Economics Dictate that Times are Changing for US Health Care

Health care delivery is fragmented, chaotic, and too expensive, so a systematic approach to care is needed.

Health care delivery is fragmented, chaotic, and too expensive, so taming the chaos will require a new breed of leaders at every level, as well as a more uniform, systematic approach to providing patient care, said Nate Kaufman, managing director and founder of Kaufman Strategic Advisors.

However, accountable care organizations (ACOs), if they are to come to fruition, must start with clinical integration, Kaufman said during his keynote address at the CIO Forum, hosted by the College of Healthcare Information Management Executives, in conjunction with HIMSS11.

"Healthcare's new leaders must organize doctors into teams; measure their performance not by how much they do but by how their patients fare; deftly apply financial and behavioral incentives; improve processes; and dismantle dysfunctional cultures,” Kaufman said in an article published on “Now is the time to start changing,” he added.

Kaufman said the only way a health system will produce better outcomes and improve profitability is through standardization. For providers choosing to maintain the status quo, the economics of the US health-care system will require change quickly, so it is better to be at the forefront than simply react to the newly enforced mandatory policies.

Having the right people in an ACO’s leadership roles of an ACO is crucial, because the system will fail without the “right people, standard protocols and the appropriate IT [information technology] infrastructure,” Kaufman said.

To begin development on a clinically accountable delivery system, Kaufman provided some guidelines for both employed and independent physicians, including:

• digital connectivity of emergency medical records with point-of-care protocols, with portals for submitting all encounter data as a traditional step;

• monitor cost and quality;

• primary care capacity (medical homes);

• engaged physician champions;

• evidence-based inpatient and outpatient protocols;

• programmatic approaches to chronic diseases;

• dedicated infrastructure, especially IT;

• performance-based rewards/consequences for providers;

• pilot testing on hospital employees; and

• collective negotiating for managed care contracting.

Physician leadership is crucial for change, Kaufman said. “It’s all about execution. If we don’t have the right players, and we don’t have the right game plan, then we’re going to fail.”