User talk:ImportantChange

This excerpt is from a roundtable discussion, held June 1, 2009, during the 2009 Medicaid Congress and National Medicare Readmissions Summit, held in Washington, D.C., June 1-2, 2009.

According to Randall Williams, MD, FACC, Chief Executive Office, Pharos Innovations:

One of the challenges of healthcare reform is that we are all biased by our experience and background, which creates a variety of existing stakeholder approaches for the way we think about healthcare requirements. Because of chronic disease, today’s costs will only escalate as our population continues to age. From the perspective of Pharos Innovations, any discussion of healthcare reform must begin with a discussion of what are we going to do differently for chronic disease.

The Four Key Concepts of Healthcare Reform Today's healthcare reform discussion centers around four key concepts.

1.	Universal access to healthcare 2.	Payment reform, in particular provider re-engineering: How do we manage our provider system through the pain of reform approaches? 3.	We’ve built a healthcare system for acute or episodic care rather than one around primary care and prevention—very crucial 4.	Addressing delivery system challenges that involve complex and largely uncoordinated relationships between patients, physicians and payers

These last two discussion points are the most interesting and the most challenging, completing what we call the “Value Quadrant of Healthcare Reform” (VQHR).

The Value Quadrant of Healthcare Reform To understand the direction we want to go, let’s first take a look at where we have been. In the bottom left-hand quadrant of the VQHR diagram below you see our “glimpse in the rearview mirror.”

We know that by targeting chronic disease from outside the care delivery system as we have in the past, utilizing a human resource based-model, we tend to see fairly human resource-based models with a modest impact. I think we can all agree that the jury is still out in terms of how big that impact is, but clearly that model set the stage by focusing on better chronic disease management.

As you move across the horizontal axis, we see an emerging conversation around information technology and a shift away from the human resource intensive, episodic and acute care-focused model to one that is technology-leveraged, proactive and continuous.

Delivering this kind of care will be essential if we are to cope with the anticipated future shortfall of physicians and nurses, in combination with our future overburdened healthcare system. We must answer the call to find ways to smartly and efficiently leverage technologies.

On the vertical access, we can see the significant shift in care delivery over the past 15 to 20 years. The system was once organized around systems of care outside of the care delivery system, but is now shifting to care controlled by the providers themselves. This also includes a pendulum shift back to incenting providers and provider systems to get organized around chronic care delivery.

The key to reaching the Value Quadrant of Healthcare Reform is to target an approach to chronic disease that uses health information technology (HIT) because that is where the cost savings are. Formally, the VQHR is the optimal, technology-leveraged approach to chronic care management that unifies disease registry functionality, care coordination and remote patient monitoring technology at the point of care delivery for maximum healthcare outcomes and cost savings.

The Value Quadrant of Healthcare Reform (VQHR) is composed of four key modular elements:

•	Chronic disease registry functionality that provides insight into a population to track chronic care management progress and target interventions to the right individuals within that population

•	Home tele-health and remote patient monitoring technology - simple, ubiquitous technology to raise the level of vigilance on individuals with chronic disease and keep them in better contact with their care team

•	Care coordination staffing infrastructure, training and performance management

•	Chronic care physician oversight, which includes provider systems that are organized and incented to deliver chronic care and actually have the resources to do it

It is our perspective that the provider nexus of care delivery needs to have a new function. We cannot take today’s provider systems, throw money at the problem, and then expect a solution. The key to success is to blend care coordination and technology across the continuum to deliver care with the support of the delivery system itself.

ImportantChange (talk) 15:24, 23 July 2009 (UTC)