During the past several months, I have been engaged in a number of meetings with health professionals from almost every sector of the health system. This includes CEOs, CMOs, researchers, community-outreach professionals, hospitals, community pharmacies, federally-qualified healthcare centers, and individual health providers. It has been rewarding to hear them all accept the basic premise of the health reform measures, with the focus being on providing high quality health services, enhanced patient safety, and achieving improved, measurable outcomes. All at lower costs than we realize today. Regardless of the politics involved with healthcare reform, we are rapidly moving to a health-system that will hold health providers more accountable for the care that is provided to patients. If we remember the Institute of Medicine Report from 2001, Crossing the Quality Chasm: A New Health System for the 21st Century, we find that a fair number of the recommendations made in that report are the foundation of many of today’s reforms. And, these recommendations were made long before the initiation of the Affordable Care Act. However, we cannot take another 10-plus years to implement these necessary changes. Patients (especially Baby Boomers) are ready today.
Mentioned in that IOM report was the strong recommendation that interprofessional collaborations would likely provide the optimal care model. There was also the strong mention that utilization of information technology would be an especially helpful tool in providing healthcare. A review of the Centers for Medicare and Medicaid Services ACO Accountability Metrics for 2012 provides key insights into the achievable outcomes that are expected to be accomplished as quality targets for patient care. There will be increased emphasis to achieve these targets in an outpatient manner, directly in the communities in which patients reside. And, while there will certainly be different models and metrics for various health systems, one can clearly foresee that interprofessional teams will be the best method for better health outcomes for patients. No single practitioner will achieve significantly improved health for all of their patients, and entire communities cannot attain improved health relying upon single and isolated practitioners. It is time for all of the various components of the health terrain to become aligned to provide coordinated, patient-centered care.
And there begins the challenge. How can multiple health professionals succeed in working together on population-health driven intiatives, in a relatively short amount of time, when we have all been conditioned to practice in silos during our entire professional careers? Overall, hospital environments possibly have the best collaborative practices; but one aim of health reform is to keep people out of hospitals, except for the very sickest individuals. How can we create similar teams to treat entire communities? Here are some of my thoughts:
1) Revise Health Education for health professions students. The Interprofessional Education Collaborative was organized to create the “how-to roadmap” for teaching and training health professions students. This offers the best hope for transforming future healthcare landscapes. This was also a foundation of the IOM report.
2) Advanced utilization of Informatics. If interprofessional teams are to function effectively, there must be shared information among these professionals. Also, there must be an opportunity for patients to have access to this information. After all, it is THEIR information.
3) Implementation of Emerging Disruptive Technologies. Emerging health technologies are outpacing clinicians’ abilities to learn and implement them into clinical practice. Further, there are significant gaps in knowledge about the effectiveness of these technologies. Concomitant study and assessment of these technologies must be undertaken. Mobile Health technologies (prior blog) and Personalized Medicine (pharmacogenomics; DNA-based clinical decision-making tools) are two key futuristic technologies to watch.
4) Realistic Reimbursement Models. The databases of major health systems are driving informed decisions about the costs of health for patients. Morphing away from fee-for-service to realistic outcomes-driven payment models can allow for appropriate reimbursement of all health professionals that provide advanced care. Pharmacists, for example, should automatically be educating, monitoring, and assisting in the management and effectiveness of cardiovascular (chronic illness) medications, while being reimbursed for that service in addition to the product being dispensed. Information should be sharable between professionals associated with the care of a single patient, and the patient must remain at the center of all health-related decisions. And, all health professionals must be held reasonably accountable for achieving positive outcomes associated with delivery of health provisions.
Other components to achieve interprofessional collaborations include understanding population (public) health; implementation of the behavioral change necessary to achieve effective teams; acceptance of futuristic technologies (stem cells, robotics, etc); surveillance of bioethics; and the list goes on. One thing is certain, we cannot achieve a healthier nation until operative interprofessional collaborations are achieved. This must happen! Patients are waiting for us to get it right! #LetsMakeItHappen
