Care Redesign

Care Redesigned for a New Age

Article · November 25, 2015

Care Redesigned for a New Age Graph

  Click To Enlarge.

By pioneering the concept of a department store that sells high-quality, ready-to-wear clothing, John Wanamaker turned shopping, as PBS puts it, “into an event for ordinary people.” Before him, shoppers cobbled together wardrobes from separately purchased component parts: cloth, buttons, ribbons, and labor. But Wanamaker didn’t just transform how clothes were made — he also revolutionized pricing. Instead of accepting that salespeople must haggle as they gauge what customers will pay against what the craftsman can charge, Wanamaker standardized pricing and made it visible to consumers, simplified the retail experience, and introduced fairness into the process. Our retail economy has never looked back.

Roughly a century later, the time has come for the same thinking to gain currency in the health industry. In short, care must be redesigned. We need to link together the components of care into a value stream, simplify how we provide and pay for services, and make the entire care trajectory transparent. New ways of thinking and behaving are hitting medicine at full steam, bolstered by advances in technology. Regulation and payment models are lagging behind, but their slow evolution cannot stop the onslaught of change.

Health care consumers are now empowered with access to online information about medical opinions, treatment options, and outcomes (although curation is spotty). Start-up companies are helping to make sense of the mess that has characterized health care pricing historically — no provider is proud of its chargemaster. Shouldn’t you be able to compare prices and outcomes wisely as you shop for your next colonoscopy? Don’t you want to find someone who can talk to you about your health and your values without recommending more (or less) treatment than you need? Maybe there will be an app for that.

The future lies in a technologically savvy system of care that is redesigned to be simple, customized, and affordable. After all, that’s what people really want. I have a basic test for innovations: Do they offer affordable care that is more personalized and more convenient? (See illustration.) In short, we need care that is driven by patient goals, not just the wisdom of experts, and that moves us out of brick-and-mortar structures into the places where people live, work, play, and pray.

Take prostate-cancer treatment, for example. We’ve moved from relying on individual providers’ expertise to embracing evidence-based guidelines and shared decision making about treatment options. We must now ask the patient what outcomes matter most: longevity, continence, sexual potency, and so on. And we can aim to improve outcomes and convenience with at-home tools for medication adherence, vital-sign and activity tracking, and (soon) lab monitoring.

The past century in medicine has been scientifically miraculous, but the focus on “curing” has often overlooked two other patient-centered values: caring for the whole person (physically, emotionally, socially, financially) and simplifying the care trajectory through care coordination. Technology, innovation, transparency, and patient empowerment are helping us rediscover our roots — as providers who aim to improve people’s lives. New systems of care, redesigned with the help of technology, can get us there, one customized experience at a time.

New call for submissions ­to NEJM Catalyst

Now inviting longform articles

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

More From Care Redesign
Coffey02_pullquote family-centered care in medical and surgical procedures

What If Family-Centered Care Were Extended to Medical and Surgical Procedures?

Though the concerns are valid, early experiences suggest that family member engagement may be an effective tool for improving the value of care.

Evidence Needed for Health Systems Change to Address Social Determinants of Health and Obesity and Diet-Related Diseases in Turn

Better Clinical Care for Obesity and Diet-Related Diseases Requires a Focus on Social Determinants of Health

To more effectively treat the problems of obesity and diet-related conditions, health systems need to restructure the traditional medical model of care delivery to address the social determinants of health.

People Living with Dementia Around the World - Value-Based Chronic Illness and Dementia Care

Value-Based Care Must Strengthen Focus on Chronic Illnesses

To effectively control costs and improve value, new models must address our increasingly older patients and chronic care patients, especially those with Alzheimer’s and related dementias.

The Barriers to Excellent Care Vary Widely Across Geographic Regions - both Rural Health Care and Urban Health Care

Survey Snapshot: Rural Health Innovations Born from Challenges

According to NEJM Catalyst Insights Council members, every health system has to develop its own definition of what is meant by “rural” health.

Same-Day Breast Biopsy Workflow at Baylor College of Medicine

How Care Redesign and Process Improvement Can Reduce Patient Fear

Seeing how clinicians take care of their own when they are in frightening situations was the epiphany that led to a same-day breast biopsy program.

Rural Health Care Is Rated Comparable or Worse Across Quadruple Aim Aspects

Care Redesign Survey: Lessons Learned from and for Rural Health

Although care delivery models in rural and urban/suburban areas are distinct, by virtue of geographic density and resource availability, each locale affords lessons for the other.

Comprehensive Intervention Review at Lurie Childrens Hospital - improving patient flow and length of stay

Reducing Length of Stay in the ED

A comprehensive redesign of triage and ED care.

Pumonary Nurse Post-Discharge Follow-Up Note for Patients with COPD

TOPS: Telephonic Outreach in the Pulmonary Service at VA Boston Healthcare System

A nurse-directed intervention targeting veterans who had been hospitalized for COPD resulted in improved access to ambulatory care and a reduced rate of readmissions.

Health Care Quality Improvement Prioritization - Keeping the Focus on the Union of Mission and Externalities

Mission and Externalities: The Imperative for Prioritization

Well-meaning providers will fail to improve the quality of care until they focus on what’s important: setting priorities and dealing with the consequences of external factors.

RumballSmith03_pullquote personalized hospital ratings

Personalized Hospital Ratings — Transparency for the Internet Age

Patient user-determined weights could become a highly desirable feature of future hospital ratings.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Social Needs

88 Articles

Better Clinical Care for Obesity and…

To more effectively treat the problems of obesity and diet-related conditions, health systems need to…

Online “Superusers” as Allies of the…

Three proposed steps for integrating peer-driven online health communities with traditional services to improve health…

Coordinated Care

129 Articles

The Evolution of Primary Care: Embracing…

Primary care must leverage disruptive innovations to ensure that patients receive first-access, comprehensive, coordinated, continuous…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now