Challenges to transform traditional healthcare servicesin a more efficient, patient-centered, and results-oriented healthcare delivery approach.
Cancer, Coronary Diseases, and AIDS as an example of increasing life-expectancy and creating populationwith chronic diseases living longer and consuming resources
Ageing Population% of population over 65 years old 80% 70% 67% 65% 66% 60% 53% 51% 50% 46% 38% 40% 27% 29% 28% 28% 30% 26% 26% 22% 20% 10% 0% U.S. France Germ Italy Japan U.K. Spain 2000 2050 Source: Standards & Poor
Ageing Population Costs in Healthcare 80% Yearly cost per capita according to age (€)% de població > 65 anys 30 70% 67% 65% 66% 28.479 60% 53% 51% 50% 46% 38% 40% 27% 29% 28% 14.996 28% 30% 26% 26% 15 22% 20% 10% 8.570 0% 2.192 U.S. France Germ Italy Japan U.K. Spain 60-65 65-79 2000 2050 80-94 ≥95 Years Font: Standards & Poor
Health Expenditures as a Percentage of Gross Domestic Product (GDP) in Increasing health expenditure in western countries Selected OECD Countries, 1960–2009. Fineberg HV. N Engl J Med 2012;366:1020-1027.
Expected growth of healthcare expenditure as percentatge of GDP in OECD countries The expenditure (8-17% of GDP) to restore health oncediseases have appeared, has a limited 15-20% impact on life expectancy in western countries
Future drivers of health care deliveryFrom reactive medicine to preventive medicinePredictive medicinePatient itself as a driver force in decisionmaking and self careCommunity patients as a decisive key player
At present, the three major hindranceto achieve the mentioned goals are:1. The lack of an integrative approach to diagnose, treat, and prevent the healthproblems from different departments in the same healthcare level organization.2. The huge fragmentation of organizations among primary care, social care,and specialised care.3. The lack of communication and standardization between different healthcareelectronic medical records.
Fragmented healthcare systems(Barriers from professionals, citizens, and insurance companies) Behaviour and attitudes of health professionals. Lack of education for professionals promoting coordinated efficient work. Lack of citizen’s education on a rational use of healthcare systems. The payment systems that in many cases do not encourage coordinated work.
What do we need to develop those new concepts…..Open healthcare organizations, with innovation capacity bothin technology and organization, focused on patient’s need, andwith an advanced culture of cooperation among different areasof knowledge and different providers of healthcare.
Scenarios on the horizonHospitals of the future will be mostly dedicatedto those procedures requiring high technologyskills and infrastructure. Therefore, they willbe smaller structures based on intensive andintermediate care units, and day-care units.Chronic disease management will be based on community territorial healthcare,where familiy phisycians, specialists, nurses, and social caregivers will have towork around the patient’s need and to prevent relapses. Home care organizationsupported by new technologies will be a key player.Both, hospital and community healthcare has to be provided by multidisciplinaryworking teams organized not to pursue more activity but to achieve the bestoutputs in health maintenance.
Adaptation of health services to chronic patients(shared care arrangements across the system)Hospital Consultant Emergency Case team Manager Primary Care Mobile teams Home Primary Patient Care Team Relatives & care givers
PERFORMANCE CHALLENGESPatient-centered approachMultidisciplinary working teamsTurning doctors into leaders in healthcare managementAccountabilityPerformance measurements Data availability for all the actors Validity and reliability of measurements Risk adjustment Time frame to be measured Attribution responsabilities to diferent providersBenchmarkingRevisiting payment systems as an incentive to deliver better healthcare
Scott A. Berkowitz, MD, MBAAssociate Professor of MedicineMedical Director Accountable Care