Ushering In The Next Era In Health Care: Holistic Model Innovations

Ushering In The Next Era In Health Care: Holistic Model Innovations
This post was published on the now-closed HuffPost Contributor platform. Contributors control their own work and posted freely to our site. If you need to flag this entry as abusive, send us an email.

In the U.S., there’s long been another harsh certainty to deal with besides death and taxes: a deeply flawed healthcare system that is disjointed, difficult to navigate and leaves many Americans without coverage. Its current service models are the biggest obstacles to improving health care delivery, noted Harvard Business School Professor Michael Porter in the Harvard Business Review this past summer.

Fortunately, healthcare innovations that disrupt the current status quo are emerging, fueled by data-driven demographic insights, strategic partnerships and creative, resourceful care providers. They are taking the form of ground-breaking models, which are ushering in a new era of holistic health care that that puts the focus back on patients and forces us to reconsider value of good health and how to attain it.

These healthcare innovations can’t come too soon, as roughly half of all American adults suffer from at least one chronic disease, and quarter suffer from two or more. In 2014, Centers for Disease Control and Prevention (CDC) statistics showed that seven chronic conditions were responsible for nearly 65 percent of all deaths. Disturbingly, these chronic conditions, and the factors that cause them, can be more common or severe for minority groups. They often receive poorer quality of care, face more barriers in seeking it and have higher healthcare costs thanks to these disparities.

While all of these chronic conditions have significant lifestyle components, the nation’s prevalent healthcare model--fee-for-service—is ineffective. “Fee for service rewards the quantity but not the quality of efficiency of medical care,” noted Porter.

More saliently, this healthcare model lacks financial incentives to focus on the long-term needs of the patient.

However, Porter and fellow HBS Professor Robert S. Kaplan have suggested a healthcare model that achieves better outcomes at a lower cost, and rewards providers for delivering it: value-based reimbursement centered on integrated, multidisciplinary care and a payment system where providers are paid for patients’ medical conditions across the entire care cycle to achieve greater value.

The push to value-based healthcare models has come from some of the biggest players, with the Centers for Medicare & Medicaid Services leading the way. For example, in 2015 the agency began the process of shifting 30 percent of Medicare payments from traditional fee-for-service-based healthcare models to alternative models that offer value and care coordination rather than value and care duplication. They hope to reach 50 percent by 2018.

Healthcare payors are following suit and playing an important role in shifting the focus to quality and outcomes. To do so, they are using their influence to create change at both the provider and patient levels.

For example, through its Healthy Indiana Plan 2.0, the Hoosier state approached Medicaid reform with a health plan that leverages relationships with providers and community partners, notes a study by Anthem Public Policy Institute. In one example, the plan works with providers to block out appointment times on designated “clinic days” for members with identified care gaps, reaches out to members to schedule those appointments and coordinates transportation for members who need it. The plan also provides financial incentives to influence member behavior—both for following through with preventative care such as screenings, and avoiding use of emergency care for non-emergent care issues.

At NextLevel Health, we are disrupting the service delivery model for Cook County’s underserved Medicaid patients through a highly personalized holistic health plan that establishes, maintains and increases their access to personalized services. This allows us to fully engage with our members and ensure they complete the cycle of care—the hardest part of the process given the challenges faced by the community.

Our approach holds great promise; our care plan completion rate was well over 50 percent for NextLevel Health members in 2015, which is twice the rate of many of our competitors. We have achieved this by embracing the following four healthcare innovations to achieve a truly holistic system:

1. Embracing the rigorous use of technology and data

Almost half of all healthcare executives believe their industry will experience significant digital disruption in the near future, notes the Harvard Business Review. It will require firms to employ more healthcare innovators, create a culture of data-driven decision-making and commit to being a more digitally adept organization to avoid being left behind.

As a health insurer focused on Medicaid patients, we believe data is critical for understanding our cost drivers as well as helping assisting our members make informed care decisions. Our team members often meet patients in person, collecting and analyzing data using tablets that offer access to crucial cloud-based information.

By studying this data, we can identify patterns and gain a better understanding of what’s driving a member’s health issues, and focus on ways to create better value.

2. Cultivating deep community connections

Population health changes, including demographic shifts and the growth in chronic disease, demand innovation at all levels of the service delivery model. But to truly make the healthcare innovations that will have impact, it’s critical to truly understand the community you serve and be part of it.

NextLevel Health’s team reflects the communities it serves: 80 percent of our staff is minority, and over 60 percent live in, or near the communities we serve. We also maintain offices in our communities to provide convenient access to our services and hire locally, providing entry-level opportunities for lay people to be part of delivery system reform. .

This commitment to the community plays an important role both in the way our members view us and for those who interact with us and may become future members. For healthcare innovators, trust is important as we embark on a new way of approaching medical care.

3. Forming key partnerships

The disadvantaged communities we serve face unique challenges and call for creative approaches. For example, it’s difficult to receive care if you can’t get to the provider, so NextLevel Health has partnered with small, minority-owned transportation businesses on Chicago’s South and West Sides and is creating an Uber-like system over our platforms that enable caregivers or members to order services.

Other key community partnerships, such as the ones we have forged with Trilogy, a community–based mental health organization addressing housing needs, and Chicago Metropolitan Breast Cancer Task Force, which provides specialty patient navigators for members with breast cancer, deepen our local ties and also helps us expand the services we can help our members access. These partnerships also enable to us gain keener insights into our community’s broader needs.

4. Facilitating member engagement

NextLevel Health uses a team of community specialists who serve as our frontline for member engagement. We recruit for these positions in the local community, so it’s not unusual for our community specialists to know members prior to visits and understand the obstacles they face—from neighborhood violence to transportation issues—that can deter them from accessing care. That familiarity helps establish an important foundation of trust as we follow up with medical providers for needed assessments and to set a care plan into motion.

Our team will meet members at home, in our offices or another location where they feel comfortable. This deep engagement with members allows us to get a better sense of other environmental factors at play, and in turn get to the heart of how to address health issues.

The shift to holistic health care has inspired many of us to find innovative ways to create new value and better outcomes for patients. It calls for us to tap the power of technology to harness data increasingly attached to our lives, combined with keener, community-based understanding of, and commitment to, all stakeholders in a community.

Popular in the Community

Close

HuffPost Shopping’s Best Finds

MORE IN LIFE