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Changing Behavior and Reinstating Trust to Improve Healthcare Delivery

Laura Joszt
Speakers at the National Committee for Quality Assurance’s Quality Talks meeting discussed challenges to improving healthcare delivery, such as changing behaviors, moving care outside of institutions, and rebuilding trust among marginalized populations.
The American healthcare system is not the best in the world; it is failing, plagued by high costs and inconsistent quality, said Ezekiel Emanuel, MD, PhD, chair, Medical Ethics and Health Policy, University of Pennsylvania, at Quality Talks, held by the National Committee for Quality Assurance. The 1-day event was held October 22 in Washington, DC, and featured “TED”-style talks from thought-provoking speakers and leaders in the industry.

Emanuel kicked off the meeting with a look at the biggest challenges in US healthcare, such as changing individuals’ behavior and migrating care out of institutions. He also expressed optimism in America’s willingness to rise to the challenges.

“When we Americans put our minds to it, we can achieve greatness,” Emanuel said.

Behavior change is something that will be needed both on the part of physicians and other healthcare providers and on the part of patients. Providers have to change how they deliver care after years or decades of delivering it in one way, and part of that change is under way with value-based payment models. While there has been skepticism from providers regarding the success of value-based models, that skepticism is going away and will continue to be driven away with the implementation of things like the Medicare Access and CHIP Reauthorization Act and the Bundled Payments for Care Improvement initiative.

Emanuel called out physicians still using the old line that they have 1 foot in value-based payments and 1 foot in fee for service (FFS). “You can’t do that,” he said, adding that the groups that have actually made the change can attest to how long it takes. Research has shown it can take 4 to 5 years to transform from FFS to value-based care. “You have to start today for 2021, 2022,” he explained.

Patients also have their part to play. Somewhere between 40% to 60% of illnesses and premature mortality are a direct result of bad behaviors, like smoking, poor food consumption, and lack of exercise, Emanuel pointed out.

He also looked at the evolution of institutions of care and how people are being moved out of the hospital to get care in the home. Emanuel expects that over the next decade there will be a big movement out of the physician’s office, as well, and into the patient’s home. This is a continuation of recent trends that have driven down hospitalizations while outpatient visits have gone up.

“We’re getting rid of institutions as sites of care; we are moving to the outpatient setting, and, I think, we’re going to move from the institutional outpatient setting to the care at home,” Emanuel said.

Emanuel closed with the belief that America’s healthcare system can solve the problems facing it, and it will “become a real beacon of lower cost, better patient experience, and higher quality to the world as we proceed,” he said.

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