Keep the patient connected and at the center of a system that learns in real time


It would be difficult to argue that health care in the United States was designed with the patient in mind. A statement like this is inherently controversial and would likely be viewed as heresy by many entrenched in the medical establishment, but I firmly believe it is true. This is not nobody’s fault per se, but rather the product of an amalgamation of policies, laws, regulations and funding sources that have created what is often referred to as the American health care system. Congress passed the Hill-Burton Act in 1946, providing funds for communities to build acute care hospitals, nursing homes, and other facilities in return for a commitment to provide care to everyone in the community that needed it. We ended up with a lot of hospitals – too many, probably – but there were still a lot of Americans without insurance and so too many of them had limited access to care. In terms of insurance, our history has linked employment coverage for working-age people and their families, while in 1965 creating Medicare and Medicaid programs to cover the elderly, low-income people, and the elderly. People with Disabilities. Yet these investments have consistently left 48 million Americans uninsured despite the United States spending about 17% of its gross domestic product on health care, which has been a major motivator for Affordable Care. The act and its provisions, which over a decade reduced that number of uninsured Americans to about 28 million. The fields of medicine and public health have long disagreed and competed for funding, with the medical and therapeutic orientation of medicine often trumping the more basic activities of surveillance and prevention, much to the surprise. of the population seeking coordinated leadership in the face of a public health crisis such as the COVID-19 pandemic. The phrase ‘social determinants of health’ seems to be all the rage in political circles these days, as many are discovering for the first time what we have known in decades: safe housing, food security, access to transportation and other basic needs can greatly affect health, often more than hospitals, doctors, drugs and devices, and yet for these needs we have created an additional patchwork of programs outside of the many health care programs. health described above.

Rather than being overly critical of our republic or hoping that our democratic country – founded on pluralist ideologies and governed by a federalist model – will quickly convert into a planned European-style society that can quickly and quickly tackle to a myriad of health and wellness issues. – related to challenges and needs, I would say that our best hope is a different path: innovation and real-time learning. Innovation is something valued and respected in America, and it plays well in political halls and in economic markets. The innovation needed in healthcare is theoretically simple: putting the patient at the center of everything and adding value over the status quo. And with all due respect to those, myself included, who have invested years in education to earn MD’s, MD’s or MD’s and the like, the innovation needed in care health care also requires those who understand our patients as customers and consumers: application developers, supply chain specialists, information technology gurus, team building coaches and those who may be. more comfortable operating in a virtual world rather than a world limited to bricks and mortar. Yes, I’m simplifying it a bit, and we don’t want to lose the strength of our clinical science business, but we desperately need more. systems science in addition to basic and clinical sciences, we also need to use behavioral and social sciences to better understand what motivates and drives our patients. And of course, all of this has to be done while creating value, which means it can’t cost more and in fact, we would like it to derive more value from the large monetary investment that we collectively make in as a nation in medicine and health. – related programs.

Articles from the December 2021 issue of The American Journal of Responsible Care® (AJAC) include multiple examples of attempts to innovate in different health care settings attempted in real time by various stakeholders. Yeager et al focus on how the use of case conferencing in a primary care setting, involving physicians, social workers, and community public health workers, can help connect the dots on patient needs by social determinants and potentially help direct patients and families to resources that may be available for assistance with housing, food, transportation and other basic needs. Lee et al present a formal assessment of the unexpected and pandemic-induced rapid transition to the use of telemedicine in a cardiology clinic, with the aim of understanding how it happened from a patient and provider perspective. and how it can be improved. I have heard from fellow clinicians tell me that the pandemic has catalyzed the adoption and use of telemedicine and associated non-traditional approaches to providing care decades later than what likely would have happened without the pandemic. . This is fine, but the need to adapt quickly means that there is a lot to learn that can be improved upon, including better understanding the benefits, as well as the limitations and acceptability of these innovations. In their commentary, Sherman and Klepper discuss how value can be created by buyers who contract directly with healthcare providers, potentially eliminating to some extent “middle parties” such as third-party administrators, who often extract dollars while providing services that are sometimes of great value. marginal value in the supply chain. Being innovative means being efficient in the way care is produced, and these authors suggest that much more is possible if provider organizations systematically assess their own production functions and have direct discussions with payers who “feed the pig.” By providing dollars for health care. business. And finally, Jennifer Bright’s commentary titled “Patient Value is the Root of a Learning Health Care System” reminds the reader that just as individual learning should be an ongoing endeavor, systemic learning should. also be. Yet in the frenzy of our day-to-day healthcare transactions, literally years can pass before organizations significantly stop evaluating whether there is a way to operate with less chaos. This is because even though we do demand and invest in learning at the individual level, such as continuing medical education for physicians, there is no proportional requirement for healthcare organizations to spend time and money. for systems learning, which could help better understand if and how the myriad parts of the healthcare business work together for patients. Bright cites the National Academy of Medicine’s definition of a learning health system as “a system in which science, informatics, incentives and culture are aligned for continuous improvement, innovation and equity, with best practices and findings seamlessly integrated into the delivery process, individuals and families as active participants in all elements, and new knowledge generated as an integral by-product of the delivery experience.1 It sounds like a utopia to me, and I don’t pretend for a moment that most health systems that I know or have studied can get there anytime soon. Instead, I would be delighted if these systems, often created by market-driven mergers and acquisitions and investor-driven attempts to prevent competing systems from gaining market share, simply added the above definition to the agenda for a board meeting and took 30 minutes to discuss the concept and honestly assess whether, in fact, their own system is on its way to truly becoming a learning health system.

In closing, I would like to thank our readers and many contributors for their contributions to AJAC in 2021, including the authors, peer reviewers and the editorial team. At the risk of using this platform to pontificate, I will come up with an idea for individuals and organizations who might be inclined to set “resolutions” or goals for 2022. My suggestion is to strive to innovate and learn in real time with the goal of making things better for patients and adding more value to the resources that have been provided to you to deliver health care. And if you do decide to set goals, be sure to collect data and objectively assess if what you are doing is making a difference, which is a basic tenet of a learning health system!

Dennis P. Scanlon, PhD


Comments are closed.