Achieving Excellence in Medical Treatment

The delivery of quality healthcare is key to mitigating the rising costs of chronic health conditions, lengthy disabilities and stubborn workers’ compensation claims. Arthur M. Southam, M.D., EVP, Health Plan Operations at Kaiser Foundation Health Plan Inc. and Kaiser Foundation Hospitals kicked off the 24th Annual National Workers’ Compensation & Disability Conference with this session providing quality measures that positively impact chronic disease and other healthcare factors affecting claimants.

Our Healthcare System

Our current system is a massive economic enterprise. The United States spends approximately 50% more on healthcare than any other country in the world.

In 2015, approximately 151 million citizens receive their health coverage from their employer, however, that trend is expected to decrease in the next three years due to changes in employment patterns. Southam also expects a rise of Medicare due to the increase of Baby Boomers into the system and Medicaid due to the Affordable Care Act.

Five years into The Affordable Care Act, politicians are still squabbling, but more people have coverage, premium trends are at a near-historic low and individuals have better coverage and consumer protections. The Act has also created meaningful movement toward the increased use of electronic medical records, with incentives for use.

Not every problem can be fixed with medical care, however. Our cultural awareness needs to be heightened to the fact that personal behavior is the largest determinant of individual health. In fact, the CDC estimates that 80% of all heart disease, stroke, type 2 diabetes and 40% of all cancer could be prevented if people did three things: eat healthy, stay active and stop smoking.

Inactivity is something, as influencers in the workers’ compensation system, that we can do something about. We need to create work environments that support activity. This is likely the easiest way to impact improvement in areas as serious as heart disease, diabetes and cancer rates.

Why Do We Need to Change?

According to “Redefining Health Care Systems” by Robert H. Brook (2015), 50 years of the quality of health services research shows:

• Socioeconomic factors are the most powerful determinants of health. If we are just medicalizing health issues, we are not getting as far as we could. We must consider environmental factors.
• Our health system is wasteful.
• Quality of care varies dramatically.
• Depression is a leading cause of morbidity. This is something we don’t talk enough about as a society.
• Physicians and patients need information and smart tools to support decision making. Science is moving so quickly that doctors cannot treat patients by solely using their brains anymore. You need tools to properly treat patients.
• Payment influences practice. We currently have a culture of, “The more you do it, the more you get paid.”

The Delivery of Quality Healthcare

Patients deserve to receive safe, timely, effective, efficient, equitable, patient-centered care. To provide this quality of care, we need to focus on:

• Financial incentives
• Chronic conditions
• Care coordination (silos do not work)
• Patient engagement
• Behavior change
• Information and technology
• Knowledge management
• Performance transparency
• Team-based care

We’ve come so far in the past couple of decades and know this for certain because we are measuring quality objectively. The Center for Medicare and Medicaid Services and J.D. Power are both leading the way in quality measurement.

Another important tool for the 21st century includes movement to broader use of electronic medical records. Perhaps the most important medical device will become our mobile phones. The medicalized smartphone is going to upend every aspect of healthcare. There are 40,000 medical apps today, some of which provide metrics. This helps to take medical care out of institutions and puts it in our homes and, realistically, in our pockets.

The advent of telehealth and telemedicine will also provide primary and specialty access to people in dense and rural areas. It will help increase voice, video and data transfer between patients, families doctors, pharmacists, etc., when they can and want to to it. Experts predict that, in five years, telemedicine will dramatically transform the experience through this greater access.