During the past 2 months, it has been a privilege for me to spend time with Physiatry colleagues who are innovating every day in their practices, from the cutting-edge use of diagnostic ultrasound to the integration of autonomic wellness. I am so glad that I took time off my work treadmill to listen and learn. Dr. Raouf (Ron) Gharbo with Autonomic Nervous System (ANS) Rehabilitation was a gracious host as I observed how he integrates cutting-edge coaching and measurement into his practice. This helps his patients become more effective at managing stress and pain as they incorporate well-established breathing and graduated exercises into their treatment plan. I would encourage interested readers to dig deeper into autonomic wellness by view Dr. Gharbo’s excellent podcasts and interviews.
I also continue to meet with hospital executives and their teams as a digital health advisor. These leaders are working hard to improve quality and safety to the sickest patients in our country. All good people working hard to do what they can.
Despite the best of intentions, both groups work in a financial model which pays for “sick care” and does not embrace innovations which improve community health. My Physiatry colleagues are providing tremendous value (quality/cost) which is not always recognized in the fee for service payment model. For example, if they improve the coping skills ability of patients by “reducing the negative effects of the racing brain” (parasympathetic health) on sleep, pain, and participation in self-care it often reduces inappropriate emergency care. This reduction in emergency care is negative to the bottom line for hospitals and their administrators. So it is unlikely that a hospital administrator would support work on parasympathetic health that would reduce emergency care utilization if it did not provide offsetting revenue streams.
Enter Dell Medical School. This cutting-edge school was founded with community dollars with the explicit mission “to improve community health”. This creates the opportunity to bundle multi-disciplinary care to reduce costs and improve quality, resulting in measurable value.
For two specialties—musculoskeletal health and women’s health—care is not only delivered differently but also paid for differently, with a bundled payment tied to a condition rather than to a specific procedure or surgery.
….Currently, payment for musculoskeletal care at Dell Med comes from a bundled payment contract with Central Health that covers patients from Central Health’s Medical Access Program (for low-income people who don’t have Medicaid, Medicare, or private insurance), patients from Community Care Collaborative (a partnership between Central Health and Seton, a health care system that is part of Ascension), and patients who pay on a sliding scale. Under the novel condition-specific bundle, payment is triggered when a patient with hip or knee arthritis comes to the clinic to initiate treatment, rather than when they undergo surgery.
The musculoskeletal health at Dell Medical aligns well with the BOLD initiative from the American Academy of Physical Medical and Rehabilitation (Physiatry). I am encouraged by the BOLD initiative which proactively aggregates data on the behalf of practicing physicians treating some of the most complex and expensive patients in the US healthcare system. I am continuing to write about how multi-disciplinary care is one on the foundational activities to improve outcomes at the community level.
Other medical specialty organizations are creating similar registries which could be coordinated with existing primary care and pharmacy care networks. For example, it would be ideal for primary care physicians, pharmacists, and spine specialists to coordinate care for very common problems such as low back pain. Given the existing opioid crisis, there are compelling clinical, financial, and community benefits to all participants. Ultimately, this work is most helpful when it supports the essential relationship between consumers and providers.
I am definitely excited about the clinical innovation that I see within subsets of healthcare; however, it is clear to me that the biggest value for patients is created with concurrent clinical and financial innovation with bundled programs.