Accountability for Patients and for Care Organizations…
Just a few weeks ago, the American Heart Association (AHA) released a scientific statement, State of the Science: Promoting Self-Care in Persons with Heart Failure: A Scientific Statement from the American Heart Association, that discusses the importance of patient self-care (PSC) and provides evidence-based recommendations to clinicians to promote self-care in their heart failure (HF) patients. The AHA placed significant emphasis on teaching patients how to recognize condition symptoms and what to do with that information, how to make appropriate behavior changes and the importance of transitions of care and depression screening. In addition, the statement acknowledged that systems of care, such as care coordination and telehealth, hold promise for improving the self-care abilities of persons with HF.
Clearly, this set of recommendations resonates with us at Pharos Innovations. These recommendations are directly aligned with the paradigm of physician- and patient-centric care coordination that we created with Tel-Assurance®. The AHA recommendations are all about accountability: the patient’s as well as the physician’s. Accountability brings better results with healthier patients and reduced hospital readmission rates—both which on the face of it, are great things.
Unfortunately, our healthcare delivery system, as currently designed, is not set up to maximize patient and physician accountability. Specifically, in the way healthcare providers are currently incented for the quantity of care, not the quality. The good news is that this is changing.
All versions of proposed healthcare reform legislation include changes to our healthcare delivery system. Versions include such options as Accountable Care Organizations (ACO), Patient-Centered Medical Homes, bundled payment models, Hospital at Home pilots and care transitions programs. Each of these models is different and most have different meanings depending on who you ask. But they also have much in common, not the least of which is realigning payment and delivery system incentives for improving quality and coordination of care rather than rewarding fragmentation and quantity.
In my opinion, each one of these has merits and, if implemented successfully, has the potential to dramatically change and positively enhance the way we deliver healthcare, especially for those with chronic conditions. Whichever of these initiatives make it into the final legislation and end up with widespread adoption, two major themes are emerging: accountability and collaboration of care.
And that is what patient self-care is all about. Being accountable makes people healthier and keeps costs down. If healthcare reform is to succeed, and I believe it will and must, we ALL (patients, doctors, payers and administrators) have to be accountable for making the best decisions that keep patients the healthiest and reduce costs. And there should be rewards for healthier patients and lower costs. Finding a path to accountability seems to be the best answer.
