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DIY Healthcare System: The Future: What’s Ahead?

Posted on Wed, Dec 31, 2014
DIY Healthcare System: The Future: What’s Ahead?

BY: TOM PECK

“You all are in the cat bird’s seat. Because you are in the hospital most of the time and in the ED particularly, the common pathway for entry into the hospital, you know what’s going on better than anyone else. You are in the best position to implement change. You are in the right spot at the right time. Our country needs your help.” With those words, David Nash, MD, MBA, dean of the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia, opened EmCare’s 2014 annual conference with his presentation entitled, “Population Health & Quality in the New World of Health Reform.”

Dr. Nash, an accomplished educator and author, was instrumental in founding the country’s first school of population health. A board certified internist, Dr. Nash is passionate about the need to reform America’s healthcare system.

He divided his presentation into five parts:

  • How did we get into this jam?
  • What is quality in healthcare?
  • What’s population health, anyway?
  • What is health reform and what’s its special connection to quality, safety and accountability?
  • What’s in the future?

Over the next few weeks, we’ll post key takeaways from Dr. Nash’s presentation.

The Future: What’s Ahead?

Dr. Nash outlined his vision, and the vision of other leading organizations, for the healthcare system of the future. Every physician will be a leader. The system will require physician leaders who "get it" and want to promote the notion of physician leadership.

The IOM published a CEO checklist for high-value healthcare. Foundational elements include a priority on governance and a culture of continuous improvement. Infrastructure fundamentals include IT best practices, evidence protocols and optimized resource utilization. Care delivery priorities include integrated care, shared decision-making and targeted services tailored to the population. Reliability and feedback components include embedded safeguards and internal transparency in terms of performance, outcomes and costs.

What’s just over the horizon? PQRS, the ambulatory report card will contain provider information including facility and physician. How can the healthcare community use the information within the context of reform and how will the public use the information?

The Accountable Care Act mandates that a tax-exempt hospital perform a community needs assessment at least every three years. Using a fairly prescriptive template the report is intended to help the organization improve its services to the patient population it serves.

What does this all mean? Dr. Nash closed his presentation by proposing three major themes – transparency, accountability, no outcome – no income. The culture of the US healthcare system and the parties operating within it must change. In the future, the culture must:
 
  • Practice based on evidence
  • Reduce unexplained clinical variance
  • Reduce slavish adherence to professional autonomy
  • Continuously measure and close the feedback loop
  • Engage with patients across the continuum of care.

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