Quit Wasting My Healthcare

Strategy #7 for Improving Healthcare Value: It’s in the Systems

You must support patients with Organized Systems.

Let me start by painting a picture of low-value systems (or lack there of).  The patient has no primary care provider.  No one to call with questions.  No one to see on short notice.  The patient goes to the ER or an urgent care center when they are sick.  The patient self-refers to a cardiologist for chest pain, a gastroenterologist for heart burn and a rheumatologist for arthritis.  They order lots of tests and brand-name medications.  None of those doctors ever communicates with each other about the patient.  None of those doctors takes responsibility for all of the age-appropriate screening tests and immunizations for the patient.  The patient has a health event—severe headache with blurry vision—is hospitalized for three days, seen by the staff hospitalist who orders lots more tests and is discharged to the care of one of his three doctors—none of whom treats headaches.  No systems.  No organization.  High cost.  Poor quality.  Low value.

However, some patients receive care in a very high quality, cost-effective manner.  What does that patient’s care look like?  It involves high-value systems.  First, it starts with some sort of primary care provider—internist, family practice doctor, nurse practitioner or physicians assistant.  That provider diagnoses and treats the majority of the patient’s acute illnesses (a cold), chronic conditions (high cholesterol) and preventive care (age-appropriate screening and immunizations).  That provider gives the patient access to their office and staff in a way that minimizes ER and urgent care visits—same day/next day appointments, same day returned phone calls, on-call provider at night via an answering service.

Second, when the patient has a problem that is outside the scope of that provider’s expertise, the provider refers the patient to a specialist who is judicious in performing lab tests, imaging studies and invasive procedures.  The referring primary care provider knows the specialist is judicious because he has worked with her before.  Then there is communication between the primary care provider and the specialist to coordinate the patient’s treatment plan and medications—avoiding test duplication and drug interactions.  Organized systems.  Lower cost.  Better quality.  Higher value.

Steer patients to providers that use organized systems and you will improve healthcare value.  Those providers are out there; you just have to look for them.