Tuesday, October 11, 2016

Accelerating Change in Healthcare - Part I

This article is a portion of the following publication:
Sorenson, T. D. (2016). Accelerating Change in Healthcare: Considerations for the Health Professions Pipeline. The Advisor: Journal of the National Association of Advisors for the Health Professions, 36(3), 9-13. 

An Era of Change Precipitated by the Affordable Care Act 
Our healthcare system is undergoing the most dynamic period of change since possibly the 1960s, when the Medicare program was created. The stimulus for this change is of course the Affordable Care Act, signed into law by President Obama on March 23rd, 2010.

The Affordable Care Act was constructed around three core principles:
  1. increasing access to affordable care;
  2. increasing consumer protections; 
  3. improving quality and lowering costs. 
From my vantage point, the first two principles have received the greatest attention in the general media. But for the typical health care practitioner, the most impactful of these has been policy reforms that emphasize quality and cost containment. The focus on quality and cost - with the expectation of increasing value of health care services - is changing how health providers and healthcare organizations are paid, which is in turn reshaping the work of health care professionals.

Quickly disappearing are the days of simply providing a service and getting paid for it - a system that produced an emphasis on the volume of service delivered more so than the quality of those services. More and more, the performance of health care providers is being measured and payment policies are being aligned with attainment of quality thresholds. This is causing health care organizations to rethink how services are delivered and by whom. The general tenet emerging is that services should be delivered by the personnel that can produce the best outcome at the lowest cost. This dynamic will change the role of health care practitioners over the next decade and in ways that can't be fully projected. As mentioned above, a challenge for individuals interested in health careers is that they are often unfamiliar with these changes, likely haven't experienced them personally and therefore are possibly not including this in their considerations of a health professions career.

To illustrate this, take the following quiz. As you go through this list, note which statements are true of you or one of your immediate family members:
  • I (or an immediate family member) have received care in a "minute clinic" (urgent care provided by nurse practitioner or physician assistant located in a pharmacy or non-health care retail space. 
  • I have a nurse practitioner as my primary care provider...I only see a physician when referred for a specific need. 
  • I have had my medication prescription adjusted by a pharmacist who met with me in a medical clinic
  • I have received an immunization from a dentist.
  • I have had an "e-visit" with a physician (symptoms evaluated via web-based communications only). 
  • I have received a prescription for a medication without seeing the prescriber in person.
  • I have worked with someone who is a "care coordinator" for my primary care clinic.
  • I have met someone who has the title "community paramedic." 
I'm sure some of these are more likely to be true than others. But each of these statements represent ways in which healthcare is being provided today that wasn't prevalent or didn't exist prior to 2010. Each of these statements is representative of the trends that are pushing for role changes in health care delivery. These trends are supported by goals to incrase patient access to services, provide care in more efficient ways, and align work with individuals that have the knowledge and skills to deliver services with high quality and produce value in the health care system.

Stay tuned for part II of this article: "I like science and I want to help people" - But what else?
Make sure to follow along!

The author of this article, Dr. Todd Sorenson, is Professor and Associate Department Head, Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN.