As the saying goes, “all politics is local”; so too is this round of healthcare reorganization. This should allay fears of national healthcare, but places significant responsibility on the shoulders of local communities. Some of us remember the reform dreams of the late 1980s and early 1990s when states were deemed the laboratories of health reform. The results of those reform efforts brought us managed care that focused on restraining costs by reducing the volume of care. Today, the healthcare system is encouraged to manage care and lower costs, but to also focus on the quality of care. Improving quality means rewarding value, not volume. It also means using technology to better coordinate patient care by reducing duplicate services, improving transitions of care by seeking the input of all health professionals, as well as other strategies for keeping patients connected, well and engaged.
What is becoming clearer is that this patient-centered focus creates new stresses on the healthcare system and its teams. Placing the needs of the patient front-and-center requires a significant shift toward collaboration. AACP and other health professions education organizations recognize that this shift in care delivery requires a shift in our education models. Team-based care demands team-based education that utilizes the concepts of leadership and control more frequently part of MBA programs than in health professions education. Patient-centered care recognizes how the individual patient is influenced by the environment or other individuals. This places the concept of population health as a primary component of individual patient health. Individuals in unhealthy communities are more challenged to live healthy lives.
The impact of the local community on individual and population health creates a market force for establishing integrated care delivery systems. If the system, whether defined as an accountable care organization or a primary care health home, is responsible for the patient in a holistic context, the local factor becomes very important in determining service areas, partnerships, community-outreach, technology needs and other strategies that combine health outcomes and successful business practices.
The local impact in healthcare reorganization provides a significant opportunity for academic pharmacy. It’s time to step outside your comfort zone and meet with the creators of these emerging integrated care delivery systems. Some of these innovative systems are being supported through the shared-savings programs initiatives administered by the Center for Medicare and Medicaid Innovation and authorized through the Affordable Care Act. AACP member schools are partnering with these CMMI innovators. While some innovators are not part of the CMMI program, they are establishing integrated care delivery systems that look very much like their CMMI-supported siblings. Either approach expects to improve the care experience for patients, improve the quality of care across the continuum, restrain costs and provide savings to the organization. Key questions include: What are the primary concerns of the systems’ creators? How do they envision meeting the need for improved health, better healthcare and lower costs? What are the specific performance goals they are establishing or are required to meet? What strategies are they developing for meeting and exceeding those goals?
Your local knowledge can offer strategies to help these programs address their specific concerns. The local conversations you and your colleagues are having will benefit your institution, faculty and students tremendously.
William G. Lang is Vice President of Policy and Advocacy at AACP; firstname.lastname@example.org.
Center for Medicare and Medicaid Innovation
Patient-Centered Primary Care Collaborative
Accrediting Association for Ambulatory Health Care
Accountable Care Organization
Primary Care/Patient-Centered Medical/Health Home