As the U.S. healthcare system confronts the need for profound change, leaders in the field are innovating on many fronts to create more health at less cost. To provide a broad view of the coming changes, a conference hosted in November gathered many of the people experiencing them up close. The one-day event titled, “The Health Care Forum 2013: Reinventing an Industry,” was hosted by The Economist magazine.
In a day full of illuminating conversations, one panel discussion – “The Patient’s Journey: The Reimagination of Care” – focused exclusively on changes in patient care before, during, and after an acute care episode. Panelists were Rishi Manchanda, a Primary Care Physician and President/Founder of public health consultancy HealthBegins; Joan Saba, a Partner at Architecture and Design firm NBBJ; and Clay Richards, President of healthcare benefits management firm naviHealth.
By session’s end, the panelists had delivered a vision of a healthcare system that defines its role more broadly and intervenes more proactively to improve patient health. In that system, healthcare professionals will act to improve the social and environmental determinants of health rather than merely treating the illnesses they cause; years before a patient arrives in a healthcare facility, that facility’s walls and spaces will have been designed so as to improve the patient’s wellbeing; and healthcare plans and acute care providers will remain engaged in their patient’s care months to years after the end of an acute care episode. If the panelists are correct, industry participants should expect to hear a great deal more in the coming years about upstream medicine, patient-centered architecture and design, and post-acute care.
Dr. Manchanda, a primary care physician and founder of public health consultancy (or, as he describes it, “think-and-do-tank”) HealthBegins, discussed “upstream” healthcare – addressing those social and environmental factors that can significantly affect patients’ health, but are rarely addressed in the doctor’s office. One example of upstream healthcare is Manchanda’s approach with a patient complaining of mysterious, chronic, debilitating headaches. Many doctors, costly tests, and medications had failed to help her because those providers had not asked the right questions. Since Manchanda’s patient intake form included questions about her social and environmental circumstances, he was able to quickly determine that the patient’s headaches were likely a consequence of moldy, roach-infested housing. He connected her with community health workers and a tenants’ rights advocacy group, who together taught her ways to control dampness in her home and helped to convince her landlord to improve the quality of her housing. The patient’s headaches resolved and her son’s asthma improved; presumably her neighbors benefited as well. When Dr. Manchanda and his colleagues connect a patient with community resources as they did in this case, they do it “with the same rigor and expectations as if we were referring her to a cardiologist.”
In another, even more “upstream” health intervention, Manchanda’s team partnered with high school students to develop a “Yelp-like” guide to community health resources.
Asked how our healthcare system, overburdened and costly as it is, could afford to step outside of its hospitals and clinics and intervene in patients’ communities, Manchanda replied, “How can you afford not to?” Upstream health risks, he argued, are often much less costly to address than are the health problems they cause. Dr. Manchanda discusses upstream medicine in further detail in his new TED Book, “The Upstream Doctors: Medical Innovators Track Sickness to Its Source (Kindle Single) (TED Books)”.
Guiding the Patient After Discharge
Clay Richards is the President of naviHealth, a healthcare benefits manager that focuses specifically on Post-Acute Care (PAC) – the nurse visitations, rehabilitation, and other care that patients (including 43 percent of Medicare beneficiaries) receive after a hospitalization. According to Richards, patients receive inadequate guidance from their health plan or provider as they navigate their Post-Acute Care experience, with the result that PAC spending is highly variable and often wasteful, and the care patients receive is often subpar. By analyzing historical outcomes and costs for patients with a particular set of healthcare needs, as well as proactively engaging with patients, naviHealth aims to help healthcare plans and providers extend the support they provide to their patients beyond discharge. In this new paradigm, Richards hopes, patients will feel informed, supported, and in control of their own care, all while receiving high quality healthcare at a reasonable cost. Richards predicts that reducing regional variation in Post-Acute Care spending would go a long way towards reducing overall spending – for Medicare beneficiaries alone, Richards says, PAC accounts for 73 percent of the total regional variation in healthcare spending.
Buildings Designed with the Patient in Mind
Joan Saba, a Partner at Architecture and Design firm NBBJ, discussed her team’s efforts to design clinical workplaces that improve the patient experience. For example, the size, shape, and contents of a patient room determine the physical distance between patient and provider. Consequently, architects and designers can deliberately create spaces that will promote patient-provider engagement, rather than the patient being “talked at.” Even the layout beyond the patient room can affect the patient experience. For example, the relative locations of nursing stations and patient rooms can affect the noise level that a patient experiences, while including spaces that encourage casual conversations between staff can increase clinical collaboration and innovation-sparking exchanges of ideas.
One example of the work Saba and her team have been doing is Mass General Hospital’s Lunder Building. Among the Lunder Building’s many ambitious design goals are maximizing patient access to natural light and views of the outdoors, minimizing noise, increasing patient visibility while protecting patient privacy, and reducing wait times. As many healthcare facilities reinvest in their decaying infrastructure, Saba believes that they can increase the financial and non-financial return on their investment by incorporating such goals into their design plans.
David Brick is a counselor in addictions and health behavior change, with particular interests in Motivational Interviewing and improving the patient experience. He is currently a Health Coach at Brigham and Women’s Hospital, working with primary care patients who are at risk for opioid misuse. He will soon be beginning a Master's program in Social Work. You can connect with David at www.linkedin.com/in/davidebrick or @primarycare_ugs on Twitter.
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