Paul Grundy, MD, MPH, FACOEM, FACPM, Member IBM Industry Academy Chief Medical Officer IBM Healthcare Industry
It is not an overstatement to say that those who do not embrace the rapid evolution of American healthcare will simply be left behind. Recent initiatives by our government’s executive and legislative branches indicate a remarkable consensus across party lines that our healthcare system needs to reward value rather than volume – a truly historic shift that is transforming healthcare as we know it. These and similar initiatives by commercial payers and provider organizations also have in common a recognition that two key value-based mechanisms already in place – the Patient Centered Medical Home (PCMH) and the Accountable Care Organization (ACO) – are not only working but are worth expanding. As this Compendium of case examples illustrates, the Medical Home has demonstrated the viability of a new model of care delivery focused on keeping populations healthy, as well as improving individual health. At the same time, early ACOs have established the governance and models for clinical integration that align health and wellness with financial risks and rewards, answering the pressing question of who will pay for all of these services.
The most successful provider organizations have taken advantage of recent breakthroughs in analytics that make data actionable and help inform advanced care team delivery, as well as automation that scales care management to the population level. Together with the care delivery and financial benefits of the medical home and the ACO, these PHM solutions have enhanced the quality and safety of patient care, and improved patient outcomes across a broad array of chronic conditions, in the organizations profiled in these pages.
At the same time, technology will only be of limited value without organizational change. In other words, by itself technology will only make organizations more efficient at being inefficient. The successful organizations profiled in this Compendium made a substantial commitment to changing the way they worked, and ensuring the support of leadership, to enable the PHM technology to have a more profound impact on the organizations’ approach. This is a critical lesson that must be accepted and made a part of the process if any PHM, ACO or PCMH initiative is to succeed.
As we observe the best practices of today and anticipate the needs of the future, we offer these elements of a successful healthcare organization for consideration:
Smarter Care Teams -- UP next
Aligning the clinical and financial
Making healthcare smarter
Increasing accountability now
Outlook for the future
