TRANSFORMING CARE – THE CALL FOR LEADERSHIP, by Scott Nygaard, M.D.

I am posting forward this Blog written by a past client, Scott Nygaard, M.D.  Scott is a very gifted healthcare leader and one of the most insightful and practical physician leaders with whom I have had the pleasure of working.  Enjoy this and feel free to respond directly to Scott as well as myself with additional thoughts.

Some say that we now have a perfect storm for health care reform and it is inevitable that we will reform the health care system now, since we are essentially now broke based on the outstanding system of care that we have in the US.  One can hardly claim it as the best health care system in the world when looking at the numbers but it is clearly the hands down winner in terms of expense at over $8400 per capita and 17.9% of the GDP. I’ll leave the details for you to review in the links below:

http://www.reuters.com/article/2012/03/27/us-usa-court-healthcare-idUSBRE82P03K20120327

http://www.nejm.org/doi/full/10.1056/NEJMp0910064

There seems to be more than enough blame to go around for the expense and lack of performance of the US healthcare system (the payment systems, the malpractice environment, the patients, the lack of IT systems, the fragmentation of the delivery system, the doctors, the patients, etc.).  You get the picture, it simply isn’t us in healthcare or is it us?  I would like to suggest that while these indeed are barriers to changing the system and make our job challenging, what this is really calling for is a clear and compelling charge for leaders in health care to step up and lead by providing a clear vision and direction for how we can actually become a part of the solution and stop playing the role of victims.

It is true that the FFS certainly does not incent the right care and promotes incentive to over-utilize services particularly if one generates a portion of their paycheck by doing more procedures, more imaging, more lab tests, more hospitalizations, more ED visits.  This is also driven by the US mindset of consumption and that “more is better”.  There actually is substantial evidence that more care is not better care and in fact more care can cause harm, creates waste and erodes quality and clearly adds cost.

The mantra that should drive us in the profession of health care is to do the following:  Provide the RIGHT CARE (based on evidence when available), at the RIGHT PLACE (appropriate place for care- office, surgery center, urgent care, ED, hospital, etc.), at the RIGHT TIME (the care I need when I need it- implies a need for 24/7 access to resources to help triage and get a patient to the right place at the right time– e.g. much could be handled in a lower cost setting within 24-48 hours by appropriate triage) and at the RIGHT COST (assumes we would actually know the cost, make the cost transparent and practice efficient medicine by serving the patient and create value for those paying the bill).  If we were diligent and began to solve for the design of a system of care that set out to achieve these objectives and with real time data, feedback, care coordination, care triage we could actually make the system work in the current environment, with the understanding that the discipline would subsequently require us to size and build the system to service the “real demand for service using the above principles.  For example, today once we purchase a piece of equipment, build a facility, etc.– this then drives the system design (e.g. we don’t purchase or build things to leave them with idle capacity- instead we purchase or build with the mindset to use more of the service to generate revenues and then we blame others for the inherent design flaw—- which has led to the failing US health care system.  This is really difficult thinking and is contrary to popular opinion but it is fundamentally the challenge that leaders must own and begin to paint a picture of a system that provides: RIGHT CARE, RIGHT PLACE, RIGHT TIME, RIGHT COST.

So where do we start:

Redesign efforts should begin with the mindset that we must create value for those we serve in our respective markets (patients, employers, payers) and must improve the health status of our communities to improve the ability of people to be productive members of society and which will allow them an opportunity to contribute to the economic vibrancy of the community/region being served.

Effective redesign should be guided by the following principles:

·       Improve outcomes of care as measured by quality metrics

·       Decrease costs of each patient encounter as well as episodes of care– with and overall focus to reduce the total cost of care

·       Increase the patient experience (Improved satisfaction and improved patient health care literacy and engagement in their care)

There is much being written about the fact that it is time to reform, the need to reform and how to reform, but it will not happen without leadership that is committed to the process of change and will refrain from making excuses and simply:  GET BUSY ON THE WORK!  Health care has been waiting for more leaders to step up and accept the mantle of responsibility to lead the change.  In a nutshell the ultimate goal should be to develop a system of care that provides the following across all venues of care (the Value Stream):  RIGHT CARE, RIGHT PLACE, RIGHT TIME, RIGHT COST.

It is past time to build a system that works for those: We KNOW, LOVE and CARE ABOUT.  That is a standard to guide our work as leaders and will get us focused on doing the right things in our effort to redesign care.  I wish you the very best on your journey of transformation. 

Scott D. Nygaard, MD MBA
Chief Medical Officer Physician Services and Network Development 
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