These new ways of working require a supporting infrastructure so clinicians feel confident they are able to perform the new tasks and roles required of them. This means ensuring the organization can support them.
The organization should support clinicians through:
A key challenge will be that the skills to develop and run some of this new infrastructure are scarce. However, not all of these functions need to be provided in-house. Outsourcing, joint ventures with other providers and partnerships with technology companies will play an important role in releasing economies of scale and moving to more sophisticated forms of outcome based finance, HR and data management.
The Geisinger Health System in Pennsylvania, US is an example of many aspects of coordinated care, including designing internal financial flows to incentivize low-cost, early interventions that prevent emergency admissions over time. They have achieved this by providing incentives to organize all of the interventions from prevention to the quaternary interventions of their own hospitals.
Established 100 years ago, Geisinger has become:
Geisinger Health System has dramatically increased the use of evidence-based, high quality, efficient healthcare for acute and chronic conditions through its ProvenCare model. This sets out clear care processes to reliably deliver a coordinated bundle of evidence-based (or consensus-based) best practice, reinforced with packaged pricing based on outcome measures.
For example, Geisinger charges a flat fee for its Plan members who need certain surgical procedures. This flat fee covers preoperative care, surgery, and 90 days of follow-up treatment (at a Geisinger facility) including that of any related complications. Pricing the bundle at a discount creates an incentive for efficiency and, in effect, offers a warranty against complications.
ProvenCare has had dramatic results on the community:
The ProvenCare product portfolio has been expanded to include angioplasty, hip replacement, cataract surgery, erythropoietin use, bariatric surgery, angioplasty with acute myocardial infarction, and prenatal care.
Geisinger has achieved physician buy-in to this more standardized approach because of three factors:
1. KPMG International, 2014.