The Patient-Family Journey from Outpatient to Inpatient: Improving Quality and Safety With the Outpatient EMR and PCP Collaboration

By David J. Badolato, MD, in PSQH.

Most Americans agree that the healthcare system is in need of a major transformation to deliver value to all stakeholders; however, there are varying perspectives on what exactly is broken and how it needs to be fixed depending on each stakeholder’s definition of value. According to the Joint Commission Center for Transforming Healthcare, “an estimated 80% of serious medical errors involve miscommunication between caregivers during the transfer of patients” (Joint Commission on Accreditation of Healthcare Organizations, 2012).

In my view, this miscommunication is a result of two key issues in today’s healthcare system. The underuse of the medical summary derived from the outpatient electronic medical record (EMR) and the minimal communication between referring primary care physicians (PCP) and hospital providers have led to serious quality and safety implications for patients. Every touchpoint throughout a patient’s (and family’s) care journey can be positively impacted by optimal use of medical summaries and enhanced collaboration among healthcare professionals.

The majority of people seek to have their medical needs met at a primary care practice level; therefore, strategies and actions that improve safety, quality, and affordability for all stakeholders require highly focused attention and research to create new initiatives that can be readily implemented at that level.

Strong foundation: PCMH model

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Comprehensive Primary Care Plus

The Centers for Medicare and Medicaid Services provide an overview of Comprehensive Primary Care Plus (CPC+) and additional links for more detailed information.

Background: Through a unique public­ private partnership with 54 aligned payers in 14 regions (PDF) (/Files/x/cpcpluspayerregionlist.pdf), the CPC+ payment redesign gives practices the additional financial resources and flexibility they need to make investments that will improve quality of care and reduce the number of unnecessary services their patients receive. CPC+ provides practices with a robust learning system, as well as actionable data feedback, to guide their decision making. The care delivery redesign ensures practices in each track have the infrastructure to deliver better care to result in a healthier patient population. CPC+ is a five ­year model: Round 1 will begin in January 2017 and Round 2 will begin in January 2018.

Link to complete PDF

Care and Payment Models to Achieve the Triple Aim

This report was produced by the AHA Committee on Research and Committee on Performance Improvement.  It discusses seven key principles for a new care delivery system. Hospitals and health care systems are striving to achieve the Triple Aim – improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care. To achieve these goals, hospital leaders are designing new care delivery systems. Adoption of these new systems can be facilitated by new and innovative payment models that center on individual and community needs and reward high-quality care with desired individual and population health outcomes. Recent changes to Medicare reimbursements support building a care delivery system based on quality and value-based payment policies. The U.S. Department of Health and Human Services has set a goal of tying 30 percent of all traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models by the end of 2016, and tying 50 percent of payments to these models by the end of 2018. The 2015 American Hospital Association Committee on Performance Improvement studied design and redesign of a new care delivery system and identified seven key principles.

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What Is Value in Health Care?

By: Michael E. Porter, Ph.D.

New England Journal of Medicine 2010; 363:2477-2481December 23, 2010DOI: 10.1056/NEJMp1011024.

In any field, improving performance and accountability depends on having a shared goal that unites the interests and activities of all stakeholders. In health care, however, stakeholders have myriad, often conflicting goals, including access to services, profitability, high quality, cost containment, safety, convenience, patient-centeredness, and satisfaction. Lack of clarity about goals has led to divergent approaches, gaming of the system, and slow progress in performance improvement.

Achieving high value for patients must become the overarching goal of health care delivery, with value defined as the health outcomes achieved per dollar spent.1 This goal is what matters for patients and unites the interests of all actors in the system. If value improves, patients, payers, providers, and suppliers can all benefit while the economic sustainability of the health care system increases.

Value — neither an abstract ideal nor a code word for cost reduction — should define the framework for performance improvement in health care. Rigorous, disciplined measurement and improvement of value is the best way to drive system progress. Yet value in health care remains largely unmeasured and misunderstood.

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The Strategy That Will Fix Health Care

Michael E. Porter and Thomas H. Lee

In health care, the days of business as usual are over. Around the world, every health care system is struggling with rising costs and uneven quality despite the hard work of well-intentioned, well-trained clinicians. Health care leaders and policy makers have tried countless incremental fixes—attacking fraud, reducing errors, enforcing practice guidelines, making patients better “consumers,” implementing electronic medical records—but none have had much impact.

It’s time for a fundamentally new strategy.

At its core is maximizing value for patients: that is, achieving the best outcomes at the lowest cost. We must move away from a supply-driven health care system organized around what physicians do and toward a patient-centered system organized around what patients need. We must shift the focus from the volume and profitability of services provided—physician visits, hospitalizations, procedures, and tests—to the patient outcomes achieved. And we must replace today’s fragmented system, in which every local provider offers a full range of services, with a system in which services for particular medical conditions are concentrated in health-delivery organizations and in the right locations to deliver high-value care.

Making this transformation is not a single step but an overarching strategy. We call it the “value agenda.”

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The Doctor Will See You Onscreen

MARCH 10, 2014, The New Yorker

One night last summer, when I was working as a medical student in an emergency room, a woman pulled me aside. Her left eye was pink and looked painfully irritated. She had been waiting for hours to get it checked but would have to leave soon to catch a train home. How much longer, she asked, before she could be seen?

We buy groceries, trade stocks, and chat with friends across the globe without getting out of bed. Yet seeing a doctor remains a fantastically old-fashioned routine: minutes of medical attention can cost hours spent in transit or in a waiting room. When the price of losing that time gets too high, we might not even bother to be seen.

There’s a potential solution to this problem: using technology to deliver health care remotely. That approach, known as telemedicine, involves locating available doctors over the Internet and connecting with them, at a moment’s notice, using video chat. Telemedicine lets you see a doctor whenever and wherever you want, freeing you to choose a doctor based on merit rather than location. It can also improve the quality of medical care and reduce costs.

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