The Center of Medicaid and Medicare Service (CMS) continues to increase emphasis on care collaboration, addressing the Care Collaboration Model outlined by CMS and the Surgeon General. Research has demonstrated bi-directional links between mental disorders and chronic conditions. Such interdependencies have limited solutions today due to the lack of a collaborative environment.
A team-based care collaborative model uses a multi-discipline group of care providers supporting and implementing treatment with the patient at the centre a bi-directional information flow is an absolute must to put the model into realisation and operation in healthcare institutes.
Today, healthcare lacks the support of a closed-loop system, one that emphasises a bi-directional flow of information. Healthcare is muddled with reactive care, instead of preventive, anticipated care. It is that lack of prevention and anticipation that have an adverse impact on the overall healthcare cost and patient outcomes. EHR and EMR systems are the main ‘anchors’ of today’s health IT.
However, there are two EHR components that are non-starters: the boundary of the health institute and uni-directional systems. HIEs (Health Information Exchange) address EHR limitations with their capability to provide support across health institutes, but actually worsen the uni-directional character of the EHR. Neither EHR or HIE can address the requirements for a care collaborative model.
The objective is to improve patient outcomes, but how do you define a patient’s outcome? Homeostasis is a biological term, referring to the stability, balance, or equilibrium within the body. Homeostasis is the process of maintaining a constant internal environment by providing the body with what is needed to survive for the well being of the whole. While disorders (physical or mental) reflect the abnormal condition of the body, homeostasis is the normal, stable and wellbeing state. The state of homeostasis should be used as the measure of a patient’s outcome, resulting from the care collaborative model addressing the integrated, coordinated care from multiple care providers.
Health Collaborative Ecosystem is the delivery process that supports the care collaborative model, with the objective of bringing the patient to the state of homeostasis. The Health Collaborative Ecosystem is the answer for such a challenge.
Why an Ecosystem?
- An Ecosystem is a collective system, including a health IT solution and consulting guidance, and support, for hospital operations in order to maximise the benefits of care collaboration, through efficiency and scalability of a care providers’ bandwidth.
- It is an Ecosystem because it must include an auditable compliance component to provide crucial measurements and enforce quality guidelines for the model according to hospital and clinic management.
- It is an Ecosystem because it must include the ability to track and monitor progress towards the state of homeostasis for all attributes contributing the patient’s overall well being.
However, to support such a
revolution, healthcare, as an industry, needs to have financial incentives
which CMS is now encouraging; a roadmap to roll out the Health Collaborative
Ecosystem without upfront risks and budget planning, but to generate new
revenue for the institutes. The implementation roadmap leverages these CMS
- Annual wellness visits;
- Chronic care management;
- Integration of physical and behavioural health through the care collaboration model.
With the Health Collaborative Ecosystem’s objective is to create a patient state of homeostasis, rural and community hospitals and clinics can accomplish multiple goals – better services to the community, better defined patient outcomes and open new avenues for health services with behavioural health and filling the revenue gap.
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What is your top management tip?
Treat people with respect, build trust, demonstrate caring, exude integrity, display dependability and character.
What would you single out as a career highlight?
The ability to help the healthcare industry overcome the problems associated with the lack of HIT interoperability which negatively impacts healthcare pros and the patients who depend on them.
If you had not chosen this career path you would have become a…?
Perhaps a physician as there are few career paths that can be so personally rewarding as the ability to be able to help others.
What are your personal interests outside of work?
I enjoy giving back to the community by volunteering and mentoring.
Your favourite quote?
The buck stops here.