“Systemness”: Which Delivery Model is Best?

02 Mar “Systemness”: Which Delivery Model is Best?

Systemness (sĭs’tə-m nes) adj.

  1. Arrange according to a system or reduce to a system
  2. The degree to which something shares the attributes of a system

Last week I attended the World Health Care Congress Consumer Connectivity conference in San Diego. The Twitter stream was at near flood capacity, and several excellent speakers were present to share their ideas. Conference attendance was affected by the economic climate but I believe the course of dialogue, the information shared, and value of the networking still proved worthwhile.

I shared a panel with Jordan Shlain, MD the founder and Medical Director of Current Health. I served as an advisor to the company through the late summer / fall and participated in their launch in December at World Health Information Technology Conference in Washington DC. Our presentation was intended to focus on “Millennial Technologies for the Medical Home” but given the light attendance, we essentially abandoned our traditional presentation given the intimate setting. After a brief introduction from me regarding the notion of Millennial Patients demanding Millennial Care, Dr. Shlain spent the balance of the session sharing some of the reasoning, thought, and opportunity behind the “direct practice” concept of Current Health.

During the presentation, several examples of “fortress medicine” were shared, including some which highlighted some individual failures and market perceptions with Kaiser and other large providers. The conversation took a couple of pointed turns as several Kaiser employees were in attendance (including an excellent Twitter follow in @janoldenburg). As Dr. Shlain would highlight individual cases which created opportunity for Current, they were countered by persuasive examples and initiatives from the Kaiser team. Abstracting out the tone, the content of the conversation was instructive in terms of alternative models of care.

Integrated health delivery systems deliver better results, period. The evidence is overwhelming as identified by the Dartmouth Atlas and countless other studies. We need to move our country to more “systemness”, which implies coordination, teamwork, shared learning, shared responsibility, and a long term perspective with aligned financial incentives. This is why I love the vision and the promise of true “health systems” like Kaiser, Intermountain Health Care, Group Health, Geisinger, and others.

However, Kaiser and all of these systems, are not perfect (nor claim to be) and despite systemic results that are superior there are individual failings (which seem to find their way into the sensational or anectdotal) that creat opportunities for viable delivery method alternatives. The notion of the medical home, or its complementary concept of Concierge Medicine, is also a “system” of care wherein a single physicians assumes the role of integration and patient experience. Assuming accountability to deliver this “virtualization layer“ enables these physicians to approximate the degree of integration that leads to better outcomes. These organizational delivery concepts have been created to remove the clinical and financial friction and frustration inherent in our current system and deliver personalized care that is safe, effective, patient-centered, timely, efficient, and equitable. We are also starting to see the positive results from these early studies.

The bottom line, we can no longer tolerate our uncoordinated, fragmented, silo’d delivery mechanisms. We must create “systemness” through all the appropriate means as any production organization has had to do as well. The culture of quality and outcomes must be built into the health care processes themselves and their must be rigorous, ongoing improvements with shared learning as the results are captured. This systemness, by any means necessary, will be good for our nations health.

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