We have a sick care system that masquerades as a healthcare system. Yet, taking care of patients with acute disease is a lot different than disease prevention, chronic care and complex chronic care disease management and population health.
We need to unbundle the two and create systems, manpower and education programs designed to address the unique challenges of each. We persist in expecting the legions of primary care physicians and some specialists to do it all, which is simply an unrealistic expectation and leads to frustration, poor outcomes, waste and burnout.
Here are some suggestions to start us on the path:
- Revise medical education competencies to recognized the emerging changes in how sick care and healthcare are being defined and delivered,
- Change onerous regulatory, legal and accreditation standards.
- Incorporate interdisciplinary professionals and reward them for providing and coordinating care along the point of care spectrum
- Close the referral leaks.
- Create a 21st Century healthcare IT infrastructure that acts like a central nervous system to aggregate the disparate points of care.
- Build a whole product healthcare IT solution.
- Create a process that clinically validates healthcare IT products before launch and system that doctors can rely on to decide whether to recommend (or prescribe) them to patients.
- Unbundle primary care and outsource to other professionals practicing at the top of their license.
- Create different reimbursement mechanisms for sick care and healthcare.
- Make systems more user friendly, particularly for patients and those solo and small private practices.
- Do a better job of training and using technicians to triage patients, like those requesting telemedicine visits, to decide not just where, but whether they need to be treated and billed. Practice tele-triage and tele-prevention before your practice tele-sick care.
Here is what a separate but equal health care system contains, and might look like:
- Replace high priced knowledge technicians with lower paid behavior change specialists
- Pay for prevention reimbursement system
- Create future jobs that don’t exist
- Train health care workers to win the 4th industrial revolution
- Match every sick care worker with health care worker on the team
- Unbundle primary and secondary care education, training and practice
- Replace the present higher ed business model with cheaper, faster, better, smarter market defined solutions (think Galvanize for healthcare)
- Teach MPH students public health entrepreneurship
- Create interprofessional entrepreneurial teams
- Create social and workforce support systems for workers no longer interested in participating in an industrial model created 100 years ago
Twisting the square healthcare peg into the sick care hole until the edges wear off does not work. We need to redesign the board.
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