The Future of Pathway Management Dr Keith Klintworth · 2019 Global health care outlook – Shaping the future - Deloitte. Do we have a smart health community in ... for understanding
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The Future of Pathway Management
Dr Keith KlintworthPrivate Acute Healthcare
ConferenceOctober 2019
Do we learn from History?
Started in 1980 to manage healthcare quality by focusing on the entire treatment journey and to enable measurement of medical decisions against an established best practice.Ambition to standardise a set of actions aiming to optimise care for a particular clinical problem in line with guidelines
Was to benefit patients, doctors and payers. Was it developed because it was the right thing to do or was it developed to manage the challenge of medical inflation?
Does the mistrust between provider, payer and patient continue to result in changes to ‘pathways’ with risks of trying to have one size that fits all?
“Smart health communities” offer one glimpse into the future –and highlight how far away we are
Doctors
PatientsPayors
The correct individuals do the correct
work (primary and secondary care divide)
using the right technology to diagnose,
treat, and deliver
Clinicians use technology and colleagues to
accurately diagnose, treat illness and deliver care
All stakeholders across the health
ecosystem efficiently communicate and
use information
Appropriate Rx at appropriate
time, in appropriate place for the
appropriate patient
Efficiency improves, waste
declines
Patients are informed and actively
involved in their treatment plan
2019 Global health care outlook – Shaping the future - Deloitte
Do we have a smart health community in
the UK?
Done well, everyone benefits from care pathways
Better decisions Less variable outcomes Reduced treatment errors Increased efficiencies and
clinical effectiveness Increased multidisciplinary
communication
Improved outcomes Reduced waiting times Fewer, shorter hospital stays Reduced readmission rates Better experience
Reduced healthcare costs Better forecasting and
premium calculation Happier customers
The maturity of care pathways is not globally consistent
The US has best (outcomes) and worst (adversarial tactics and “game-playing”) of healthcare pathways
A great deal of enthusiasm and energy for “integrated care” in the public sector; in the private sector, present but more niche
Switzerland is considering abandoning clinical pathways in favour of clinical processes
Very early stages –intransparent, variable care and difficulties in agreeing incentives
Broader organisational hurdles impede better pathways and care
Individualism, engaging clinicians last, “Not invented here” syndrome, “not rocking the boat”, and other “not”sCultural
Information sharing, competition, complianceRegulatory
Over-optimistic projections, unrealistic aspirations from limited resources, and inadequate attention to low hanging fruitExpectation
Concern about reduced income in a fee-for-service world Financial
Misaligned incentives, short-termism, budgets, and “turf”; not putting the patient at the centreOrganisational
Historically, much challenge came from physicians
Clinical pathways were (are) feared to lead to: Dehumanisation of work and loss of autonomy Interfering with the doctor/patient relationship as Complexity of integration in a changing digital world Suspicion of improvements in clinical outcome Cookie cutter approach and lack of personalisation Confusion via impossible simplification of complex treatments
If doctors don’t engage who will create the pathways?US Insurers driving value/outcome based remuneration with no payment if off pathway!
Now that we have managed the averages is it time to manage the outliers?
The Future of Care PathwaysCare Pathways
Driving quality (and includes patient satisfaction) measures that together describe a care pathway for a particular population (e.g. PMI) or a group of patients (e.g. chronic conditions). Quality assessment of Clinical pathways has focused on isolated aspects of care in specific settings and does not assess quality holistically for patients with a given condition and therefore inadequate for understanding and improving performance at a system level.
This is where the Insurer can add the value by integration and personalisation of the Healthcare journey to drive patient satisfaction, speed of access, endorsement of quality and cost-effectiveness.
Providers are empowered to do and evidence the right thing – whether on or off-piste of clinical pathways or clinical guidelines.
In the ideal world giving patients assurances that a multidisciplinary team has made the decision on your care journeyHealthcare of the future 2019 SHTI259-00252012- Kings Fund report measuring quality along the care pathwayAug 2015 – Catalyst.phrma.org; Future of clinical pathways
Seeing a doctor and following his/her idea is not a pathway
Having symptoms Surf the internetSymptoms
worsenConsultant-
delivered service
All possible diagnostics “to
be sure”
Not much wrong
Book an appt.
Pathways need to be broader and better.
Surgery required
Surgery complete
Having symptoms
Seeking information
online
Offered guided self-
management
Holistic primary care
management
Prompt face-to-face assessment
Digital triage + pre-prep
Specialist fast-track
management
Surgical/ inpatient
intervention
Enhanced follow-up and
recovery
Symptoms worsen
Symptoms bearable
Inadequate improvement
Inadequate improvement
Primary care option
Needs clinician
Care PathwayPopulation
wellbeing/prevention
control of risk factors
Primary diagnosis/Investigation/ referral
Appropriate secondary treatment
Recovery and rehabilitation
Secondary prevention
End of
Life care
The Future of Pathways
Need to deliver on providing consumer – centric careconsumers are dissatisfied with;- poor service- lack of transparency around price, quality and safetyconsumers are expecting solutions that;- are coordinated, convenient, customised and accessible
This has been driven by:Rise of chronic conditions and need for long-term care management
Financial scrutiny due to high deductible insurance plans with excesses and out-of-pocket expenses
Explosion of digital tools to inform, educate and empower patientsConsumers experience in other Industries
Competition from tech-savy companies that bring a non-traditional mind-set to healthcare delivery
Parting thoughts
BUT this needs strategies, products and services that bridge the gap between providers, payers and patients.
We need to understand and act on how consumers would like to use digital health telehealth wearable monitoring
and fitness devices online resources social media…
Enga
gem
ent w
ith te
ch
So we can develop patient-engagement strategies that help individuals make informed care decisions, which in turn…
Cus
tom
er-c
rafte
d so
lutio
ns
Would help healthcare organisations improve effectiveness, efficiency, value in service delivery and excel in quality measures that reflect the patient experience…Be
tter o
utco
mes
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