Patient-centric Value-based Healthcare

Healthcare in the new millennium is in a state of flux. The U.S. healthcare system is both costly and inefficient. One of the many causes of dysfunction is called silo-ing.

In agriculture, farmers use structures called silos to store their crops separately. There is a parallel practice of silo-ing in the American healthcare system. Clinical care in the United States is a mix of many stand-alone silos. Unfortunately, this has a detrimental effect on providing high-quality patient care.

Physicians, hospitals, and clinics are all known to jealously guard their patient information. Digital health devices silo store patient data as stand-alone incidents instead of providing a cohesive view of a patient’s entire medical history and treatment plan. Our current healthcare model has many practitioners, each controlling small subsets of data. Sharing information between different departments or specialties is not as common as one would hope.

Building cohesive healthcare

Healthcare silos weaken and often threaten the well-being of patients treated by several different specialties. In too many cases, the left hand may not know what the right hand is doing. The solution is to build strong interdisciplinary teams that work as a cohesive unit.

In the past, the focus of healthcare has been provider-centric. This system of care is slowly being phased out in favor of a patient-centric care model where organizational structures revolve around the patient and not the department treating them. The goal is for team members to share their expertise with their coworkers. Caregivers would have a clearly defined role within the healthcare team and more streamlined communication.

At every level, clinicians can better coordinate patient care through cross-functional teams. Clinicians coordinate better care across the board, increasing the number of positive patient outcomes.

Too many cooks (or docs)

For example, when a patient with varying symptoms arrives at the emergency department, it’s common for several specialties to have a hand in treating the patient. Often patients are treated by one specialty to be passed on to another. The provider may prescribe medication based on the patient’s current set of symptoms. However, the patient may have been taking other medication for another problem linked to the problem at hand.

Healthcare silos are especially damaging to patients with chronic conditions such as diabetes. A disturbing number of diabetics are unaware that their condition puts them at a much higher risk for cardiovascular disease(CVD.)

Patient-centered care

Since communication between specialists is spotty at best, health problems are dealt with episodically rather than preventatively. Even more concerning is that diabetic patients are often left out of the conversation when their treatment plan is formulated. This lack of a patient-partnered approach is one of the leading causes of healthcare silos.

Ideally, healthcare systems would place patients at the epicenter of treatment instead of barely on the outskirts. Specialists would share information and collaborate to determine the best course of treatment. Having a general practitioner at the helm to coordinate care with the specialties involved would lead to better patient outcomes.

One way to achieve this is by adopting a value-based approach to patient care.

Value-based healthcare is a healthcare delivery model that pays providers based on their patient's health outcomes. This care model prioritizes preventative care, which reduces the occurrence of chronic disease.

Value-based care versus the fee-for-service model

Value-based healthcare delivery differs from the fee-for-service approach. Under a fee-for-service system, healthcare professionals are paid based on the number of services delivered, as opposed to the quality of care provided. The “value” in value-based healthcare measures patient outcomes against the costs necessary to attain the best results.

The main goal of value-based care is to create a better experience for patients. Patient-centered value is only considered successful if a patient’s health outcomes improve. Therefore, descriptions of value-based health care that focus mainly on cost reduction miss the point. If the real goal of value-based health care existed only to cut costs, it would only be value-based for the stockholders and insurance companies. You know, like it is now.

A value-based healthcare system provides numerous benefits that positively impact healthcare providers, stakeholders, patients, payers, and society as a whole.

For example, people spend less money managing chronic conditions like diabetes, obesity, high blood pressure, or COPD. Chronic illness is costly and time-consuming for most patients. Value-based care results in patients requiring fewer office visits and procedures.

Healthcare practitioners enjoy increased efficiency and patient satisfaction. Although providers must make an initial investment to provide prevention-based patient services, the payoff is that fewer resources are needed for chronic disease management. When value is prioritized over volume, both quality of care and patient engagement increase.

Changing to a value-based health care model requires that physicians reassess their role within the scope of the entire care team. Doctors also need to redefine what an effective care solution really is, and the importance of prioritizing the outcomes that their patients desire. Ideally, this philosophy and process should be taught in medical school.

Healthier patients, happier healthcare teams

In the long run, the preventative approach means healthier patients and reduced healthcare spending. In the United States, healthcare costs are almost 18% of Gross Domestic Product (GDP). Value-based care has the potential to rein in exorbitant healthcare expenditures.

Of course, Medicare for All would be the best solution, but until we stop allowing insurance companies to call the shots, this is where we are.

In the context of value-based care, collaboration between nurses and physicians is critical to provide optimal patient care and clear communication in the workplace. Collaboration and cooperation mean mutually searching for solutions to problems and formulating and implementing plans for treatment.

Collaboration between providers can improve the quality of healthcare services. This is particularly true in a hospital setting where professional interaction is key to providing the highest standards of care.

Collaboration between nurses and doctors improves patient outcomes while lowering healthcare costs. Effective teamwork also leads to increased job satisfaction and patient safety. Studies show that poor communication can contribute to continuous conflict between nurses and physicians resulting in medical errors and poor outcomes.

To be clear, the issue at hand does not involve conflict between physicians and nurses that arise from personality clashes common in any professional setting, especially those involving ongoing collaboration.

Interpersonal tension and conflict are common in all manners of business and interpersonal relationships. Some people are more reserved, have less patience, or have greater or differing expectations. However, the sheer number of reported physician-nurse conflicts is more widespread than issues attributed to typical personality clashes would suggest.

Several potential triggers for doctor/nurse conflict between physicians and nurses include the power imbalance and different goals still inherent between the medical and nursing professions. And, of course, issues related to traditional gender roles.

Nurses: the physician's bedpan-wielding helper

Studies suggest that unsatisfactory interprofessional relations between physicians and nurses have been a contributing factor to the nursing shortage. Frustrated nurses leave the profession, and potential nurses shy away because of the infamous doctor/nurse power imbalance. Since COVID, nurses have been leaving the profession in droves.

Nurses and physicians do not always appreciate each other’s roles in achieving optimal patient outcomes. Earlier research studies show that doctors and nurses view collaboration differently. Physicians consider collaboration as the nursing staff following their orders, while nurses see their function as a complementary role to the physician rather than a subservient one.

This is counterproductive, as nurses and doctors are both responsible for the majority of patient care. Communication is poor, and many interchanges are dysfunctional at best. Improving communication between physicians and nurses is critical, especially in the context of value-based care.

One issue stands out as a contributing factor to doctor/nurse tension. Traditionally, relationships between doctors and nurses have been a hierarchical one distinguished by dominance on the physician’s part. Conversely, nurses are relegated to the role of assistant instead of a valued members of the healthcare team.

Not that long ago, almost all physicians in the U.S. were men, and nursing was traditionally a female-dominated profession. Even now, most nurses are still women, although more men are joining the ranks as well. Conversely, even though most physicians are still male, there is a growing number of women practicing medicine.

The conflict between physicians and nurses directly correlates with the traditional gender roles of men and women. Some theorize that physicians view a nurse’s role as subservient, mainly because nursing has traditionally been a female profession and females have played a subservient role in society in general.

Consequently, nurses have typically seen their role as secondary to the physicians’. This power imbalance due to educational and socio-economic differences between physicians and nurses creates the illusion that nurses’ opinions are irrelevant compared to physicians. It’s not uncommon for situations to arise where nursing recommendations are disregarded or overruled by physicians. Not surprisingly, this results in resentment and frustration for the nurse.

There must be an available method of conflict resolution to address minor problems before they become major ones. Nurses may avoid conflict or consider it inevitable. Effective conflict resolution encouraging interdisciplinary collaboration could help alleviate tensions between doctors and nurses resulting in better overall outcomes.

This sounds like a positive, actionable solution. Still, it’s not very realistic to expect doctors to participate in conflict resolution if they are content with the status quo or consider the problem solely a nursing issue.

Change is never easy. All participants must be willing to engage and compromise. Once the positive impacts of value-based care become evident, everyone on the team, including physicians, will find the initial effort is well worth it as patient care and outcomes improve.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376155/

https://healthinformatics.uic.edu/blog/shift-from-volume-based-care-to-value-based-care/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7185050/

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs