The healthcare technology track at this year’s South by Southwest Interactive in Austin, TX was the expected showcase of technology-driven vision, hopes for “disruption” and an expected revolution in consumer-driven health. And while all of those concepts are indeed on the cusp of change and important to begin to prepare for, it was the changes to systems that captured my attention this year. Technology is an enabler, but it doesn’t lead in healthcare. Systems do.
The story of Southcentral Foundation (SCF) in Anchorage, AK was presented in a SXSW session entitled “Alaska’s March to Wellness.” It piqued my interest for a couple of reasons: first, truly optimized systems based healthcare is much more impactful and second, this particular population is one of the most heavily burdened in the US: Native Americans in harsh, remote and relatively underpopulated environments. The disruption of the indigenous culture, poverty and a troubled history have set up Native Americans to disproportionately suffer from a number of chronic diseases, including metabolic diseases like diabetes, high blood pressure and obesity. Contributing to this situation are a host of challenges like high rates of teen pregnancy, alcoholism, smoking and behavioral health issues. Appropriate efforts to intervene on clinical illness require an understanding of the culture and require addressing the host of behaviors that lead to diminished health.
The presenters were Dr. Katherine Gottlieb, CEO of the SCF and Douglas Eby, MD and VP of Medical Services for the system. In addition to being the guiding force behind the system for over 20 years, Dr. Gottlieb is a recipient of a MacArthur Foundation Grant, the “genius award” given to some of the most promising and innovative contemporary thinkers. Along with her, Dr. Eby was a quiet genius as well, passionate and articulate about what differentiated the systems’ model from so many others. In a low-key and self-effacing style, Eby also clearly articulated a key issue in healthcare: medical doctors are selected for specific attributes: scientific knowledge, analytic skill and memory, which are all “test-taking” skills not necessarily associated with empathy and ability to build rapport with patients. Additionally, a generalization can be made that a doctor often simply does not have the time available to dive deeper than diagnosis and treatment, creating an unsatisfying experience for the patient with little follow-through and often not tacking the confounding factors leading to illness.
This is finally being realized as an issue to contend with in healthcare and SCF has enabled a culturally appropriate and team-based approach to patient care. These approaches to care, like the Patient Centered Medical Home (PCMH) model favor an appropriate handoff between each member of the team, so that clinical staff are “practicing at the top of their license,” and focused on the hardest and most specialized elements of treatment, while other members of the team like “care coordinators” are working on care plans, followups, addressing social issues or just “nudging” patients towards better behaviors. The work of a PCMH isn’t just focused on a patient, either. Families are often addressed as part of the solution and involved in care, planning and decision making for loved ones.
This sort of “blocking and tackling,” enabled with software like Disease Registries, Care Management or even Customer Relationship Management (CRM) tools integrated into EMRs to ensure collaboration can be a critical factor in creating long term improvements, especially with patients with chronic diseases who are often beset by multiple illnesses and other non-clinical challenges. While the “return on investment” is still being debated on these models, they are typically associated with improved outcomes and higher levels of patient engagement and perceptions of quality, which can positively impact survey scores as an indicator of quality. Additionally, the organizational, administrative and technological work involved also has benefits to the provider organization as well, as the Alaska Health System experience has borne out.
While some of this is still “squishy” as we try to quantify benefits and outcomes, it’s clear that patient engagement can be critical to improved outcomes and that, along with patient experience, will be parts of the dimensions of how we evaluate healthcare.