As healthcare workers, CRNAs have an interest in the future of healthcare.  In an era where the healthcare industry is tasked with producing better patient outcomes at a lower cost, it is becoming more apparent that the status quo is not working.   In the October 2013 issue of the Harvard Business Review, Authors Michael Porter and Thomas Lee discuss changes that are intended to address the challenges of faced by our current healthcare system.   Below is a brief review of the major points.  Click here to review the original article.

Both healthcare consumers and payers are not happy with our current model for healthcare delivery.  They agree  that it is now time for a new strategy that maximizes value for patients.  The authors foresee the future of healthcare being organized around the patients’ medical condition rather than Physician medical specialties.   The future of healthcare will move away from supply driven healthcare based on what physicians do and move to a consumer driven system based on what patients need.  This change in has been termed the “value agenda”.    With this agenda, the overreaching goal for medical providers as well as all stakeholders must be improving value for the patients.  To do this, the healthcare system must either improve outcomes without increasing cost or it must lower cost without compromising outcomes.

This excellent article continues with a description of areas that need to be addressed in the move from the current state to the future state of healthcare.   The Authors identify 6 essential components:

• Organize into integrated practice units:  This changes the way healthcare workers are organized to deliver care.   In this model, care teams are organized around the needs of the patient.  Dedicated teams of clinical and non-clinical workers come together to provide everything that is needed to treat a specific medical condition.  In this model, the patient could go to one location and receive medical care, therapy and other support by an integrated team who work together to ensure optimal outcome for the patient.
• Measure outcomes and cost for every patient: Current quality metrics do not measure quality but rather processes.   In the future state, patient outcome and the cost to achieve it will measure the value received.  Rather than assessing how many treatments were given, providers will be measured by whether or not optimal results were achieved.   In this model, all providers must work together with the common goal of improving outcomes.   Physicians, nurses, therapists, and others must all work as a unified team focused on the patient.
• Move to bundled payment for care cycles:  Fee for service rewards the volume of care delivered but not the outcome achieved.   Bundled payment encourages teamwork and high value care.   Wallmart recently introduced a program which identified centers of excellence for specific medical conditions.   A single bundled payment is made for all the care necessary and the provider team must work together to deliver an excellent outcome within parameter of the bundled payment.   In this system, teamwork and focus on patient outcome are essential.
• Integrate care delivery systems:  As the healthcare system moves to bundled payments, care for specific conditions will be concentrated into fewer locations with healthcare teams who specialize in that condition.   Integrating healthcare delivery offers the patient a “one stop shopping” experience at a place known for excellence.  Having highly skilled professionals working as a team with a high volume of patients with a specific condition encourages excellence.  Patients may need to travel farther but will receive the best possible care.
• Expand the geographic reach:  Once a team of healthcare providers has achieved a level of excellence treating a certain medical condition, the system must leverage their expertise by increasing the volume of patients they treat.  Rather than duplicating efforts at every clinic in the system, referring patients to a high excellence/high volume location will both improve outcome and reduce cost.
• Build an enabling information technology platform:
  A supporting information technology system is required to support all of the elements described above.   The current model of silos of healthcare delivery has allowed technology to develop within each silo.   Moving to the future state of integrated care, one data platform that can be accessed by all members of the team is essential.

The healthcare system is changing.  Those who cling to the past will become dinosaurs.  Patient safety and satisfaction combined with improved value (improved outcomes) will be the hallmark of the future of healthcare delivery.   How will this play out for CRNAs?   Rather than your value being totally at the head of the OR table, expect to become part of a collaborative team focused on patient outcome.   As centers of excellence emerge, the variety of cases you do may become narrower as your team is called upon to do a higher volume of patients with similar conditions.   Expect to play a larger role in the overall peri-operative experience of the patient to include postoperative care.

In the era of healthcare reform and changing expectations of patients and payers, the only thing that is certain is that changes will be made.

Click here to read the original article