The U.S. health care system, especially health care providers, needs to start taking a more holistic approach toward patient care, according to a panel of experts that spoke Tuesday morning at Trinity University.
The panel’s in-depth health care discussion was part of the REACH Symposium: Health Care 2016 and Beyond, a forum organized by Trinity’s Department of Health Care Administration and the Centene Corporation, which brought health care professionals, leaders, and experts together to discuss the trends facing the U.S health care system this year.
Doug Hawthorne, CEO emeritus of nonprofit health care company Texas Health Resources and a Trinity University board chair member, urged the group to move away from traditional standards of healthcare, particularly in hospitals, to better the system as a whole.
“I think we need change in health care and I think all of you would agree its time,” Hawthorne said. “The walls of the traditional hospital have to come down.”
There is a strong focus on the short-term treatment of sick patients in clinical settings, but not always a strong emphasis on patients’ long-term health and recovery.
“We have to be looking left and right of the hospital,” Hawthorne said. “On the left side how do we improve one’s health and wellbeing, and then on the right side if they have to use that hospital experience how do we keep them from returning?”
Dr. Helen Burstin, chief scientific officer for National Quality Forum, echoed Hawthorne’s sentiments, stressing the missing relationship between healthcare providers – physicians and hospitals – and after-care social services for patients.
“When we have a health care system based so heavily on care that only occurs in specific settings, without connectivity in those settings we are failing patients,” she said. “There has to be a greater degree of collaborations across those settings.”
Burstin put her thoughts into perspective by sharing a story of a former patient who experienced fainting for unknown reasons. He went to the hospital where doctors ran some tests and after determining he was okay, and eventually sent him home. A few days later, the patient fainted again, and finally sought Burstin’s help. She said when he arrived for his visit, she realized that his previous doctors didn’t give him any information on what to do if he were to faint again and didn’t connect him with resources after his hospital experience.
“If somebody comes in with a hip fracture, it’s not okay to (look no) further than what happens in the emergency department,” she said.
This “looking further” approach Burstin said, could include home health care and remote care, which would involve more use of technology-focused services like mobile apps where patients can record medical information to send to their health care providers.
The medical school curriculum, she added, should also focus more on implementing a more broadly-scoped standard of care that encourages physicians to look beyond finding a diagnosis.
“We’ve all been focused on getting the diagnosis and getting treatment without thinking more broadly,” she said. “It’s hard because for medical students and residents there’s hard stuff and soft stuff in training … we should bring them together.”
The “soft stuff” includes things like physician interactions with patients before, during, and after their treatment. The use of technology, she added, is also key to making sure physicians-in-training evolve to keep up with the changing health care landscape.
“Technology-use in medical field needs to happen,” she said. “It’s slowly changing but not fast enough.”
Other panelists and audience members said standardized treatment protocols have begun to override personalized care, putting patient health and wallets at risk.
Kevin Haar, president of Appistry Inc. which creates software that analyzes genome tests, said a personalized approach to treatment of disease and injury is critical, especially when treating cancer which effects everyone differently. Genomic testing analyzes the behavior of a cancer tumor to determine how aggressive it may or may not be. With that information, doctors are able to determine what the best course of treatment would be for their patients.
“The standard of care today is that a patient will go through three sets of chemotherapy in a hospital before that patient is submitted to genomic testing to figure out what therapy would in fact work,” he said.
The cost of chemotherapy varies between brand and method, but the treatments can cost patients hundreds of thousands of dollars each year. An alternative treatment route like genomic testing could open the doors to patients for less costly treatment routes that are just as effective.
Using valuable data collected through processes like genomic testing can also give the medical community the ability “to use massive data collection and analysis for hypothesis generation, scenario building, and more tailored protocols for patients,” said Alan Weil, editor-in-chief of interdisciplinary health journal Health Affairs.
The panelists agreed that investments in preventative care, along with expanded health resources beyond hospitals or clinics, is the key to lowering medical care costs for everyone. Implementing community health programs and ensuring that patients have access to health resources can prevent chronic illnesses that generate 86% of health care expenditures in the U.S., according the the Centers for Disease Control and Prevention.
Another part of preventative care, according to the panelists, includes tackling bigger, social issues that have lasting effects on a patient’s overall wellbeing.
“We’re increasingly recognizing that many outcomes that we attribute to health care are often much broader,” Burstin said. “There are opportunities to invest where we think will make a greater difference.”
Weil agreed with Burstin, adding that bigger investments in social programs and resources, in addition to competency among health care providers and patients, is key in bringing down health care costs and ensuring the long term health for patients.
“We have to move dollars out of health care and into the social sector,” Weil said. “I don’t think it’s very disruptive to tell hospitals to try to figure out who the Meals on Wheels agencies are and to build relationships with home health agencies.”
Still, each panelist hesitated to appear too hopeful concerning the future of U.S. health care. In order for the system to change and shift its focus, Haar said, patients, too, will have to be willing to embrace new policies.
“The policies and procedures that have been in place for a long time are what people are comfortable with, so it’s also more of a social change,” he said.
Weil reminded the group that though these discussions about expanding health care beyond hospitals and clinics are important, any change in the politically-charged world of health care policy will take a long time to reach fruition — if at all.
“Care is still squarely-rooted and anchored in those central locations,” said Weil. “As much as there’s talk about moving care outside those locations in the future, we’re certainly not there yet.”
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*Top image: A boy receives a flu shot. Photo by James Gathany for the CDC, public domain image.