May 1, 2015

Healthcare in America – Part III: Towards Integrated, Collaborative Care

Healthcare in America, Jared DuPree

By Jared DuPree, PhD, MBA

Note: This is the third article in a six-part series over 2015 addressing healthcare in America.

If you didn’t have a chance to read the first two article of this series, Click here to read Healthcare in America (Part I): A New Way of Thinking where I discussed these new ways of thinking that are shaping the changing landscape of healthcare:

1. Physicians and providers want the freedom to treat people the best way possible.

2. Physicians and providers want to focus more on prevention and long-term health strategies.

3. Physicians and providers realize that in order to truly help people, they need to work together and treat the entire person including mind, body, emotions, relationships, and lifestyle.

Click here to read Healthcare in America (Part II): A Changing System, A New Set of Rules where I suggested there are four new rules in our system of healthcare that will impact us greatly:

1. Insurance companies are investing more in wellness incentives and services. Insurance companies, Medicare and Medicaid are extremely motivated to help patients be healthier because it saves them money.

2. Providers are more incentivized to provide services that improve overall health and wellness and prevent sickness due to incentives in the market and by insurance companies.

3. Consumers have more choices on how to take care of their health. Health savings accounts, high deductible plans and concierge medicine is making it possible to for consumers to save more money and get better care while incentivizing them to be healthy long-term.

4. Corporations are more incentivized to provide innovative healthcare solutions to employees. Corporations realize that healthy, happy employees means better productivity and company success; corporate and business innovations are leading to rapid improvement in how companies take care of employees which are leading to innovative services, technologies, and solutions.

In this third article, I would like to share my recent experience attending the International Foundation of Integrated Care’s annual conference in Edinburgh, Scotland. Most of Europe including the United Kingdom (England, Scotland, Northern Ireland) use some form of socialized medicine. In other words, the government provides healthcare as a social service to their citizens. In the United States, our healthcare is part of the free market system with government influence (e.g., Affordable Care Act).

There are pros and cons to each system. Socialized medicine can make it easier to provide uniform policies and procedures that impact data sharing, working together among providers and tracking progress nationally. However, socialized medicine can also become bureaucratic, slow to respond or innovate and political. When I was in Edinburgh, I spoke with a number of national leaders from various countries about their experience with socialized medicine and integrated care. My goal was to learn from their mistakes and see what parts of integrated care could work in a free market system like the United States. Most of them felt that the government side of medicine made decision-making too political. While I was there, they announced average treatment times in waiting rooms throughout the UK. These waiting times are used in the media to bolster political support for different candidates or to raise concerns for other candidates. One doctor mentioned to me that the report is useless because hospitals will often switch people from one area of treatment to another in the hospitals to impact times. He mentioned it was unfortunate that the current system placed too much emphasis on areas that weren’t truly valuable in improving care. I met another national expert from Canada and she felt their system was broken. I left feeling relieved that the United States isn’t currently involved in a socialized medical system. It appears to do more harm than good.

However, I did learn from their experience with integrated care. Integrated care is a concept in healthcare treatment that suggest physicians and specialists should integrate treatment more. In other words, physicians should communicate more with one another and approach patients from a “team approach.” In addition, integrated care suggests including other types of providers in the care of a patient including nutritionists, fitness experts, counselors, life coaches, social workers, etc.

For example, if a patient is dealing with a heart condition, we may involve a cardiologist along with their primary care physician, a nutritionist, a fitness expert and a life coach or behavioral health specialist. The providers would talk to one another and develop a common treatment plan. The cardiologist would obviously address the heart condition itself while the primary care physician would address other health conditions. The nutritionist would help make changes in their diet, the fitness expert would help improve cardio and exercise and the behavioral specialist would help the patient have more life balance, reduce stress and address motivation or mood issues they may be experiencing. Integrated care would also allow for each of the providers to share in the patient’s notes through a system that maintains privacy but encourages the sharing of information. The focus of treatment would be on long-term wellness and health rather than short-term solutions.

In the UK and other countries with socialized medicine, integrated care has been implemented as part of government protocol. In the United States, there are some shifts occurring that we have already discussed in previous articles that make integrated care more viable in a free market system:

1. Because insurance companies and other entities are going to reward clinics and providers that help patients be more well, integrated care at primary care or specialty care clinics is being considered to help improve wellness.
2. Because research suggests that the use of a behavioral health specialist as part of the treatment team improves patient care, treatment adherence and patient satisfaction, a number of clinics are beginning to offer integrated services.
3. Because private technology companies are beginning to develop technology that will allow different electronic record systems to “talk” to one another, the ability to work more collaboratively with technology will be available.

Currently, I am providing some consultation to Southwest Spine & Pain as their Director of Behavioral Health where we are implementing an integrated, collaborative care model. We are one of only a few clinics in the country that are developing an integrated specialty clinic. We are excited to pilot this model and discover ways to improve patient care and long-term wellness. WholeFIT of St. George is also partnered with a group in Houston, Texas and works with colleagues at the University of Texas Medical Branch-Galveston to refine the model. When in Edinburgh, I spoke about what we are doing in St. George and many internationally have identified our efforts as unique world-wide. We are excited in St. George to pioneer some innovative models of integrative and collaborative care and be an example to the world where integration in a free market system is not only possible, it becomes the highest standard of care available as we consider methods to take care of patients and their families.

Next Issue: Healthcare in America Part IV: Treating the Whole Person

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