Follow the Patient, Not the Money, for Quality, Cost-Efficient Healthcare

By Richard Watson, MD, Co-Founder, Motient
Twitter: @Motient_io

It would not be surprising to anyone associated with healthcare to state that money drives the motivations and decision-making in the industry. It is certainly noted that the rank-and-file patient care cohort continues to carry the quality torch, but even these voices are filtered through a complex algorithm of “metrics” and “standards.” It has long been noted that the easiest way to control this US healthcare behemoth was through constriction of the dollars and then releasing surplus through carefully gated wickets. And so, as one could imagine, all behavior is now judged against the perceived disruption of revenues.

Now, during the last two years of navigating the rapidly decreasing number of resources, facilities and systems have come to the end of mitigations. The need to move patients creatively in the environment of no hospital capacity and the flexibility needed to make decisions on the fly is not supported in the current CMS reimbursement environment of comply or appeal. Even the easing of constraints does not offer the motivation and direct view to revenues that our health care system requires.

Connecting the Right Resources to the Right Needs

What will it take to comprehensively adapt to a rapidly changing environment? If we approach the answer from the standpoint of what is lacking in the current environment, it would be quickly evident that the system has little ability to match needs with resources. Continuing to push the needs of the patient back to the pinnacle of health care decisions must be the fundamental guiding light for decision-makers. Next, the system should have the ability to assess, categorize and apply the correct resource to the correct need. Standardizing this idea of capability is critical to understanding capacity, which is crucial to the idea of margin in the system. But that is not the whole story. When a new movie hits the streaming services, and suddenly the network is dealing with an isolated surge, the server confirmation flexes to meet demand. The system is decentralized so that multiple resources can be dealing with the traffic, not just a central hub. The math surrounding distributive networking comes into play to shift resources to areas of need. No doubt we are a ways from that dream in healthcare. But we can begin to reward those types of behaviors in the reimbursement process.

Systems that consistently assess the acuity and needs of the patient, track and connect with ecosystem resources using consistent methodology as well as analyze post hoc for trends and outcomes should be rewarded. These small steps are quickly obtainable if the revenue path is clear. We must continue to embrace the idea that matching the right patient with the right resource at the right time is the surest path to the highest quality, cost-efficient care. The technology is there to deal with this environment, and interested groups can see this vision. The question will be if larger facilities and particularly larger health systems can look beyond their own desire for advancement and make the choice to join the ecosystem. I can imagine that the disincentives for that type of protectionist behavior will have to be in place.

We Must Change for the Better, and for Each Other, to Get Where We Need to Be

If there is a lesson we should learn from the last couple of years, it is that we are all in the same sandbox, and we need each other. Citizenship in this privileged industry requires us to care about each other and look beyond self-interest. We no longer have the luxury of a never-ending supply of healthcare, and it will take several years to build back from where this pandemic has taken us. The reimbursement system must change, not only to recognize from where we have come, but those changes must also take us to where we need to be.

This article was originally published on the Motient blog and is republished here with permission.