The U.S. healthcare system is undergoing a dramatic transition as the industry strives to achieve the goals of the Affordable Care Act (ACA) to improve an inefficient, unsustainable system. Physicians, insurers, pharmacists and other players in the patient care arena are shifting roles and forming more collaborative, coordinated networks to fill the gaps in care and reduce practice redundancies.
What are the key changes in this new healthcare scenario? Part one of this seven part series discussed what’s ailing in the traditional model. In part two of this series dedicated to the emerging role of the pharmacist in the healthcare ecosystem, the topic of challenges of healthcare reform is discussed.
Challenges of Healthcare Reform
Clearly, our healthcare system must change so we can provide more effective, efficiently administered, holistic care for patients. Action is urgently needed to fill gaps in the system, synchronize care among all healthcare team players, improve coordination of care between sites providers and more strategically allocate resources.
The primary focus should be on the patient and improved outcomes, which may best be achieved with more comprehensive, coordinated primary care. However, considering the limited time of the primary care physician facing a growing population of aging and chronically ill patients, many aspects of primary care can be transferred to other care team members, such as pharmacists and nurses. Pharmacists are well equipped to expand their role, shifting from the outpatient pharmacy risk bucket to the whole-patient risk bucket.
The healthcare system already has many of the needed resources for high-quality care, but it must be better organized to optimize efficiency and improve patient care. The system needs technology that integrates all patient information in a single database where medical records can be accessed quickly by all care team members. An incentive model is needed for each team player, as well as a mechanism to share the total cost-of-care risk with other providers and payers.
Among the greatest gaps in the patient care continuum are: follow-up care after hospital discharge and outpatient procedures, monitoring adherence to prescribed treatments and comprehensive care management of chronically ill patients. Recurrent hospitalizations represent a substantial and often preventable human and financial burden, with 19% of Medicare fee-for-service patients re-hospitalized within 30 days of discharge. Half of the re-hospitalized patients never see an outpatient doctor prior to re-hospitalization.4
Such gaps and fragmented care highlight the need for a whole- system approach to care delivery, where performance is measured and providers will be held accountable for performance across the continuum of care.
Part three of the series will discuss New Models of Patient Care.
Previous Articles in Series:
4. Hansen L. Transitions of Care and Hospital Readmission: Understanding Risk and Risk Reduction. Excerpt from Rehospitalizations Among Patients in the Medicare Fee-for-Service Program by Jencks SF, Williams M, and Coleman E. N Engl Med 360;14. April 2, 2009.