Our current healthcare system isn’t plagued by one large problem but rather many smaller issues, including staff shortages and provider burnout, lack of access to quality healthcare, and rising healthcare costs.
Barriers to Care
It is estimated that by the 2030s, there will be a shortage of 124,000 physicians and 200,000 nurses due to retirement and burnout – a detriment to an aging population suffering from many chronic illnesses. In addition to staffing shortages, older Americans often face barriers to health, including a lack of options in rural areas where it can become challenging to travel long distances to providers, difficulties using medical charts and understanding medical information, and the struggle with the transition from private insurance to Medicare.
When they are able to access healthcare, Americans often struggle to afford it. According to recent Kaiser Family Foundation polling, approximately half of adults in the U.S. find it difficult to afford healthcare costs, with one in four stating that they or a family member have struggled to pay for care within the last 12 months.
How Can We Address Barriers to Care and Decrease Healthcare Costs?
These barriers, like many others, make administering and accessing care complex.
“Care is all about the relationship between one person that wants to help someone and one person who needs help… between them are the prior authorization people from the insurance company, and the schedules, et cetera,” says Dr. Amy Compton-Phillips, current President and Chief Physician Executive at Press Ganey and Vytalize Health Board Member.
Dr. Compton-Phillips spent the first 22 years of her career as a physician at Kaiser Permanente, starting as a frontline clinician at two medical offices back in 1993. Compton-Phillips began practicing value-based care right out of the gate, eventually becoming Chief Quality Officer at Kaiser. She was then recruited to a fee-for service environment at Providence, quickly realizing how different both were.
The stark differences in environments prompted her to ask questions like, “how do we make the right thing easy to do for clinicians and help keep people healthy and well? Essentially, how can we decrease the complexity in the healthcare landscape and enable great outcomes at an affordable cost for all?”
Though Dr. Compton-Phillips started her medical career in a value-based care environment, the reality is that the care delivery model is still in its early stages. “Currently, we are [only] 10% to 20% penetrated with a huge upside opportunity,” she says.
Value-based care provides a huge opportunity for providers and practices to lead the changes they want to see in healthcare. Accountable Care Organizations (ACOs) like Vytalize are working to drive affordability while improving patient experience and ensuring high-quality care.
Compton-Phillips suggests that the two crucial foundational elements with the most significant impact on improving care quality while reducing costs are hospital days and coding. In order to deliver top-notch care to patients, healthcare providers need to be adept at identifying, documenting, and monitoring chronic conditions. Furthermore, when dealing with patients suffering from chronic illnesses, it is vital for physicians to authorize only the essential duration of each hospital stay, ensuring optimal use of healthcare resources.
How can providers keep these patients out of the hospital? By ensuring that they work to keep high-utilizers well and in care management programs that better address their health concerns, while still proactively managing conditions that are predictive of high-utilization.
Also influential in improving health and lowering costs is the integration of storytelling and data. For Compton-Phillips, one cannot exist without the other. She uses the analogy of the head and the heart, coupled with psychologist Jonathan Haidt’s the Rider and the Elephant. “The Rider often feels like they’re in control. But, if the Elephant gets spooked and wants to go another direction, there’s no way that the Rider is going to be able to control the Elephant. The Rider is the head, and the Elephant is the heart, and in value-based care, the Rider is the data and statistics while the Elephant is the story. To influence behavior change, we must bring data to life with anecdotes, essentially enabling the Rider and Elephant to move in the same direction.”
How to Know Where You are Going When You Have No Map: The Future of Value-Based Care
Value-based care is already revolutionizing the way we look at healthcare and the possibilities of a system that provides the best care at an affordable cost. The opportunities to truly impact the way clinicians provide care, eliminate waste (whether that is time or financial), and improve the health and wellness of patients are endless.
Compton-Phillips recognizes that there is no map to where we are going. She asks, “what is the pathway of the best odds to have the right success for the [patients] we serve?” noting the similarities between her work to treat the first COVID-19 patients in the United States and Vytalize’s work to be the best facilitator of people’s health through a fairly new care delivery model.
Though this elusive map does not exist just yet, she is hopeful we can get to the destination because “there is always the capacity to learn more, discover more, and to be delighted and surprised. If folks can wonder about information and seed their brain with ideas, they can continue to grow – and the same goes for value-based care.”
At Vytalize, we understand that the journey to a better healthcare system is uncharted. Yet, we see this as an opportunity to shape the course alongside partner providers, practices and patients.
If you’re a provider hoping to navigate the uncharted waters with a trusted partner in value-based care, contact us today!
