Healthcare Delivery and Care Coordination Changes on the Horizon

With the implementation of the Patient Protection and Affordable Care Act (PPACA), the delivery of healthcare will transform in the near time horizon. These changes are driven by necessity. There are three key dynamics changing what healthcare will look like in the near future:

  1. Growing patient demand – increasing number of baby boomers going on to Medicare and the uninsured receiving medical coverage
  2. Declining number of physicians
  3. Reduction of reimbursement to healthcare providers

How the market responds to these dynamics is evolving though it will require a convergence of technology with a broader range of healthcare services.

Technology

Technology provides the infrastructure to support scaling of solutions. It will also be an enabler of delivering quality healthcare in a cost effective manner. Here are some examples of how technology is used today and we can anticipate expansion:

  • Telemedicine – Neurologist are on-call using a computer with a camera and live video feed supporting emergency room doctors to determining if the patient experienced a stroke, and if TPA should be administered
  • Medication Therapy Management – clinical staff will follow-up with patients on a regular basis to ensure they are continuing to take their medication as prescribed. Ensuring a patient’s proper following of a medication protocol and ongoing review of the patient’s condition supports high quality outcomes, prevents visits to the emergency room and readmissions
  • Case Management – Case managers will work with the medical team to map out the process flow, planning, and patient placement through the course of a scheduled procedure. The Case Manager provides the balance of planning the delivery of care to the patient in convenient locations while coordinating scheduled events with caregivers to ensure the best practice is followed while efficiently using the healthcare delivery system’s resources.

Broader range of services

Healthcare professionals outside of traditional services will deliver broader ranges of medical care. Due to the shortage of physicians and overutilization of a hospital’s emergency room for basic care, a triage system of care will be implemented. Nurses, pharmacists, and specialty trained clinical personnel will deliver basic medical care, preventive services, and chronic condition treatments/monitoring.

The front line of the triage process is a nurse that will direct the patient to the most cost effective point of care. Therefore, specialty trained clinical personnel (e.g. monitoring of blood pressure, treat minor clinical conditions) will deliver basic medical services whereas more serious clinical conditions are directed to the appropriate level of medical care. This approach guides patients to receive the appropriate level of care in the most expeditious and cost effective manner.

I would like to hear from the reader’s feedback if they are seeing a transformation in the delivery of healthcare and would they be supportive of this model.

5 comments Add your comment

Living With Open Eyes

December 21st, 2012
9:33 am

It would be cheaper(and more effective) for the patient to just go to any licensed general practictioner and let a trained medical professional-the doctor- decide where the patient needs to go for treatment.And then the insurance companies should just pay the bills: they spend more money trying to get out of paying than if they just paid up. Of course more than two thirds of the pencil pushers would have to join the real labor market then, and compete with the illegal aliens for real “jobs” that everybody swears are out there.

MyidealDOCTOR

January 2nd, 2013
1:03 pm

Telemedicine will be one of the fastest growing segments in healthcare due to these issues. It is cost effective and saves a tremendous amount of time. Telemedicine for your common and acute ailments is essentially a phone call or a web video diagnostic consult 24/7/365 by a U.S. based licensed physician. Prescriptions may be prescribed if deemed medically necessary. Telemedicine will be one of many changes needed in healthcare to control costs while increasing access.

Bob Wells

January 2nd, 2013
2:13 pm

I agree with the comments regarding Telemedicine. This is a service that has been proven to be a cost effective means of delivering high quality healthcare throughout the world. The U.S. population will need to start embracing these types of healthcare service offerings that is less in-person though just as effective as an office visit.

Detria

January 16th, 2013
4:47 am

I think it is a good transition, as a Transition Care Coordinator I see more of our elderly patients choosing to live at home. Sometimes getting them to the Dr. for a medication change or a check up can be difficult. Being able to communicate in this form is good for the patient in mind.

Kathy

January 16th, 2013
7:27 am

Unfortunately letting patients go to any provider created some of the mess we have today with poor quality outcomes and unsustainable costs. Managing an aging population with many chronic illnesses requires different skill sets. As an RN community care manager, working with many physicians and post acute providers, coordinating care and cost along the continuum is a necessity. This process requires elements of project management as well as care management. It is about team and that team is directed by a qualified, primary care physician. That is when the system works well for patients, families and all of us.