»WHY WHAT YOU ACCESS MATTERS
By Jay Want
It's been a whirlwind year in health care reform, a more tumultuous one than in any recent memory. One shift some might have missed is the change from providing access as the major goal of reform, to a more refined goal of providing access to a well-functioning system. The latter, as it turns out, is much more challenging than simply finding financing for universal coverage.
A well-functioning system is one that adheres to the Institute of Medicine principles: care should be safe, timely, effective, efficient, equitable and patient-centered. The hard reality is that very few Americans – perhaps about 10% of us – have access to a system that is all of these things. Those fortunate few are served mostly by large multi-specialty groups, like Denver Health or the Group Health Cooperative of Puget Sound. The data are clear that these delivery systems produce higher quality, lower costs and higher patient satisfaction.
So what are the rest of us to do? The answer is to foster the development of systems in our own communities that have the same characteristics.
Here are some of the attributes these systems share:
- They excel at coordinating care, and use electronic health records to streamline communication and minimize duplication
- They live within a global budget that provides an incentive to get exactly the right care to people as efficiently as possible and to fix things right the first time
- When a system of care is flawed, people have a natural incentive to solve the problem together, rather than thinking, "I'm just responsible for my piece."
The reality is that the best medical systems are those that behave as communities, not as individuals. They cooperate with one another, they are stewards of common resources and they problem-solve together to serve common goals, including cost, quality and patient satisfaction. There is a term for this you will hear over the next couple of years: "accountable care organization." Many are working on what it will take to foster ACOs, and create access to them for everyone in Colorado. One group is the Governor's Center for Improving Value in Health Care. Another is the Colorado Clinical Guidelines Collaborative, which has been working on one component of ACOs, the patient-centered "medical home" – continual care that is managed and coordinated by a primary care physician.
The ACO approach will require changing the way we pay for care, the way we organize it and the way care systems work with the communities they serve. The tricky part is getting from where we are today, with most of our care disorganized, to a desired future state, where most is organized.