Care Redesign

Survey Snapshot: Identifying the Barriers to Improving Care, and Overcoming Them

Insights Report · May 26, 2016

Care Redesign Insights Report Chart: Barriers to Improving Value of Care

From the Care Redesign Insights Report: Why Population Health Management Is Undervalued. Click To Enlarge.

Anna M. Roth, CEO of Contra Costa Regional Medical Center and Health Centers in Martinez, Calif., spoke with Edward Prewitt, NEJM Catalyst’s Editorial Director, about the findings of the first Catalyst Care Redesign survey and report.

 

On the top barriers to improving the value of care:

“It depends on the lens you apply.” The top responses to this question “reflect a combination of patient engagement and the fee-for-service payment structure. It’s really important to step back and understand what we mean when we say ‘value.’ I think most people in health care are thinking about finances, but patients are thinking about their quality of life and the ability to engage in things that matter to them. Most of the time we’re asking this question of clinical people or of health leaders, but if we ask patients what is important to them, I think you would see a shift in this chart. . . . The health care industry believes value has to do with return on investment. That’s true, but it cannot be decoupled with what matters to the patient.”

“In looking at the overall report, you saw that in the [respondent] comments and in the discussion, there is a balance between population health approaches and the person in front of you. Those things can’t be separated. In the coming years the top performers will be those systems and clinical folks who really understand how to implement the balanced approach.”

On designing a health care system to remove these barriers to improving the value of care:

“When I was heading back from the IHI [Institute for Healthcare Improvement], returning to my organization and realizing I was going to have this leadership responsibility as CEO, I had a series of conversations with Dr. [Donald] Berwick [then president of IHI]. I asked him, ‘What is the most important thing for me to focus on?’ As the CEO, you’re tasked with setting the vision for your system and then actually implementing it. He said, ‘You need to find out what the patients in the community need you to be, and then you need to be that.’ What this means is you need to really learn how to understand what is happening with the population in your region. And then you need to meet their needs individually.”

“What I want [as a patient] this year could be very different from next year, and I want my health system to be able to adapt to that. We need to have an ability to deliver reliable care in a standardized manner, but also with a sensitivity and ability to understand what matters to patients when we’re encountering them. That isn’t easy to do. What that turns into is trusting in your frontline people to make decisions, and providing them with the right tools to make those decisions. Make sure your policies don’t get in the way. This is with the assumption that we are nesting delivery of our services in science, but in a way that is sensitive to the needs of individual patients.”

 

Call for submissions:

Now inviting expert articles, longform articles, and case studies for peer review

Connect

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

Learn More »

More From Care Redesign
Community Resource Referral Type

Assessing and Addressing Social Needs in Primary Care

Lincoln Community Health Center improved care quality by measuring and responding to upstream social and economic risk factors disproportionately affecting low-income households.

Time Driven Activity Based Costing for ECMO

Achieving Value in Highly Complex Acute Care: Lessons from the Delivery of Extra Corporeal Life Support

To improve both the value and outcomes of ECLS, Cedars-Sinai Medical Center created guidelines for ECLS delivery and explored opportunities for more efficient care.

ARISE and SFHN BHVS Collaboration

The “Behavioral Health Vital Signs” Initiative

A safety net system’s trauma-informed approach to integrating interpersonal violence into behavioral health programs in primary care.

OpenNotes Epic Patient Email Cascade Chart February 1, 2018 - August 14, 2018

Measuring Performance of OpenNotes Initiatives to Target Improvement Efforts

How a New York safety-net health system used data science to identify obstacles to OpenNotes use, address technical barriers, and develop strategies for improving clinical note sharing by providers and viewing by patients.

Mapping a Technology Strategy for Bundled Payment Care Using a Value-Driven Framework

Harnessing Emerging Information Technology for Bundled Payment Care Using a Value-Driven Framework

A four-part framework developed by physicians at Partners HealthCare provides a stepwise process for assessing and integrating technologies to effectively use data through a continuous patient experience.

UCLA Health CKD Risk Stratification and Management

Proactively Catching the Declining Patient

A coordinated effort by UCLA leaders to identify a high-cost population with chronic kidney disease and to modify care processes and personnel has led to improved health and reduced utilization.

Telehealth and remote monitoring are little used and ineffective for chronic disease care

Survey Snapshot: Treating Chronic Disease Proactively

Though survey respondents don’t indicate strong use of telehealth and remote monitoring, NEJM Catalyst Insights Council members discuss the ways they’re using these tools to monitor chronic disease, with good results.

Platforming Health Care Operations - Consumer-Driven Health Care - Business-Minded Optimizations

Platforming Health Care to Transform Care Delivery

Health care leaders need to focus less on ownership and control of the delivery process, and more on outcomes, cost efficiency, and customer experience.

Shah05_ integrated systems innovation pullquote

Build vs. Buy: What Should Health Systems Do?

The consolidation craze continues, but vertical integration has yet to demonstrate real progress toward the Triple Aim. Health care leaders would do well to consider innovative approaches that are working in other industries, including the tech-enabled full stack model.

Diagram Illustrating the COPD Care Pathway at Allegheny General Hospital

End-to-End Care for COPD Patients that Improves Outcomes and Lowers Costs

Allegheny General Hospital created a comprehensive solution for patients with chronic obstructive pulmonary disease (COPD) that led to improved clinical outcomes, reduced hospital admissions and readmissions, and a resultant decrease in the total cost of care.

Connect

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

Learn More »

Topics

Design Thinking

20 Articles

Taxonomy of the Patient Voice

While health care pursues the important trend of putting patients at the center of care,…

Measuring Performance of OpenNotes Initiatives to…

How a New York safety-net health system used data science to identify obstacles to OpenNotes…

Proactively Catching the Declining Patient

A coordinated effort by UCLA leaders to identify a high-cost population with chronic kidney disease…

Insights Council

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

Apply Now