Customizing healthcare: How a new approach to diagnosis, care, and cure could transform employer benefits in a postreform world

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40%
of health leaders surveyed by PwC acknowledged that handoffs among clinicians were difficult or very difficult.

Touchpoint 1:

Coordinated-care teams

An all-too-common complaint about today’s healthcare system is the siloed nature of care. Patients usually see different doctors for different ailments, and there’s little—if any—interaction between physicians in the sharing of diagnoses, treatment plans, test results, and so on.

While frustrating and inconvenient for patients, that scattershot approach is also a problem for employers, who usually see it translate into increased costs arising from duplicate or unnecessary treatments—yet payment and regulatory silos make it difficult to achieve a more integrated approach. Forty percent of health leaders surveyed acknowledged that handoffs among clinicians were difficult or very difficult.3

Coordinated care, also known as chain care, adapts to the patient as information is continuously exchanged and care plans are updated. At its heart is the seamless sharing of accurate and current information. As one health industry executive says, “We need to build an accurate patient profile and keep it available and accessible to all who need it to treat the patient. We need information on past medical history and treatment in order to look more comprehensively at patients.”4

Payment and financing are migrating from funding the treatment of sick patients to initiatives to keep them well in the first place.

The key to success is interoperable electronic health records (EHRs)—an important focus of new laws in the US. Beginning in 2011, health systems that meet the government’s newly defined meaningful-use standards will be eligible for grants via the 2009 stimulus package’s Health Information Technology for Economic and Clinical Health Act. Additionally, for those who do not achieve the new standard, there will be penalties. For example, in 2015, Medicare will reduce reimbursements to those who do not adopt or are late in adopting EHRs.5

As a result, many health systems are beginning the process of proving meaningful use by complying with a set of regulatory metrics that will be phased in from 2011 to 2015. With each phase, health systems will be responsible for connecting to a broader set of industry constituents. The benefits of a national health information highway could be considerable; however, for health systems, getting there may be challenging.6

According to our research, a vast majority of health industry leaders say that making patients’ EHRs available to clinicians would reduce duplication and increase the efficiency of the team. In all likelihood, they say, it would result in more-effective clinical decision making, improved safety and quality of care, and, ultimately, better health outcomes. Similarly, they see that making EHRs available to patients would enhance patients’ ability to self-manage their health and take a hand in their own wellness. This is already happening at integrated organizations like Kaiser Permanente, which provides for its patients all of the information that spans the course of their care.

Coordinated care, also known as chain care, adapts to the patient as information is continuously exchanged and care plans are updated.

“There is electronic health tracking from the moment you walk in to the moment you depart,” says Philip Fasano, Kaiser’s chief information officer, who added that one-third of Kaiser’s 9 million members access Kaiser services remotely. “You leave with a summary when you walk out the door. If the doctor prescribed medication, you can pick up the prescription before you leave Kaiser. If you need a lab test, you can go across the hall. By the time you get home, you can view your lab results online. We want to give you the tools to manage your own health.”7

It should also be noted that the reform bill recognizes the importance of coordinated care. Because hospital readmissions of chronically ill patients are extremely costly to the government— as well as to insurers, employers, and patients themselves— the legislation penalizes hospitals for readmissions, medical errors, and inefficient operating systems. So does Medicare. In a Medicare publication about the new law, US Department of Health and Human Services Secretary Kathleen Sebelius had this to say to eligible consumers, “If you’re hospitalized, the new law helps you return home successfully— and avoid going back—by helping coordinate your care and connecting you to services and supports in your community.”8

With the focus on EHRs and meaningful use, employers are beginning to work with insurers and providers to understand when and how insurers and providers are phasing in EHRs. And as they do so, employers can look for opportunities to leverage the systems for employees, such as providing self-management tools. Additionally, employers can undertake other efforts that aim to provide employees with better information in support of shared decision making and choice, such as health-oriented social networking.


3 PwC’s Health Research Institute, HealthCast: The customization of diagnosis, care, and cure, April 2010.

4 Ibid.

5 PwC’s Health Research Institute, Ready or not: On the road to meaningful use of EHRs and health IT, July 2010.

6 Ibid.

7 PwC’s Health Research Institute, HealthCast: The customization of diagnosis, care, and cure, April 2010.

8 Centers for Medicare & Medicaid Services, Medicare and the New Health Care Law—What It Means for You, May 2010.


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