Modern health systems often fail to provide care that is focused on patient and family needs and expectations. Most systems can’t consistently measure outcomes that matter to patients. And can’t improve their health-related quality of life and overall function.
Moreover, current health systems often can’t effectively involve patients and their families in the care process or provide empathic care.
Equitable access to health services is rarely achieved even in countries with universal health coverage. The ongoing Covid-19 pandemic has highlighted gaps in accessibility and equity.
Furthermore, economic sustainability is elusive, particularly in developed countries. Future health spending is expected to rise even further as new techniques and therapies become available.
These gaps have been present for decades, yet health care systems have failed to close them. Change will require a major redesign. read on...
Change in the U.S. is likely to happen first in regions in which there is a high proportion of accountable care and in organizations, such as Kaiser, that are responsible for the care of populations. In other parts of the world, it will occur in the organizations associated with leading institutions, as in the UK’s Global Digital Exemplars program.
The pace of digital transformation in organizations is likely to be limited by the number of people with training in informatics in these institutions. The extent to which organizations emphasis person-centered care may be governed by whether leadership values improvement in this area, and by regional availability of health information exchange allowing systems to take full accountability.
Hospitals today are typically responsible for the largest portion of spending in health care, but we expect that within 10 years, care will move from the hospital into the community and the home. Three trends are accelerating this shift. First, hospital-at-home programs are growing, because they improve outcomes at lower cost and with higher patient satisfaction.
If we are to sustain health and prevent disease, we must focus on the healthy, predicting and preventing chronic illness. Non-MDs, such as nurse practitioners, genetic counselors, case managers, and health coaches, will be central to this shift. Under accountable care arrangements, providers must also address the social determinants of health, including socioeconomic status, education, the environment, employment, and social support networks. Providers and payers must extend their reach into the community and link health care with social care.
Finally, future health systems need to be learning systems, as described in the National Academy of Medicine roundtable on Evidence-based Medicine: “science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience.” Current health care systems implement innovation in a linear fashion — from laboratory to clinical trials to clinical practice. Yet they often fail to deliver improved outcomes, even for innovations that were successful in the laboratory or trials. Health systems represent complex dynamic systems, and implementation strategies need to adapt based on the change at hand as well as system characteristics
Inconclusively. Technology will take over some sections of traditional turf. Artificial intelligence, for example, will help radiologists be more efficient and accurate, with a possible outcome of fewer radiologists required. Similar transformation will likely happen in pathology. Over time, with the aid of AI, these specialties might evolve to become a new medical specialty — the medical diagnostician. There is also major redundancy in cancer care — most patients likely will not need to see an oncologist, an oncological surgeon, and a radiation oncologist, as often happens today. Changing reimbursement, AI, and advances in precision medicine will drive efficiency through consolidation and changing professional roles.
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