a new era of efficiency. In practice, however, EHRs are not designed to communicate with each other, and there is no good way to quickly and easily share information between systems. Clinicians cannot use them effectively to notify one another, nor can they create meaningful communication, collaboration and care coordination between systems.
There are also procedural and cultural issues at play within health care organizations. How do you define urgency? How do referring physicians prioritize their patients to receiving offices? How do primary care physicians communicate with specialists? These are questions a health care organization must look into based on its unique market dynamics, business model, patient load and network of providers.
Steps in the Right Direction
To apply smart analysis, remain competitive and ensure high-quality care, it is critical for hospitals to understand how patients are falling off the radar as well as when they fail to transition to the next step in their care.
From working with hospitals and health systems on patient referral and access, I've learned that there are several key steps that leaders can take to optimize their existing resources and connect patients effectively:
Map your network. It's remarkable how many organizations don't have a clear line of sight into who their employed and affiliated physicians are, and how those physicians align with the organization's clinical, population health and business objectives. Recognize which providers are willing to participate in solutions that improve care and access. With a firm understanding of your network participants and who's on board, it becomes easier to implement changes and match the appropriate resources to patient need.
Improve pre-appointment processes. Improving pre-referral communications between providers helps to reduce unnecessary care and ensure that a patient's clinical pathway is appropriate. Good communication can determine if any pre-visit testing needs to occur to ensure that the specialist makes the best decision. Additionally, it's important to engage patients directly in getting to the next step in their care. Traditionally, connecting a patient to a specialist has been a reactive process: Clinicians give a patient a specialist's phone number and wait for him or her to call. By taking into consideration each patient's unique needs and by reaching out, providers can schedule more effectively and ensure the right resource match.
Empower allocation. Every patient's need and acuity is different: Some can wait; others cannot. Some hospitals have had great success by empowering scheduling staff to focus on the most acute patients first simply by capturing the perspective of the referring physician as to acuity and evaluation time frame.
Enable tracking. Providers and their staff need intuitive technologies and workflows that educate them regarding resources and the most appropriate direction for any given patient in real time. In the absence of purchasing new technology, providers can create internal processes to ensure that they track each and every transition in care.
A Competitive Edge
The recent scandal over delayed care at the Veterans Health Administration represents what many hospitals and health systems experience: long wait times for appointments and frustrating patient experiences with bureaucracy, causing patients to fall through the cracks. In fact, to both patient and provider detriment, 20–40 percent of patients never follow up on their referral appointments. This problem only will increase as the Affordable Care Act adds patients to the ranks of the insured.
As organizations shift to an outcome- and quality-based model, it's more crucial than ever that we maximize existing medical resources to provide the best care to all patients. In this new world of medicine, coordinated care, access to resources and providing an excellent patient experience will make or break a hospital's ability to compete.
Daniel Palestrant, M.D., is the co-founder and CEO of par8o, a Boston-area company that helps providers improve the patient experience.