Results of implementing the Health Rosetta
18 Elements of the Health Rosetta
However, most can be implemented individually.
1. Transparent Medical Markets
Wildly variant, opaque pricing for items such as scans, surgeries and other medical services. If there is any price/quality correlation, it’s inversely correlated. Sometimes “transparency” solutions are available giving the best, bad deal while still having co-pays, deductibles, the oxymoronic "Explanation of Benefits", etc. and all the other things that make for a horrible consumer experience.
The good news is there is a solution to the most vexing problem healthcare has had -- pricing failure.
- Fair, fully transparent price to employer/individual at high quality centers who readily accept quality reporting such as Leapfrog.
- Providers able to set a price that works for them while avoiding claims/collections hassles and accompanying receivables.
- No charge for individual going to these providers. No EOBs, bills, etc. -- just a thank you note.
2. Concierge Style Employee Customer Service
3. Value-based Primary Care
- Flawed reimbursement incentives have turned primary care into “loss leaders” that are like milk in the back of the grocery store (i.e., low margin designed to get people to high margin items)
- Short appointments due to not investing properly in primary care
- Primary care shortage due to making primary care discipline unappealing
- Long wait times to get in can lead to small “fires” blowing up
- Medically unnecessary face-to-face appointments clog the waiting room and delay care for people who truly need face-to-face encounters
- Record levels of dissatisfaction & burnout amongst PCPs
- High Net Promoter Scores
- Quadruple Aim leading organizations
- Ounce of prevention is worth a pound of cure
- Same or next day appointments for issues not addressed via email/phone
- Extensivist (for the sickest patients) has smaller panel allowing proactive care management & coordination.
- Can reduce issues 40-90% and spending 20-50%
4. Access to World Class Acute Care for Complex, Expensive Procedures
Due to the infrequency of these procedures (transplants, neurological procedures, cardiac, spine and other six-figure or more procedures), the Transparent Medical Network is a good tool to pair with this since those procedures happen more frequently. It raises the visibility and understanding how there is wide variance in value between different provider options.
- Second opinions at no charge for employee at world class Centers of Excellence facilities (e.g., Mayo & Cleveland clinics)
- Unit cost often higher but lower complication rates & avoidance of unnecessary procedures makes it have a strong ROI.
5. Aging & End-of-Life
6. Retirement Healthcare Costs
7. Quality/Safety Embedded in Provider Network
8. Active ERISA Plan Management
- Fully-compliant ERISA plans that protect companies from abuse
- ERISA fiduciary oversight and review at least as strong as 401k oversight and management
- Use TPA networks focused on high quality providers and geographic coverage
9. Actionable Analytics
Focus on data ==> information ==> knowledge ==> wisdom Example: MyHealth Access Network (an HIE in Oklahoma) can provide analytics offering advanced decision-support tools such as Archimedes IndiGO. This tool integrates dozens of health/disease determinants to provide previously unavailable treatment guidance based on medical evidence.
10. Value-Based Plan Design
- Designed to encourage appropriate health-seeking behavior and avoid over treatment & lower value providers.
- Strategic use of copay reductions or waivers, premium reductions, and health saving contributions.
- Leading employers recognize not all incentives are financial — e.g., convenient, no cost primary care
11. Direct Resources to Evidence Based Tools
- Minimum of 30% of care not evidence based
- Only about half of that care for which good medical evidence based guidelines exists is actually rendered according to guidelines
- Massive overuse of imaging (e.g., 80M CT scans/yr in US)
- Codifying Choosing Wisely & Consumer Reports recommendations
- Designing EHR systems to provide point-of-care evidence-based decision support: important information must find the physician at decision time rather than the physician needing to find that information.
12. In-Depth Pharmacy Management Woven into Primary Care
- Pharmacists represent another medical silo frequently uncoordinated from rest of system
- Frequent duplicative & conflicting prescriptions
- Adherence issues due to cost, complexity and lack of understanding
13. Disease Specific Care Pathways
14. EHR Technology
- Most EHRs are designed around the need for documentation & billing accuracy, and are obtrusive to the clinical visit. Perverse payment incentives trump clinical efficacy.
- More personal health records have been accessed by hackers than have been made easily available to patients themselves
- Modern EHRs provide physicians with robust real-time decision support and deliver the interoperability to deliver the value of health information exchanges
- Secure, easy and open access to one’s own health records will be made as available as other sensitive data such as financial records
15. Community-Based Health Initiatives
16. Health Information Exchanges
- Currently an aggregator of clinical, hospital, imaging and laboratory data including admission, discharge and transfer
- Users generally must actively fetch data
- Sequestration of health information at provider or system level may inhibit consumers from seeking care from independent providers providing higher quality and service at lower cost
- HIE data tightly integrated into individual EHRs to present a global view of patient.
- Actionable and critical data in HIE must be pushed to those providers able to act on those data. HIE data on diagnosis and medications pushed to first-responders in the field.
- Analytics capabilities sit atop data repository to provide unique Big Data reports
- Employers and public health have access to de-identified Big Data to guide planning, regulatory and purchase decisions.
- Availability of information through HIE allows consumers to seek care based on value without fear of missing information or care coordination failure
17. Coordinated Care
Care may be fragmented in two situations leading to preventable errors:
- When a person is receiving care from two providers, especially when that care exists in different places at different times and
- During transitions of care when one provider takes over from another.
Examples include a patient seeing several specialists as well as a primary care physician; A patient transitioning from hospital to home, hospital to skilled nursing facility or to a hospital offering a higher level of care.
- Providers coordinate care by asynchronous communication facilitated by electronic health record systems, either by sharing the same system or through a health information exchange
- Providers utilize HIE for direct, secure communications between primary care and specialty care, such as Doc2Doc, which can reduce unnecessary in-person consultations
- Provider provide warm handoffs during transition of care, up to and including POTS dialog when appropriate. Providers commit to thorough and timely documentation, especially for discharge and transfer summaries.
- Providers and specialists develop treatment compacts that avoid duplicative testing and treatment or conflict
18. Wellness Initiatives
An intermediate level of care between ordinary wellness and conventional preventive care: Alignment between wellness and primary care to focus on that portion of population that is well but at increased risk for common diseases such as diabetes. With many specious ROI claims in the Wellness field, independent and credible third-party validation should be part of their program (e.g., Validation Institute).