Clarity Health Services Blog

In the “good old days” of medicine, as physicians we used to get together over a quick cup of coffee or a half sandwich in the physicians’ lounge of the hospital. We’d help one another figure out the best way to care for our patients, not because we each had a particular financial stake in the outcomes, but because we knew that we’d serve our community better if we were all able to help each other deliver the best care to all our patients. In a very real sense, every patient under the care of any one doctor present was also a patient of mine, and vice-versa. We were a community of providers.

Today’s health care environment is vastly more complex than it was back then. Even so, we need to take steps towards regaining that same sense of community among our current practices. Our first step is to use tools (like Clarity) that make it easier for providers to work together across differing systems and organizational boundaries.  Beyond that we need to look toward delivery system changes. There’s a model proposed by many health care reformers known as the “Accountable Care Organization” or “ACO”. In an ACO, a defined group of providers and practices – and potentially a hospital or other facilities – takes joint responsibility for the quality, effectiveness, and cost of delivering health care to a defined population. Whereas today’s health care delivery choices are largely managed by insurers, in an ACO, it is the providers that have responsibility for all aspects of care.

We see the potential for an ACO in our area which is comprised of independent, yet inter-dependent, practices working together. In this scenerio, providers can continue to  practice community-centric medicine as independent practitioners, while at the same time, act in accordance with commonly shared core values while agreeing to be  jointly accountable for the care of their common patients.

ACOs are somewhat new and different than other delivery system models. In subsequent posts, we’ll look at the people, processes, and payment approaches that make ACOs a promising approach to some of the difficult issues we face in our health care system.

As I write this, I’m recalling my early days in practice.  There were about 90 of us on the active medical staff of the local hospital. The Physicians’ Lounge was our place to gather.  Beyond the usual banter about the stock market or last night’s high school football game, a lot of important patient care “stuff” happened there. We discussed difficult cases. We arranged referrals and consultations. We shared follow-up results. We decided on “next steps” for our patients. And we learned a lot from one another. Primary care physicians still rounded on their patients and provided the “bridge” that spanned outpatient and inpatient care. Care seemed better coordinated and our sense of professional community was pretty high.

Times have certainly changed.  Driven largely by the growing financial pressures facing most physician practices (and hospitals), care is rarely delivered that way any longer.  Primary care physicians have become much more focused on their clinic practices. Hospitalists provide the bulk of inpatient care. Patients increasingly rely on specialty care (especially in the face of a serious primary care shortage). And payers are more intrusive than ever. The result has been a rapid decline of our sense of community.  We’re physically more detached. Paper work piles up in front of and between us. Communication among us is often lost “on hold.” Physician dissatisfaction is high.

Even more concerning is the fact that patient care delivery is also becoming more fragmented.  No one seems happy.

While we can’t turn back the clock to the “good old days” in the Physicians’ lounge, what can we do to recreate community among physicians? First, we can make it easier to do the right thing. At NPN, we’ve adopted Clarity as our care coordination service in large part because it makes it easy for physicians and their staffs to collaborate on patient care and communicate more effectively about what’s clinically important, while at the same time, continuing to do the work they have to do anyway. Indeed, it’s faster, cheaper and easier to collaborate and coordinate referrals this way than the old way.  And it fosters communication and community.

Using Clarity to coordinate care is one step down the road to actually organizing ourselves in a new way, remaining independent while becoming jointly accountable for all aspects of care for our patients. I’ll have more on this in my next post.

In sports, you have to know who is on your team so that you can deliver a winning performance. It’s pretty easy to know who is on your team — just look around the field and find the players with the same color jersey.  In medicine, teamwork is essential but finding your teammates is not so simple. More often than not, the members of a patient’s care team aren’t even in the same building, and one team member may not even know another clinician is on the team!

A gastrointestinal specialty practice deals with the challenges of this “invisible team” all the time. Before they schedule certain procedures, they need to check their patients’ history to determine, for example, whether they need cardiac clearance. One particular gastro practice working with Clarity was prepping for a patient, and saw a cardiac referral in the patient’s referral history online in Clarity. This allowed them to quickly and easily contact the cardiologist on the patient’s care team, and obtain the required clearance.  Had they not had Clarity, they would have had to work back through the PCP in hopes of tracking down the patient’s cardiologist.

It’s great to know who is on your (patient’s) team!