To create better clinical outcomes, quality care and quality of life of the elderly and disabled throughout the Spectrum of Care by the implementation and harmonization of clinical medicine and health information technology in healthcare.
To positively influence the successful transition to Person Centered Value Based Care one company, one organization, one committee, one person at a time.
Myself and many other Healthcare Executives, Providers, Government Agencies, Associations, Organizations, etc. have been working diligently on bringing the extended segments of Healthcare (Acute, Post Acute, Aging, and Specialty Medicine) into a Person focus on their complete comprehensive health environment. As stated in the CMS guidelines to VBC, the measurement of success is patient outcomes. Not just the outcome of a procedure or a surgery but the total Person’s health. Again, in the elderly aging market the focal healthcare focus is to treat and prevent chronic conditions.
Tomorrow’s healthcare must be a harmonization of Clinical and Technology. These two specialties cannot be separated, yet they are because they are made up of corporation Vendors with technology skills and Providers with Clinical Skills. In my experience I was responsible for E.R. Squibb Diagnostic reagents. I worked with Clinical Physicians on the correct diagnostic agent to use with x-rays. We could only make advancements if the instrument technology innovation continued. I left Squibb to join Siemens Medical Instrumentation (Searle previous to acquisition). We were working on the CT Scanner, MRI, Digital Ultrasound. This new technology required compatible diagnostic agents. I had to work with a different set of physicians. The two sets of specialties did not look at diagnostics as a system with a focus on clinical outcomes. Another example is today’s interoperability of data. The technical community looks at the situation as interoperability. The Clinical community as Transitions of Care. Many times, I must remind the people on technology committees of which I am a member that it is not only data that we are Transitioning but a Person (Human). The following chart I have used for many years to illustrate the resulting changes made from the digitizing of healthcare.
“The business model is The NinthWave ConceptTM. That is, to recognize the clinical and business healthcare trends of Legislative and Regulatory agencies that are pushing healthcare. Then to project the end objective and recognize the future wave (The NinthWaveTM) or vision. Logic plays an important role, but it is not just placing a finger in the air to check the wind. It takes knowledge, experience, data, and analytics.” The NinthWave ConceptTM works, I have been using the concept since 1974" John Derr, RPh. FASCP
In conversations about healthcare policy, we mainly discuss how we can help solve a healthcare incident. It is part of the “Get Sick; Get Fixed; Get Paid” Scenario. It doesn’t make sense that in order to receive the tremendous benefits of our providers that we have to first get sick. When we think of our senior citizens the majority have already gone through the above scenario and look to how can my remaining years be of the best quality possible.
In order to illustrate where quality of life fits into a person’s healthcare solution, in 1998, I put together what I call the Wellness Wedge (See Illustration)
As we age from inception to passing, we have a certain Quality of Life that we have become used to based on the style of life we were born into. This is not to say that it is acceptable, but it is what it is. Within the constraints of our person environment, we do have the opportunity to improve our Quality of Life. During living, we have Acute Healthcare and Social Determinants of Health events that cause us to seek care from the Healthcare community. We depend upon clinical and technical science to provide the solution to the event and return us back to or above the Quality of Life we had become used to Living. If Clinical Technology cannot bring us back, we are forced to establish a new classification and elements of tomorrow’s Quality of Life.
After an event, we as Providers have a discussion with Patients on their future Quality of Life. The problem is that the acute cycle continues. But this is not what the person desires in real life. In aging, a Person’s events tend to me more frequent and compounding. This is especially true as the Person acquires comorbidities requiring Chronic Care (See page on Chronic Care)
The HITAC Act of 2009 stated that the digitized Healthcare System had to have a Person Centric Focus. The ownership of a Person’s Healthcare is legally is the Person themselves. Yet the Provider holds the data close to themselves probably due to the fear of mis interpterion of clinical diagnosis. We have had to pass regulations like Data Blocking and other policy measures to ensure data sharing. There is a movement by technology to aggregate Person Provider data and eliminate what has been call the Data Silo Barrier.
At the passage of the HITAC Act we had three Definitions of Records: Personal Health Record (PHR); Medical Health Record (MHR); and Electronic Health Record (EHR). These were included in the CMS definition of terms. Microsoft and Google tried to enter the PHR market but eventually had to delete their products because it depended on the Person to enter their Healthcare data which was proven unrealistic. The history of the PHR could be:
The Person Team (Family/Care Givers) in partnership with their Primary Care Physician (PCP) Team (Specialties/Diagnostics/Environment/etc.)will work together to develop and track a Quality-of-Life Wellness Plan. The Person and their life desires and capabilities have to be part of the Wellness Wedge scenario. It has been said that the elderly lack the knowledge and capability to participate in digital healthcare. That want to be told what to do as they will be confused. This is probably true in many situations in the “Get Sick; Get Fixed; Get Paid” healthcare model. Things are changing with today’s Clinical Technology and the up coming “Baby Boomer” Generation. There are millions of Elderly Persons and their Family's who are not sick requiring care that want a partnership with their PCP to develop, together, a Holistic, Longitudinal, Life Wellness Plan. This cannot be achieved with a focus on Acute Events.
Healthcare Providers, Associations, and CMS understand the care issues surrounding the Person with comorbidities requiring Chronic Care. The Person requiring Chronic Care certainly understand what they must live with to have a tolerable Quality of Life. As an Example: Multiple Specialties, Constant Medical Appointments and Tests; Multiple Portals; Multiple Medications; Restrictions on Life Activities; Family Issues; Mental Health Issues and on and on. There are many Chronic Care Management(CCM) programs and the ARHQ has a major research program underway.
A Chronic Care Model was published in1998* and there are companies with a focus on Chronic Care, yet the market continues to grow as illustrated by the ARHQ chart.
The VBC model has a focus on Person outcomes not anyone disease state or acute event. Current clinical technology is moving toward the ability to aggregate data bases and sharing information is accelerating. Nevertheless, the Provider and payment systems continue to have an Acute Care focus which will not lead to the reduction of Chronic Care costs and low Quality of Life of the Chronic Care Person.
The solution could be a life care plan based on Longitudinal; Holistic; Mental/Behavioral; Activities; Environmental; Social; etc. verified data, that is aggregated and processed through analytics leading to information will that enable us to get to prevention and wellness.
A nurse once told me that: “she wants to know when an event is going to happen rather than when it has already happened(Acute Care).
*Chronic disease management: what will it take to improve care for chronic illness? EH Wagner PMID: 10345255
When I was on the Federal Advisory Committee for the HITECH Act I found that the result of LTPAC not being included in “Meaningful Use” it led to a misunderstanding of LTPAC providers. An Elderly Person will move around this Spectrum of care depending on acuity diseases state. We use “Spectrum of Care” as treating an incident is usually titled “Continuum of Care” which has a start and finish as in Acute Care. Whereas a Person requiring Chronic Care uses the Spectrum of Care.
The ONC asked me to develop a White Paper about the many Providers that made up the LTPAC Spectrum of Care (see the Article Section of this website). This paper was in conjunction with the LTPAC Health IT Collaborative (www.LTPACHIT.org). We found that there 5 Valued Quality of Coordination of Care (VQCC) Differentials between LTPAC and Hospitals. These differentials are a benefit to Persons with Chronic Care requiring a holistic and longitudinal care focus.
‘To catch the mighty NinthWaveTM at the critical moment requires special skill’. Contact me. The ‘critical moment’ is here today. Let’s ride this wave of opportunity together and make a difference in healthcare care starting today.
