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Dr Dennis Scanlon on Barriers for Learning Health Care Systems


Dennis P. Scanlon, PhD, professor of health policy and administration at Pennsylvania State University and editor-in-chief of The American Journal of Accountable Care®, talks about major systemic and fundamental barriers to health systems becoming learning health systems.

Fee-for-service payment models and out-of-date infrastructures are among the biggest barriers for learning health care systems, said Dennis P. Scanlon, PhD, professor of health policy and administration at Pennsylvania State University and editor-in-chief of The American Journal of Accountable Care® (AJAC).


What are the biggest barriers to a health system becoming a learning one?

I think there are a number of systemic and fundamental barriers. I would say one is our payment model—how we pay for health care, the traditional fee-for-service model. We've tinkered with a lot of different variations of that, whether it's partial capitation, whether it's accountable care organizations, whether it's episode-based care or bundle-based care. But, as I look at how things have happened in the past 2 decades and really even the past decade since the Affordable Care Act was passed, while we made some progress on that, we're still largely a discounted fee-for-service health care system. So there's no doubt that payment and reimbursement is a clear, fundamental barrier.

Beyond that...we are stuck in our history, in many ways, of doing the same thing the way we've always done it. What do I mean by that? If you look at traditional clinical training—whether it's in academic medical schools, even nursing school, pharmacy school, or you name it—we haven't really evolved at a level of training future clinicians to operate in a world that is heavily digitally oriented, where patients and customers and consumers want to be treated as customers and consumers. They want digital technology; they want easier communication. We also have organizations that have been structured from a organizational standpoint—in terms of their governance, in terms of their operating structure—very inefficiently. They don't think about their cost of production because they've never really had to. They don't think about production functions. They don't think about how to substitute or change to produce care that's better in more efficient ways.

So, I think there are a lot of systemic barriers. I think data, access to data, transparency, and information to drive decision-making: that lacks in health care. Really, at the end of the day, I'd probably say it's a confluence of historical payment models largely driven by fee-for-service, lack of transparency still, and not a good flow of information, some of which, quite frankly, is to the advantage of people who make money by that lack of transparency. Then I'd say just historical infrastructures that really are not up to date with the way the rest of the the world or other businesses function.

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