Making Sense of the Complexity and Keeping Perspective

After several decades studying our healthcare system and seeking solutions to the crisis, we've had to address multiple complex issues concerning such things as evidence-based medicine, clinical outcomes, performance measurement, quality improvement strategies, cost control methods, transparency of cost and effectiveness, health information technology, and the use of incentives. I found it is easy to get lost and confused unless you have a big picture view to help keep the details in perspective.

One way to keep such a perspective is to see the solution as a series of changes in healthcare policies and practices focused on enabling all patients to receive the most cost-effectiveness care – be it well-care (i.e., prevention), catastrophic care, and compassionate end-of-life care. This means:

• Patients and providers must know the best (most cost-effective) treatments/interventions for each particular health problem/risk
• Providers must be able and motivated to deliver that care
• Patients must able to select the best providers to treat them and be motivated to comply with their plans of care.

Accomplishing this requires addressing the following issues (among others):
1. We have to replace ignorance (see the Knowledge Gap) with a concerted collaborative effort to gain the knowledge needed to make better decisions. Two tactics to achieve this are;

• The development, dissemination, and implementation of evolving evidence-based practice guidelines, which includes dealing with the difficulty of using outcomes data to evaluate performance. Implementing this tactic requires addressing several problems with current practice guidelines and quality improvement (QI) programs.

• The use of evolving health information technology (HIT) tools, including advanced knowledge tools for supporting diagnostic and treatment prescription decisions and driving an evidence-based decision support process. There are several concerns about HIT and solutions.

2. Current day policies and practices, which impede providers from spending the time and having the resources to give patients the best possible care, should be changed (See Healthcare Fidelity )

3. Treatment decisions should be tailored to the specific needs of the individual patient taking into account the person’s age, gender, race, genetics, environment, concomitant treatments, quality of life preferences, and other factors that may be relevant to a high-quality plan of care (see Personalized Care ).

4. Increasing provider motivation to change is another issue needing resolution. This is related to the Pay for Performance (P4P) issue.

5. Creating a sane payment system would certainly help, including addressing the issue of transparency of care cost and effectiveness.

6. Consumers should be better informed so they can distinguish among levels of quality by knowing the relative cost and degree of defect (underuse, overuse, and misuse) of healthcare resources.

7. Consumer education and wellness programs are also important so people can help prevent their own health problems and managed chronic conditions effectively.