With the world in respite from the global pandemic and the socio-economic recovery becoming the new narrative, it’s a fitting time to review our regional health systems. The pandemic was, first and foremost, a health crisis impacting individuals and communities, as well as a test for the health systems that serve them. Although health systems in this region responded well and did not buckle under the pressure, the experience has nonetheless provoked a rethink on how they are set up.
A hospital-centric system is inherently capacity constrained, which during times of crisis necessitates controls on access and consequently causes delays in the treatment of non-urgent cases. Elective cases can always be rescheduled, however, the impact on patients with chronic conditions, requiring long-term care, can be harmful. The population in this region is growing, ageing, and has a higher incidence of non-communicable diseases. Consequently, demand for hospital access will only rise in future. Building more facilities is an overly simple yet unsustainable response; hospitals are the most expensive of all possible care settings and not the most cost-effective choice for long-term care. Left unaddressed, the higher burden on the state and on health insurers will pass on to taxpayers and employers, who may choose to sacrifice access and quality of care for the sake of affordability.
So, what can be done to ensure healthcare remains accessible, affordable and delivers high-quality outcomes? The pandemic has galvanised thinking on how the model of care must be fundamentally redesigned. Fragmented facilities offering stand-alone services must be optimised at a system level, patient encounters better coordinated, and preventative population-level initiatives taken so the system can move from ‘managing sickness’ to ‘managing health and wellness’. In this new model of care, health services can be delivered across multiple platforms and in a variety of care settings, choreographing an ensemble of caregivers. In other words, a health system is needed that is integrated, value-based and outcome-driven, and benefits all stakeholders.
Continuum of care
An integrated health system is at its core a patient-centric model, based on robust primary care and public health management, and organised around care pathways. The hospital plays a supporting or maybe anchoring role but remains part of an overall continuum of care managed across facilities and providers and, where possible, the patients’ home. New treatment regimens, technologies, patient preferences, and payer pressure are already helping hospitals transition inpatient visits to day surgery and outpatient services. Not only does this free up hospital beds and reduce average lengths of stay, but it also reduces the risk of hospital-acquired infections such as MRSA.
By also integrating other caregivers into the pathway, such as from primary and social care, mental health, community nursing and charities, sizeable benefits can ensue. These include less duplication, inefficiencies, and delays, which in turn improves patient experience and cost-effectiveness. These can be furthered by using the group’s scale to capture savings in drug and equipment sourcing. Importantly, it also encourages a holistic view of a patient’s health, which can greatly improve outcomes.
A key feature of integrated health systems is the existence of strong system gatekeepers, manifested in the form of primary care, robust referral mechanisms, and payer approvals that enforce evidence-based diagnosis and treatment. Advanced health systems even enlist pharmacists to the front line through retail clinics, home visits, and medication reviews.
Another enabler is population health management in which educational, therapeutic and behavioural interventions are launched to ensure health services are optimised to the needs of a community. By analysing health needs, patient visits, and epidemiological trends, system managers can identify and close patient care gaps, align system resources, and educate and inform individuals on how to improve their health and avoid disease. Public health awareness and education are vital to the success of an integrated health system. Community screenings, health assessments, and awareness campaigns are just a few ways in which individuals can take greater responsibility for their own health; which in turn can reduce demands on the system.
Successful service line integration is an important step to developing a connected health system. Breaking down silos between departments and facilities and reconfiguring patient flows promotes greater clinical communication and collaboration, eliminates the wasteful duplication of resources, and allows gaps in specialist provision to be closed.
Pooling volumes also creates critical mass, which in turn minimises the risk of patient harm. Aligned services ultimately lead to a smoother patient pathway and the ability to add alternative care settings besides the hospital.
Related to service line integration is the need for consistent clinical coding. By adopting a common coding standard such as ICD-10, facilities and physicians can share patient pathologies, collaborate, and undertake the system-level analysis. Electronic health records (EHR) are the primary vehicle for this data exchange and are an investment many healthcare providers have already completed.
EHRs are just one facet though of the digital transformation needed to establish an integrated health system. One positive from the pandemic has been the willingness of patients and physicians to adopt new technology. While telemedicine has made remote consultations acceptable and viable, web-connected devices for remote monitoring and even drug delivery will in time become the norm, reducing the need for sick patients to travel to hospital for consultation and diagnosis.
In essence, integrated health systems are breaking healthcare out of the hospital by focusing on end-to-end patient needs. The benefits of revolutionising the traditional model are compelling, but the transformation is fraught with challenges, not least organisational, cultural and operational in nature.
Increasing levels of health literacy and re-educating the general population about how and when to access care will also be required. Existing healthcare providers must now define the future role they want to play in an integrated system, the partnerships they need to support their patients across the care continuum, and how these can be formalised such as through joint ventures or mergers and acquisitions. In doing so, they will be better equipped to deliver affordable, accessible and high-quality healthcare in the future and during pandemics.
Farhan Mirza, Alvarez & Marsal Middle East