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OPINION

Health care should be structured around how patients experience it

Health care is organized around facilities and medical specialties, not around patients’ conditions or symptoms.

Health care is stuck in a bad place. It’s complicated, expensive, and fraught with disparities. Built to deliver acute care in a different era, health care services doesn’t work well enough at addressing the chronic diseases that account for more than 70 percent of US health care spending. This isn’t an indictment of the millions of dedicated professionals who provide care. It’s an indictment of a broken system that urgently needs transformation. Health care needs a new normal.

Fixing health care’s dysfunction requires access to effective care for everyone; changing how care delivery is organized so that it works better for individuals, families, and health care professionals; and redefining success as achieving measurably better health outcomes at lower costs. Getting those three things right won’t solve every issue, but it will enable better health for everyone.

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Efficiency necessitates providing effective early-stage care for all. Every country that has universal access to early-stage and preventive health care has lower per capita health care spending than the United States. That result holds in systems with a single-payer as well as those with universal coverage implemented through an array of health plans. The explanation is simple: Care is less expensive and usually more effective when provided at the early stages of a disease or condition. As a person’s health worsens, care becomes more expensive. For example, Type 2 diabetes is often reversible with appropriate early care. But if it goes untreated or is ineffectively treated, diabetes can lead to kidney failure, blindness, amputation, and disability. These results are devastating and life-altering for patients and families, and caring for them is extremely expensive.

Care needs to be reorganized for success with chronic disease. Most people with a chronic condition need services from multiple places, provided by caregivers who don’t share information or integrate their efforts. The result of this fractured care is more treatments, complexity, and spending, but not effective solutions tailored to patients’ health circumstances. That’s because health care is organized around facilities and medical specialties, not around the conditions or symptoms that cause individuals and families to seek care. The new normal needs services designed as solutions that support patients and clinicians to achieve better health results. This would mean a structure of care designed to serve patients who have similar needs, such as back pain or heart disease with high blood pressure. Care would be relationship-centered, with interdisciplinary teams working with patients throughout their ongoing experience and measuring outcomes so those teams can learn and succeed with more patients.

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Success means achieving the purpose of health care: helping patients and families improve health outcomes. Measuring patients’ outcomes remains rare today. Health care’s open, undiscussed secret is that most clinicians track processes but not results for each patient. Consequently, clinicians know what medicine was prescribed or procedure performed, but not how much the patient improved as a result of that care. Simply put, most clinicians work without feedback on the outcomes patients achieve. Even in orthopedic surgery, where functional outcomes are straightforward to measure, less than 10 percent of surgeons routinely track these outcomes. The lack of outcome measurement slows learning and improvement and is part of why health care often fails to achieve the results that it could.

Some organizations are getting it right in providing care for frail elders with multiple chronic conditions. Traditionally, frail elder care is reactive; treating the consequences of falls or providing hospital care for poorly managed heart disease are examples. As a result, frail elderly people get a lot of acute care in emergency departments, hospitals, and nursing homes, and the financial cost is extraordinary. Leading organizations (including Boston-based Commonwealth Care Alliance and Iora Health) are creating a new normal by offering care that starts with home support and necessary services to keep frail elders living safely and independently at home. Proactive care teams that include nurses, psychologists, pharmacists, and doctors prevent events that lead to very high spending on emergency and acute care. These teams improve the quality of life for elders who prefer to be home rather than in a nursing home, and they save money at the same time. Reducing the need for and costs of treatment by improving health outcomes is characteristic of the most effective health solutions.

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Achieving a new normal in health care won’t come from expanding traditional models or incrementally changing them. What’s needed is a new health ecosystem, structured around how patients experience health, dedicated to delivering effective solutions, and premised on consistently measuring the health outcomes that matter most to patients. The new normal in health care is being defined by organizations that design solutions around patients’ needs and measurably improve outcomes that affect quality of life and dignity of death.

Elizabeth Teisberg is a professor at Dell Medical School and McCombs School of Business at the University of Texas, Austin; executive director of the Value Institute for Health and Care, and the Cullen Trust for Higher Education Distinguished University Chair. Scott Wallace is an associate professor at Dell Medical School and managing director of the Value Institute for Health and Care.

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