Why reorganizing care delivery is so complex

This is the continuation of a series that started in the previous VBHC Thinkers magazine. The previous post addressed the overemphasis on data as the holy grail for fixing healthcare and the underestimation of reorganising care delivery.

Despite the prevailing dominance of the fee for service model, the shift to Value-Based Healthcare is well underway in the minds of many healthcare providers. Even without firm financial incentives, care teams have started on the reorganisation of care processes: away from recording what is happening to the patient, towards organising work proactively. This has been ongoing for a while and is now being accelerated by the global pandemic. However, this exercise is deceptively complex for multiple reasons.

Organising care across the traditional silos is the first cause of complexity. With care providers becoming accountable for outcomes that are measured downstream in the care delivery process, the period that precedes and follows an episode of care, surgery or treatment becomes more important. The complexity lies in dealing with additional stakeholders (who will be dealing with the patient?), loss of control (how can we make sure that the right things happen to the patient?) and length of time (if we are accountable for outcomes after 1 year, what do we need to do during that year to ensure the best outcomes?). In other words, the scope for a care team has become significantly wider: the process starts sooner and ends much later than in the siloed, fee for service model.

If covering more of the end-to-end care journey wasn’t enough, Value-Based Healthcare requires also a deeper scope for the care team. The inclusion of outcomes addressing Quality of Life and the psychosocial domain are forcing care teams to go beyond the clinical intervention and consider the goals, beliefs, anxiety, fears of patients as an integral part of the care delivery process and not as a side note. This is a second source of complexity in reorganizing care delivery.

If the increased scope wasn’t enough, care teams have access to more knowledge, tools and treatments than ever before. On the surface this sounds like a good thing. But consider the fact that the Journal of Infectious Diseases publishes over 2,000 pages of new infection-related science each year. This is just one journal. Humans still have only one brain. There is no way a single care team can stay abreast of all the science, medical devices, treatments for the medical conditions they treat. Let alone the advent of apps, AI models and the like that all claim their benefit to outcomes. The complexity is order of magnitudes larger than your average supermarket choice paralysis.

So, we have three clear sources of complexity. Add in the hippocratic oath and maintaining the status quo becomes an attractive option.

And yet, many care teams ignore all the above and shed blood, sweat and tears to reorganize care delivery. To add insult to injury, they are stuck with tools that are not fit for purpose, documenting their new care delivery processes in spreadsheets, presentation software and word processors. Yes, the cabinets are filled with standard operating procedures on paper. Yes, the latest version of the protocol has been printed and hung up so everyone can see it. And yes, the guideline organisations keep publishing text-based PDFs on their websites.

At Awell Health, we believe it’s about time care teams get access to a tool that helps them deal with the complexity of who is supposed to do what, when and where in a care journey that spans the full continuum of care. A tool that allows to create evidence-based blueprints for care delivery processes that can be easily shared with others. Where clinicians collaborate, each adding to the whole from their own expertise. Blueprints that can be adapted to local workflows easily, without needing someone from IT. A domain-specific tool, built to translate the clinical thought process into standardized yet highly flexible digital care pathways.

We won’t be able to solve today’s problems with yesterday’s solutions, definitely not when such level of complexity is required.