Working together to deliver exceptional, patient-centered care.
By William A. Fera, MD
We are entering a new horizon in healthcare. The delivery system is transforming rapidly from siloed, provider-centered, volume-driven care to integrated, patient-centered, outcome-driven care. In the years to come, the key to achieving high performance and patient-centered goals will be the ability for physicians, hospitals, payers and other stakeholders to collaborate.
Derived from the Latin collaborare, meaning “to labor together,” the concept of collaboration involves building relationships through productive interaction and working together to achieve something of value. In healthcare, that something of value is the triple aim: better care for individuals, better health for populations, and lower per capita cost for healthcare overall.
Below is a look at the primary drivers of industry collaboration and their implications for healthcare providers.
New Payment and Delivery Models
In the quest to deliver quality healthcare and “bend the cost curve,” new delivery and payment models represent a migration from fragmented care to coordinated care, volume-based to value-based payment methodologies, and individual encounters to the overall health of defined populations. Close collaboration between hospitals and physicians in concert with payers will create the infrastructure for these new models. The shift toward integrated delivery requires that providers of care be integral partners in developing cost-saving initiatives, shared savings plans and metrics for gauging quality.
The Patient Protection and Affordable Care Act (ACA) is a prime catalyst for collaboration, providing incentives for highly coordinated care, delivered with greater efficiencies and at lower costs. It has spawned a range of pilot payment programs in both the federal and commercial sectors, from patient-centered medical homes to Accountable Care Organizations and to a variety of risk-sharing models, bringing organizations new opportunities to collaborate in care delivery and share derived financial rewards. Healthcare providers seeking to pursue these opportunities need to assess their capabilities in a new light and find complementary partners.
The Consolidation Wave
Healthcare and hospital mergers have increased significantly in 2010 and 2011, and the trend is expected to continue through this year and beyond. In fact, a recent survey of hospital leaders found that 78 percent of organizations are exploring or have mergers and acquisition deals under way.
The main driver of planned acquisition activity is to gain share in new markets, either product or geography. Transactions range from hospital acquisitions of physician practices at one end of the spectrum, to the formation of Accountable Care Organizations at the other–and a variety of mergers, joint ventures and collaboration agreements in between. Hospitals and physicians are expected to continue to fortify their positions through consolidation strategies that ensure their viability and add breadth and depth to their service offerings.
Health Information Technology
Emerging technologies enables collaboration to better coordinate patient care. Along with reducing medical errors and improving administrative efficiencies, health information technology also helps providers navigate changes in reimbursement and manage costs.
For thousands of hospitals and physicians across the country, electronic health records, spurred by federal incentive payments, are the new norm. Health information exchanges, enabling information sharing among multiple providers, facilitate collaboration across systems and settings in the continuum of care.
In the new era of collaborative care, they will enable vital communication at critical care transitions, as well as provide data analytics to determine best practices in improving quality while reducing costs – aggregating data to collaboratively manage individual patients as well as entire populations.
The patient-centered approach–through which effective care is determined by a team of health providers in consultation with patients and delivered to achieve the best outcome for the patient–is cited by many as the primary cure for what ails our healthcare system. Numerous studies have found that safety and quality of patient care are directly linked to a collaborative clinical environment.
A truly effective healthcare team engages physicians, nurses, pharmacists, technicians and other professionals in shared ownership of the patient-care experience. High-functioning, collaborative teams typically navigate complex tasks with greater ease, develop more integrated care plans based on collective experience and coordinate their activities more efficiently.
With the emergence of new care-delivery models, the patient-care team will need to extend to clinicians outside the hospital environment, calling into play even more the ability to solve problems interactively, make decisions collectively and coordinate care seamlessly across specialties, disciplines and settings of care delivery.
New Relationships with Payers
Providers and payers have one of the most complex relationships, and the most crucial, in our healthcare system. Emerging regulations, new payment models and an expanding delivery environment have accelerated the need to move beyond a history of adversity to align interests and collaborate in patient-centered care.
Many have heralded the current climate as a new beginning of shared incentives to come together in delivering the most cost-effective and medically appropriate care. They also are applying new reimbursement methodologies that focus on measuring and rewarding evidence-based standards and well-defined outcomes, building the technology infrastructure for sharing and analyzing clinical and claims data, and creating new ways to engage patients in a technology-savvy world.
Partnerships in Wellness
The ACA includes numerous mandates and incentives that promote wellness and healthier lifestyles. Successful partnerships among many stakeholders will be needed to create initiatives for improving health while helping to conserve limited public healthcare funds.
Healthcare providers are collaborating with community partners–from schools to community health centers, government agencies to local and regional nonprofit groups– to develop wellness programs. Initiatives range from providing early interventions for at-risk, first-time mothers and developing wellness centers for seniors, and also to fighting childhood obesity through after-school recreational programs and engaging the media in creating messages about healthy eating and living.
The Leadership Challenge
In the midst of a radically new healthcare reality, provider care organizations will be called upon to reinforce an integrated system, an inter-dependent culture and an innovative approach to patient-centered care. They will need to create a clear and compelling vision of the collaboration imperative. They must work purposefully in bridging the divide between disciplines, across geographies and throughout emerging partnerships.
The transformative power of collaboration begins and ends with leaders who passionately believe in it, genuinely live it and continuously pass it on. Success requires realizing that there is only one way to move forward: together.
The views expressed herein are those of the author and do not necessarily reflect the views of Ernst & Young LLP.
Dr. Fera is a principal in Ernst & Young’s Health Care Advisory Services practice based in Pittsburgh, Penn.
This article highlights major trends discussed in Ernst & Young’s annual publication for the provider care industry, New horizons. Access the report at www.ey.com/US/en/Industries/United-States-sectors/Health-Care