The Future of Pathway Management

Dr Keith KlintworthPrivate Acute Healthcare

ConferenceOctober 2019

Do we learn from History?

Started in 1980 to manage healthcare quality by focusing on the entire treatment journey and to enable measurement of medical decisions against an established best practice.Ambition to standardise a set of actions aiming to optimise care for a particular clinical problem in line with guidelines

Was to benefit patients, doctors and payers. Was it developed because it was the right thing to do or was it developed to manage the challenge of medical inflation?

Does the mistrust between provider, payer and patient continue to result in changes to ‘pathways’ with risks of trying to have one size that fits all?

“Smart health communities” offer one glimpse into the future –and highlight how far away we are

Doctors

PatientsPayors

The correct individuals do the correct

work (primary and secondary care divide)

using the right technology to diagnose,

treat, and deliver

Clinicians use technology and colleagues to

accurately diagnose, treat illness and deliver care

All stakeholders across the health

ecosystem efficiently communicate and

use information

Appropriate Rx at appropriate

time, in appropriate place for the

appropriate patient

Efficiency improves, waste

declines

Patients are informed and actively

involved in their treatment plan

2019 Global health care outlook – Shaping the future - Deloitte

Do we have a smart health community in

the UK?

Done well, everyone benefits from care pathways

Better decisions Less variable outcomes Reduced treatment errors Increased efficiencies and

clinical effectiveness Increased multidisciplinary

communication

Improved outcomes Reduced waiting times Fewer, shorter hospital stays Reduced readmission rates Better experience

Reduced healthcare costs Better forecasting and

premium calculation Happier customers

The maturity of care pathways is not globally consistent

The US has best (outcomes) and worst (adversarial tactics and “game-playing”) of healthcare pathways

A great deal of enthusiasm and energy for “integrated care” in the public sector; in the private sector, present but more niche

Switzerland is considering abandoning clinical pathways in favour of clinical processes

Very early stages –intransparent, variable care and difficulties in agreeing incentives

Broader organisational hurdles impede better pathways and care

Individualism, engaging clinicians last, “Not invented here” syndrome, “not rocking the boat”, and other “not”sCultural

Information sharing, competition, complianceRegulatory

Over-optimistic projections, unrealistic aspirations from limited resources, and inadequate attention to low hanging fruitExpectation

Concern about reduced income in a fee-for-service world Financial

Misaligned incentives, short-termism, budgets, and “turf”; not putting the patient at the centreOrganisational

Historically, much challenge came from physicians

Clinical pathways were (are) feared to lead to: Dehumanisation of work and loss of autonomy Interfering with the doctor/patient relationship as Complexity of integration in a changing digital world Suspicion of improvements in clinical outcome Cookie cutter approach and lack of personalisation Confusion via impossible simplification of complex treatments

If doctors don’t engage who will create the pathways?US Insurers driving value/outcome based remuneration with no payment if off pathway!

Now that we have managed the averages is it time to manage the outliers?

The Future of Care PathwaysCare Pathways

Driving quality (and includes patient satisfaction) measures that together describe a care pathway for a particular population (e.g. PMI) or a group of patients (e.g. chronic conditions). Quality assessment of Clinical pathways has focused on isolated aspects of care in specific settings and does not assess quality holistically for patients with a given condition and therefore inadequate for understanding and improving performance at a system level.

This is where the Insurer can add the value by integration and personalisation of the Healthcare journey to drive patient satisfaction, speed of access, endorsement of quality and cost-effectiveness.

Providers are empowered to do and evidence the right thing – whether on or off-piste of clinical pathways or clinical guidelines.

In the ideal world giving patients assurances that a multidisciplinary team has made the decision on your care journeyHealthcare of the future 2019 SHTI259-00252012- Kings Fund report measuring quality along the care pathwayAug 2015 – Catalyst.phrma.org; Future of clinical pathways

Seeing a doctor and following his/her idea is not a pathway

Having symptoms Surf the internetSymptoms

worsenConsultant-

delivered service

All possible diagnostics “to

be sure”

Not much wrong

Book an appt.

Pathways need to be broader and better.

Surgery required

Surgery complete

Having symptoms

Seeking information

online

Offered guided self-

management

Holistic primary care

management

Prompt face-to-face assessment

Digital triage + pre-prep

Specialist fast-track

management

Surgical/ inpatient

intervention

Enhanced follow-up and

recovery

Symptoms worsen

Symptoms bearable

Inadequate improvement

Inadequate improvement

Primary care option

Needs clinician

Care PathwayPopulation

wellbeing/prevention

control of risk factors

Primary diagnosis/Investigation/ referral

Appropriate secondary treatment

Recovery and rehabilitation

Secondary prevention

End of

Life care

The Future of Pathways

Need to deliver on providing consumer – centric careconsumers are dissatisfied with;- poor service- lack of transparency around price, quality and safetyconsumers are expecting solutions that;- are coordinated, convenient, customised and accessible

This has been driven by:Rise of chronic conditions and need for long-term care management

Financial scrutiny due to high deductible insurance plans with excesses and out-of-pocket expenses

Explosion of digital tools to inform, educate and empower patientsConsumers experience in other Industries

Competition from tech-savy companies that bring a non-traditional mind-set to healthcare delivery

Parting thoughts

BUT this needs strategies, products and services that bridge the gap between providers, payers and patients.

We need to understand and act on how consumers would like to use digital health telehealth wearable monitoring

and fitness devices online resources social media…

Enga

gem

ent w

ith te

ch

So we can develop patient-engagement strategies that help individuals make informed care decisions, which in turn…

Cus

tom

er-c

rafte

d so

lutio

ns

Would help healthcare organisations improve effectiveness, efficiency, value in service delivery and excel in quality measures that reflect the patient experience…Be

tter o

utco

mes