Best Care at Lower Cost The Path to Continuously Learning Health Care in America (2013) / Chapter Skim
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10 Actions for Continuous Learning, Best Care, and Lower Costs
10 Actions for Continuous Learning, Best Care, and Lower Costs
Pages 281-312
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From page 281... ...
This chapter summarizes the recommendations presented in Chapters 6 through 9 and then describes the roles of the various stakeholders in the system in implementing these recommendations. ACHIEVING THE VISION Based on the findings and conclusions identified in the course of its work, the committee recommends specific actions, supported by the material presented in Chapters 6-9, that will accelerate progress toward continuous learning, best care, and lower costs.
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Recommendation 7: Optimized operations. Continuously improve health care operations to reduce waste, streamline care delivery, and focus on activities that improve patient health.
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Strategies for progress toward this goal: • Health care delivery organizations and clinicians should fully and effectively employ digital systems that capture patient care expe riences reliably and consistently, and implement standards and practices that advance the interoperability of data systems. • The National Coordinator for Health Information Technology, digital technology developers, and standards organizations should ensure that the digital infrastructure captures and delivers the core data elements and interoperability needed to support better care, system improvement, and the generation of new knowledge.
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policies with respect to actual or perceived regulatory impediments to the protected use of clinical data, and clarify regulations and their interpretation to support the use of clinical data as a resource for advancing science and care improvement. • Patient and consumer groups, clinicians, professional specialty societies, health care delivery organizations, voluntary organiza tions, researchers, and grantmakers should develop strategies and outreach to improve understanding of the benefits and importance of accelerating the use of clinical data to improve care and health outcomes.
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• Health care delivery organizations, including programs operated by the Department of Defense, the Veterans Health Administration, and Health Resources and Services Administration, should moni tor and assess patient perspectives and use the insights thus gained to improve care processes; establish patient portals to facilitate data sharing and communication among clinicians, patients, and families; and make high-quality, reliable tools available for shared decision making with patients at different levels of health literacy.
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Care delivery and community-based organizations and agencies should partner with each other to develop cooperative strategies for the design, implementa tion, and accountability of services aimed at improving individual and population health. Strategies for progress toward this goal: • Health care delivery organizations and clinicians should partner with community-based organizations and public health agencies to leverage and coordinate prevention, health promotion, and c ommunity-based interventions to improve health outcomes, includ ing strategies related to the assessment and use of web-based tools.
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Strategies for progress toward this goal: • Health care delivery organizations should utilize systems engineer ing tools and process improvement methods to eliminate inefficien cies, remove unnecessary burdens on clinicians and staff, enhance patient experience, and improve patient health outcomes. • The Centers for Medicare & Medicaid Services, the Agency for Healthcare Research and Quality, the Patient-Centered Outcomes Research Institute, quality improvement organizations, and process improvement leaders should develop a learning consortium aimed at accelerating training, technical assistance, and the collection and validation of lessons learned about ways to transform the ef fectiveness and efficiency of care through continuous improvement programs and initiatives.
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• Health care delivery organizations should reward continuous learning and improvement through the use of internal practice incentives. • Health economists, health service researchers, professional spe cialty societies, and measure development organizations should partner with public and private payers to develop and evaluate metrics, payment models, contracting policies, and benefit designs that reward high-value care that improves health outcomes.
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• Leaders of these organizations should define, disseminate, support, and commit to a vision of continuous improvement; focus atten tion, training, and resources on continuous learning; and build an operational model that incentivizes continuous improvement and ensures its sustainability. • Governing boards of health care delivery organizations should sup port and actively participate in fostering a culture of continuous improvement, request continuous feedback on the progress being made toward the adoption of such a culture, and align leadership incentive structures accordingly.
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To guide success, progress on the recommendations in this report should be monitored continuously. Implementing the actions detailed above and achieving the vision of continuous learning and improvement will depend on the exercise of broad leadership by the complex network of decentralized and loosely associated individuals and organizations that make up the health care system.
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Next Steps To help achieve a learning health care system, patients will need to play the following roles: • Engage actively in their own care and health and, where appropri ate, that of family members and loved ones through approaches that include questioning, education and lifelong learning, the use
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• Contribute to continuous learning by providing feedback at every level of their care experience. • Participate in the development of a robust data utility and the use of digital tools for care management and coordination.
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. Education and continuing education need to focus on methods for using new evidence in clinical decision making, engaging in lifelong learning, understanding human behavior and social science, and delivering safe care in an interdisciplinary team environment (AAMC, 2011; Lucian Leape Institute Roundtable on Reforming Medical Education, 2010)
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• Utilize digital health record systems in meaningful ways to capture patient experience and apply decision support at every level of their practice. PROFESSIONAL SPECIALTY SOCIETIES Roles in Learning Bringing together clinicians and providing a forum for action, professional specialty societies play important roles in promoting learning.
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Next Steps To help achieve a learning health care system, professional specialty societies need to play the following roles: • Collaborate with other stakeholders to consider the necessary com mon core data elements and measures for managing high-impact conditions. • Facilitate, along with other relevant organizations, the develop ment, accessibility, and use of evidence-based clinical practice guidelines.
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DELIVERY SYSTEM LEADERS Roles in Learning Because of their size and care capacities, health care delivery organizations play a critical role in driving improvement in the health care system by using new practice methods, setting standards, and sharing resources and information with other care delivery organizations. In addition, many of these organizations have made significant investments in health information technology and in building their research capacity, which has allowed them to become leaders in generating and using evidence to improve patient care; many academic health centers and health systems have developed substantial research infrastructures for deepening clinical and biomedical understanding.
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In doing so, it will be important to consider several factors specific to health care, such as patient diversity and the technical complexity of modern medicine, as well as local factors that could affect implementation. Next Steps To help achieve a learning health care system, leaders of health care delivery organizations need to play the following roles: • Set bold, mission-driven aims for clinical, financial, service, and ex perience outcomes against a frank assessment of the current reality, and implement those aims with a prioritized, aligned approach.
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. In the employer-sponsored insurance market, health care premiums for family coverage have increased by 113 percent over the past decade (Kaiser Family Foundation and Health Research & Educational Trust, 2011)
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Through a number of ongoing initiatives, such as the Partnership for Patients, the Innovation Center will play an important role in improving care delivery and payment policies in Medicare and Medicaid and ensuring that payment policies support continuous learning by clinicians and health care organizations -- a critical goal for a learning health care system. Although it is too soon to judge the effectiveness of the Center's work, the goal of improving payment policies is a critical one.
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Many employers have indicated their willingness to support continuous learning and improvement by introducing payment and contracting policies that reward safe, high-quality, high-value care that improves health. Challenges to Learning Rising health care costs have eroded employer-sponsored health care coverage and its generosity.
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Given this broad charge, the health researcher community includes those involved in the design and operation of clinical trials, the development of clinical registries and clinical databases, the creation of standards and metrics, modeling and simulation studies, studies of health services and care delivery processes, and the aggregation of study results into systematic reviews and clinical guidelines. This work has been supported by a number of agencies and organizations, including the Agency
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. Results of previous surveys of health researchers suggest that the current formulation and interpretation of privacy rules have increased the cost and time to conduct research, that different institutional interpretations of the Health Insurance Portability and Accountability Act (HIPAA)
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. These models can then be used to simulate clinical trials and individualize clinical guidelines according to a patient's particular situation and biology, which can improve health status while reducing costs (Eddy et al., 2011)
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Next Steps To help achieve a learning health care system, health researchers need to play the following roles: • Actively engage with care communities to advance understanding of clinical research and clinical trials and thereby enhance balanced consideration of and enrollment in clinical trials. • Develop and implement new methods for conducting clinical re search that overcome the limitations of the traditional research enterprise.
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This legislation formalized the Office of the National Coordinator for Health Information Technology in the Department of Health and Human Services and provided substantial financial incentives for health care providers and hospitals to adopt and use electronic health records. Resources devoted to those programs include $2 billion for programs by the National Coordinator, as well as almost $30 billion in Medicare and Medicaid incentive payments to physicians and hospitals (Blumenthal, 2009; Buntin et al., 2010)
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• Consider interoperability and integration in clinical workflows in designing digital health systems. HEALTH PRODUCT INNOVATORS AND REGULATORS Roles in Learning By conducting clinical research and developing innovative new treatments and interventions, health product innovators play a pivotal role in a learning health care system.
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Next Steps To help achieve a learning health care system, health product innovators and regulators need to play the following roles: • Build a learning system across the industry, anchored in ethical practice, that allows for the most effective public-private partner ships, learning, and diffusion of innovation. • Probe the unique systems, processes, and needs of high-quality, high-value health care, and conduct applied research on innovative approaches to meeting those needs.
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GOVERNANCE Roles in Learning All governance groups, from boards of health care organizations to governmental bodies, need to be actively involved in promoting a learning health care system. The leadership of these groups, often in collaborative forms, will be necessary to motivate the actions required to create a learning health care system.
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Other committees and governance structures in the organization have similar opportunities to encourage continuous improvement from all the organization's employees. Next Steps To help achieve a learning health care system, governing bodies need to play the following roles: • Embrace a culture of continuous improvement, with a focus on sharing and learning within and across systems.
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2010. The "meaningful use" regulation for electronic health records.
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Menlo Park, CA: Kaiser Family Foundation and Health Research & Educational Trust. Kocher, R., and N
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2006. Engagement of leadership in quality improvement initiatives: Executive quality improvement survey results.
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