Monday, October 29, 2007

Patient-Centered Life-Cycle Value Chain: the Well Care link

In my previous post, I discussed the second link in the Patient-Centered Life-Cycle (PCLC) Value Chain, which is sick-care. In this post, I discuss the third link, which involves well-care, as well as the integration of emergency-care, sick-care and well-care.

Well-Care (Prevention & Self-Management)

The third link in the PCLC Value Chain involves well-care, which includes prevention & self-management. Three well-care delivery models are the:
  • Preventative Maintenance model, which focuses on (a) delivery of primary prevention -- such as physical activity, nutrition, stress relief, vaccinations, etc. -- that help people avoid health problems, as well as promoting peek performance, and (b) secondary prevention for at-risk persons to prevent recurrences of health problems, such as avoiding recurrent coronary artery disease events in a person with a history the illness.
  • Recovery/Rehabilitation model, which focuses on adherence (compliance) to doctors’ orders to foster recovery, rehabilitation, and complication avoidance for patients having chronic or catastrophic health problems.
  • Compassionate Home Care model, which focuses on making people near end of life as comfortable as possible in a supportive environment where they have dignity and family support.
Well-care is delivered by wellness coaches/practitioners, such as specially trained physician assistants, nurse practitioners, home health aids, personal trainers, and others:
  • Recovery/Rehabilitation and Preventative Maintenance well-care may be delivered face-to-face, over the internet, and via phone sessions. They include processes for: (a) ongoing risk and health status assessments; (b) ongoing generation of personal health plans identifying any risk factors people may have, as well as primary and secondary prevention plans of action (i.e., health directives); (c) health education presenting concrete, understandable action steps and psychological counseling for dealing with physical problems and psychological stressors; (d) compliance motivation involving motivating and reminding people to do the things that will help them improve their own health; (e) accessing health coaches for health information and advice; (f) outcome studies used in continuous quality improvement feedback loops; (g) care coordination for patients with catastrophic health problems, so multidisciplinary teams can work together effectively; (h) promotion of environmental and workplace safety; and (i) encouraging lifestyle and attitudinal changes for peek performance.
  • Delivering Compassionate Home Care well-care includes processes for helping individual obtain home care nursing and homemaking assistance; arranging for transportation to and from doctor appointments; and addressing the psychological, social and spiritual well-being of patients and families.

Integrating Emergency-Care, Sick-Care & Well-Care in the PCLC Value Chain

Instead of viewing emergency-care, sick-care and well-care as separate and distinct, the PCLC Value Chain solution integrating all three. This process involves a new kind of coordination and collaboration between:
  • First responders focused on safe passage to and from disaster sites, victim rescue and triage, and trauma center response
  • Medical and related sick-care practitioners focused on the diagnosis and treatment of health problems
  • Well-care practitioners focused on prevention, recovery, and self-maintenance.
This integrated care strategy promises to bring the greatest value to patient/consumers over their life times by helping assure adequate resources are available and the right care is delivered cost-effectively in all possible situations. It provides a sensible way to keep people healthier longer, recover from illness and dysfunction more quickly, avoid complications of chronic disease, and enable first responders to rescue victims effectively in emergencies. This shifts our current healthcare system from being overly focused on episodic acute care to embrace prevention and chronic condition management, as well responding in emerging environments.

In subsequent posts [starting here], I discuss what’s needed to implement this integrated care strategy successfully, including:
  • Specific clinical and financial processes of our current healthcare system that must be transformed
  • Specific infrastructural needs, in terms of health information technology use.

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