The Medical Ad-Hocracy To Integrate or Not... David M. Lawrence, - PDF document

The Medical Ad-Hocracy To Integrate or Not... David M. Lawrence, MD, MPH 2012 “ ...she...developed frustration and cynicism about the health care “ In the first month of her syste m ... the mixed signals, the combined hospital and nursing delays, the unexplained changes in home stay, Mom was cared for by treatment plans and prognosis, and ten physicians..., (and) at least the uncertainty about when she fifty...nurses, ten physical and could leave... ” occupational therapists, and a host of nurse aides. ” (Health Affairs 22, no. 2 (2003): 238-242) (Health Affairs 22, no. 2 (2003): 238-242)

✤ Rich Umbdenstock, Executive Director of AHA: ✤ “ONE” ✤ “SYSTEM” ✤ A careful balance between standardization ✤ Common: experience, diagnosis and and customization treatment, processes, communication, ✤ (what Richard Bohmer calls “iterative decisions, collaboration, support, and standardized” care…R. Bohmer: measurement, accountability, learning, Designing Care 2010) pay/incentives, dispute resolution

✤ Transparency: visibility into every step in the process ✤ Clear boundaries: where “care” starts and stops ✤ Agnostic about where care occurs (best place) and who does each job (best person) ✤ Technology substitutes wherever possible Level One Pre- End-of- Pre- End-of- Primary Acute Primary Acute Life Life Primary Primary Care Care Care Care Care Care Care Care Level Three Level Two End-of- End-of- Pre- Pre- Primary Acute Primary Acute Primary Life Primary Life Care Care Care Care Care Care Care Care

Level Four End-of- Pre- So why do it? Primary Acute Life Primary Care Care Care Care Why, then? BECOME AN ACO? ✤ Competitive Flexibility ✤ Strategic Flexibility ✤ Ethical High Ground…the right thing to do Competitive Flexibility... you others ✤ highest quality + lowest cost = greatest value... others you QUALITY COST

What care delivery integration Getting there... can produce... Patient-Centered Design ✤ ✤ A measurable cost advantage by reducing unnecessary variation ✤ A measurable, patient-centered quality advantage by reducing unnecessary variation and designing care for and with the patient Variation ✤ ✤ Resulting in a measurable value advantage for the patient, families, community and payers ✤ And maximum competitive flexibility Strategic Flexibility... Three possible futures... ✤ Full capitation and rewards for integrated systems ✤ FFS and fragmentation (status quo) ✤ Consumer-driven Health Care Choice ✤ How care delivery integration positions you in different futures ✤ Government-run system ( “ single payer +/- single provider ” ) status quo integration futures Ethical Consistency Capitation and + ++++ Integration FFS and ✤ We want to deliver care that is consistently safe, effective and affordable for the individual patient, the community, and the nation. fragmentation ++/+++ +++ (status quo) ✤ Systems that protect individual physician autonomy and status quo care delivery model cannot do this. ✤ Systems that focus on collaboration, teamwork, and meticulous Consumer- + +++/++++ system design for and with the patient can meet these goals, and are Driven Choice ethically consistent with our oaths as professionals and care-givers. STRATEGIC FIT

Because? Thank You