by Susan Eustis
Changes in the US healthcare delivery and reimbursement systems mean that doctors and hospitals will be reimbursed for making assigned groups of patients healthier. Reimbursement drives healthcare delivery. A change in reimbursement will mean rapid change in the healthcare delivery model. This change in the model represents coming change in the overall healthcare delivery systems.
As wellness centers replace traditional doctor patient relationships, there is going to be need for a lot of change. Nutrition and exercise make healthier people. This has not been the purview of hospitals and doctors. There is an inevitable move to wellness if the reimbursement moves to wellness. In order for doctors and hospitals to get the highest reimbursement, there is need for a lot of patient adoption of nutritional and exercise best practice. This is the best way for healthier patient groups to evolve.
This change will not be easy. Hospitals and physician groups are pretty set in their ways. They are often arrogant, mitigating against a culture of change. In some sense the arrogance is well founded because the doctors are the experts and deserve to be followed and not challenged. The doctor’s job is to deliver advice that is right and that needs to be accepted, not questioned. But, the doctors are arrogant. One nice doctor when I told him about the coming IBM Watson said, “Where’s the swagger?”
In any case, the difficulties of implementing massive change in the healthcare delivery system are massive. To be able to move in whatever direction is required at the moment has not been a hallmark of the healthcare delivery system. The doctors and hospitals are the very last group to embrace and adopt automated process, even the military has been considerably faster.
When that change in reimbursement comes in, which it is starting to do already, when the reimbursement is really tied to wellness and how well the patients in a group are faring, the first thing the administrators are going to say is, (to quote Tom Hanks in another situation) ‘We have a disaster on our hands.’ Now is the time to say very calmly and quietly respond, ‘Let us see what we can do about wellness, lets take care of this, don’t worry.’ The issue is to address the solutions that will maximize reimbursement for the healthcare providers, whatever they are. Reimbursement drives healthcare. If the reimbursement is tied to wellness, things will change in the care delivery solutions provision.
Wellness using nutrition and exercise is part of the solution. Then there are other aspects, introducing efficiency into the care delivery system. As part of solution to making groups of patients more well, there may be a strategy of matching patients with doctors who are specialists in treating particular configurations of conditions presented by particular patients.
Just as you want a surgeon who is specialized, who operates on a particular part of the body every day instead of a surgeon who only does that once a year, so also, it is necessary to have specialists treat the patients conditions they are most familiar with. Herein lies the best use of tele-medicine and computers like IBM Watson. There is a matching service so that the regular doctor immediately connects, via video with the appropriate physician for care delivery and that care is effected immediately and by the specialist who is more appropriate.
So this wellness task is somewhat like a dating service, matching patients and specialists where the regular doctor (or his nurse) has a physical presence with the patient and the specialist is available via video.
IBM Watson holds some of the keys for implementing some of this health care delivery system model change. IBM Watson is a computer that is likely to be available in the cloud as illustrated in other blogs in the series. A recent meeting in Waltham MA IBM Campfire series to doctors illustrated the value of Watson to a regular physician practice. Watson is an analytics and natural language computer. It is supported by a lot of other IBM technology, in particular IBM WebSphere systems that provide application server and mobile application development capability. These IBM WebSphere mobile systems can be used to develop apps. Apps are what the hospitals and physician practices are going to use to roll out new patient wellness programs.
The aspect of the wellness task is to switch hospitals and physicians to providing wellness is thus dependent on wide adoption of smart phones and tablets which is already well underway for both patients and clinicians. The real need is to do wellness programs now. It should be open systems approach, people like their own nutritional counseling and their own exercise programs, the point is that they do them, not that the healthcare delivery system dictate what is being done. The point is that some program be adopted and monitored for each patient. (That folks is all of us.) There are a lot of people who provide wellness better than the hospitals and doctors do, yet it is the doctors and hospitals that get reimbursed for wellness so there is a major disconnect here. An open systems approach will probably work best.
The issue is to find and use automation that matches patients to solutions for achieving wellness. Apps work here. Systems have to be able to quickly and with lightening speed go through a file that says who is the best person to take care of this and to make the match. Tele-medicine and tele-health promise to be a part of these solutions.
The problem is to match skill sets with the tasks at hand. This is true for exercise and nutritional programs, and it is true for finding the most efficient and effective treatment for different patient illnesses.