For your final project you will use what you have learned during this course, outside resources, the NEJM e-book (from week 2) and your experiences in healthcare to write a proposal on how you would transform healthcare delivery to be more effective and efficient. You should include an analysis of the skills and knowledge that will be needed for Respiratory Care Practitioners in this more effective and efficient healthcare delivery system.
Unlocking the Opportunities
for Health Care Delivery
Transformation
Unlocking the Opportunities for Health Care Delivery Transformation
1
E
very health care organization’s goal is to transform care delivery to achieve
better outcomes and lower costs. Can this transformation be arrived at
through continuous improvement, or does real change demand disruption?
“I feel our current system of health care is so fundamentally flawed and rife with
anachronistic processes and perverse disincentives that the only likely way we’ll achieve
true transformation is through disruption,” says Richard Zane, MD, Chief Innovation
Officer at UCHealth System and Chair of the Department of Emergency Medicine at
the University of Colorado School of Medicine.
Zane is one of eight NEJM Catalyst Insights Council members – a qualified group of
U.S. health care leaders and clinicians at organizations directly involved in health care
delivery – who candidly shared their experiences and insights for this ebook. This past
year, NEJM Catalyst Insights Council survey results illuminated the opportunities and
barriers that exist in health care delivery transformation, as you will see in the data
shared throughout the ebook. You’ll also get an inside look at how our eight leaders
are helping their organizations hurdle the hard stuff, so they – along with their
patients – can enjoy the benefits that transformation promises.
“I FEEL OUR CURRENT SYSTEM OF HEALTH CARE IS SO
FUNDAMENTALLY FLAWED AND RIFE WITH ANACHRONISTIC
PROCESSES AND PERVERSE DISINCENTIVES THAT THE ONLY
LIKELY WAY WE’LL ACHIEVE TRUE TRANSFORMATION IS
THROUGH DISRUPTION.”
RICHARD ZANE, MD
catalyst.nejm.org
Unlocking the Opportunities for Health Care Delivery Transformation
2
Demanding Deep Change
RICHARD ZANE, MD
Chief Innovation Officer at
UCHealth System and Chair of
the Department of Emergency
Medicine at the University of
Colorado School of Medicine,
Aurora
“MEDICAL HOMES, NEW
PAYMENT MODELS, SCRIBES,
PRACTICE REDESIGN, AND
THINGS LIKE THAT ARE SLOW
AND ITERATIVE. THERE IS
NOTHING DISRUPTIVE
ABOUT THEM.”
Many health care leaders join Zane in calling for
bold changes in health care, saying the industry
is too mired in traditional thinking and heavyhanded government regulation. “The waste in
health care is shocking. The redundancy in health
care is shocking. And the profits in health care
are huge,” he says. “There just can’t be any more
tolerance for the high cost and truly mediocre
outcomes.”
Taking a slow-but-steady approach to
transformation won’t move the needle, in his
opinion. “Medical homes, new payment models,
scribes, practice redesign, and things like that are
slow and iterative. There is nothing disruptive
about them,” Zane says. Gaining “wholesale
change” is going to take either an outsider like
Amazon, Google, “three guys in a garage in Palo
Alto,” or a partnership like CVS and Aetna.
Disruption could also come from “a health care
system or two not so completely addicted to
fee-for-service care that they can’t know change
is coming, and who view fundamental change as
an opportunity to lead instead of a big threat.”
These are health systems with “not much to
lose,” like Intermountain Healthcare or University
of Colorado Health, which he describes as
“forward-thinking and willing to embrace and
define disruption” and “without much
competition.”
As an example, he says health care can be
“Amazon Primed” by offering a few free
primary care visits via a virtual home
health system with an annual membership.
Such out-of-the-box thinking is difficult for
entrenched health systems because many are
“totally hooked” on fee-for-service medicine. “It’s
the entire system, which includes the providers.
If the general principle of a new idea means
agreeing to take a pay cut, everyone is less
willing to do that.”
catalyst.nejm.org
Unlocking the Opportunities for Health Care Delivery Transformation
A third of our Insights Council respondents to
our survey on payer-provider integration indicate
that the top barrier to organizations
implementing value-based payments is that one
of the involved parties does not have strong
incentive to proceed.
JOANNE ROBERTS
Senior Vice President and Chief
Value Officer at Providence
St. Joseph Health, Renton, WA
“UNTIL WE SHOW
CONSUMERS WHAT
EXCELLENCE LOOKS LIKE,
THEY WON’T KNOW. ONCE
THEY SEE IT, I BELIEVE THEY
WILL GO FOR IT.”
3
“
Then who will drive disruptive
transformation in health care? “Patients
and payers will grow intolerant” of the
state of care and push harder to get away
from fee-for-service and other constricting
parameters, says Zane.
Joanne Roberts, Senior Vice President and Chief
Value Officer at Providence St. Joseph Health,
headquartered in Renton, Washington, agrees that
real change in health care will require more
aggressive moves than the shift to value-based
care has required thus far. “I just think the system is
still so unwieldy and difficult to use. Patients aren’t
shopping around, they are just filling themselves
with dread about having to go through the health
care system. Until we show consumers what
excellence looks like, they won’t know. Once they
see it, I believe they will go for it,” she says.
What
is the
barrier
to implementing
What
is the
toptop
barrier
to implementing
value-based
atyour
yourorganization?
organization?
value-basedpayment
payment at
”
32%
One of the involved parties does not
have strong incentive to proceed
One of the involved parties does not
have strong incentive to proceed
catalyst.nejm.org
Unlocking the Opportunities for Health Care Delivery Transformation
4
Data for Disruption
IN THE PAST, DATA WOULD BE
USED TO REPRIMAND LOWPERFORMING HOSPITALS, BUT
THEN LEADERS “FLIPPED THE
CULTURE,” AND NOW, LOWPERFORMING HOSPITALS
ARE PAIRED WITH HIGHERPERFORMING HOSPITALS TO
INCREASE LEARNING.
JOANNE ROBERTS
Offering transparency into quality, patient
satisfaction scores, and other measures has the
potential to overturn health care delivery because
patients will demand value, or so the hypothesis
goes. In practice, transparency has yet to drive
wholesale change. The top two barriers to successful
implementation of transparency in organizations,
according to our survey on the topic, are data
limitations (collecting, risk-adjusting, disseminating)
(chosen by 54% of respondents) and lack of buy-in
among providers on transparency’s importance
(48%). Roberts also finds that patients don’t yet
seem to want detailed information on quality and
cost, even though they are on the whole paying a
larger share of health care bills.
regional, local, unit, or provider-based, is presented in a
non-blinded fashion so that the organization can be
constantly learning. In the past, data would be used to
reprimand low-performing hospitals, but then leaders
“flipped the culture,” she says, and now, low-performing
hospitals are paired with higher-performing hospitals
to increase learning.
What are the top two barriers to successful
implementation of transparency in organizations?
Data limitations
(collecting, risk-adjusting,
disseminating)
54%
Providence St. Joseph Health is tackling these
barriers by focusing on transparency inside
the system, which leaders hope will translate
into excellence that consumers can see.
For instance, the health system collects data, under
the rubric called “Value-Oriented Architecture,”
which reveals variation of quality against costs at
a granular level and shares it across “all strategic
domains,” Roberts says. All data, whether system,
48%
Lack of buy-in
amongproviders
on transparency’s
importance
catalyst.nejm.org
Unlocking the Opportunities for Health Care Delivery Transformation
FREDERICK SOUTHWICK, MD
Professor of Medicine at the
University of Florida College of
Medicine, Gainesville
ANALYTICS ARE USUALLY
NEITHER GRANULAR ENOUGH
NOR TURNED AROUND FAST
ENOUGH TO RESONATE WITH
PHYSICIANS.
Effecting behavior change through analytics is not an
easy task, according to Frederick Southwick, MD,
Professor of Medicine at the University of Florida
College of Medicine in Gainesville. Analytics are usually
neither granular enough nor turned around fast
enough to resonate with physicians. “Feedback is very
helpful, but I think a lot of it needs to be more
qualitative and less quantitative,” he says. Traditional
scoring systems like Press Ganey take weeks to make
their way back to medical staff. “How can you change
your behavior if you don’t remember what happened?”
5
realize he was towering over the patient in an
intimidating manner. Since then, he has made a
conscious effort to be eye level with patients. The
experience led him to believe that all medical staff,
including seasoned physicians, could use a coach to
review and then help improve their performance.
Although he has received pushback from some staff,
Southwick is intent on making coaching commonplace
within the organization.
Delays in feedback also have an impact on patients
because when feedback is requested at the time of
their stay, “it is diametrically opposed to the feedback
survey results.”
To ensure that patient feedback is taken
seriously, the medical staff Southwick leads
does end-of-round check-ins where everyone
on the care team reviews what they observed.
All members are free to speak up and Southwick
himself is open to criticism. Four years ago, a medical
student noticed that a patient seemed uncomfortable
as Southwick did his consultation. Southwick didn’t
catalyst.nejm.org
Unlocking the Opportunities for Health Care Delivery Transformation
BEATA SKUDLARSKA, MD
Executive Medical Director for
Palliative, Geriatric and Hospice
Care at Atrium Health, Charlotte
“WE HAVE TO STOP ASKING
HOW WE’RE DOING AND ASK
HOW PATIENTS ARE DOING?”
Transforming data collection and analytics usage is
going to take a complete redesign of feedback
solicitation, according to Beata Skudlarska, MD,
Executive Medical Director for Palliative, Geriatric and
Hospice Care at Atrium Health in Charlotte, North
Carolina. Data collection today tends to be diseasespecific, focusing on a population’s hemoglobin A1c
numbers or vaccination rates, for example, but she
contends that’s not what patients are after. “Patients
want to know about their functional status, but we
don’t yet have a good grasp of that,” she says.
Until feedback scoring systems such as Press
Ganey and Leapfrog become patient-centric
instead of taking the point of view of the
health system, hospital, and provider, invoking
change will be difficult, she says. “We have to
stop asking how we’re doing and ask how
patients are doing?”
“Data and analytics is where I would actually like to
see more resources, and where I find frustration,”
says Irwin Brodsky, MD, MPH, Medical Director for
Diabetes at Maine Medical Center in Portland. He
credits his health system, MaineHealth, for being
“forward-thinking,” but would like to see greater
investment in data and analytics to fully assess the
value of certain clinical programs.
6
As an example, when he assumed the administrative
duties of the diabetes center, he integrated a
psychologist into his subspecialty endocrinology practice
to overcome behavioral health barriers to successful
diabetes management. “For years, people would come in
to the practice with poorly controlled diabetes that
seemed to result from mental health problems, like
depression and stress. It was embarrassing for me to
report back to their primary care physicians that our skills
as endocrinologists were inadequate to improve their
patients’ blood glucoses. We started the conversation
about integrating behavioral health services multiple
times but had no measurements to quantify the
contribution of behavioral health disorders to diabetes
control and to justify the integration,” he says.
In partnership with the MaineHealth Clinical
Integration Program, his practice contracted
with Maine Behavioral Health to bring on the
part-time expertise of a psychologist who can
bill for consultations separately. Since then,
Brodsky has noticed a positive effect,
anecdotally, although he’d like to have
analytics to back up that assessment.
Even though MaineHealth is an accountable care
organization and receives merit-based incentive
payments, “our minds are still in fee-for-service because
that’s how we get paid,” Brodsky says. “We’re trying to
innovate but it’s difficult to switch over.”
catalyst.nejm.org
Unlocking the Opportunities for Health Care Delivery Transformation
7
The Need for Integrated Care
CHRISTOPHER DALE, MD, MPH
Chief Quality Officer at Swedish
health system in Seattle
INTEGRATION OF MENTAL
AND BEHAVIORAL HEALTH
CARE IS NEEDED “FROM
A SOCIETAL PERSPECTIVE,
BUT IT’S EXPENSIVE.
Integrated care will definitely require transformation at some health
systems. Integration of mental and behavioral health services has
posed a significant challenge to primary care. Roberts says she’s
looked at many integration models and has yet to see one that works
ideally. In part, the difficulty stems from the broad nature of different
conditions, which can include depression and suicide diagnosis and
treatment, addiction and substance abuse therapy, behavior change
management, and more. “We all know it’s important, but I think we
need to define what we mean by mental and behavioral health and a
standard range of services a clinic should have,” she says. Providence
St. Joseph Health is trying to discern those standards through
its partnership with the Well-Being Trust and the Institute for
Healthcare Improvement.
Christopher Dale, MD, MPH, Chief Quality Officer at
Swedish health system in Seattle, which is part of
Providence St. Joseph Health, says that integration of
mental and behavioral health care is needed “from a
societal perspective, but it’s expensive.” Nonetheless,
Swedish has started blending these services into its
primary care practices.
“
What do you consider the top two most
What do you consider the top two
pressing
barriers
related
to to
delivery
most pressing
barriers
related
deliveryof
healthservices
services
ofmental
mental and
and behavioral
behavioral health
your
community?
ininyour
community?
”
34%
Our survey on mental and behavioral health integration finds that the
most pressing barriers to integrating these services into care delivery
are absent or inadequate insurance coverage (34%), fragmentation of Absent
Absentor
orinadequate
inadequate
care (33%), and lack of access to specialty care (32%).
coverage
insurance coverage
33%
Fragmentation
Fragmentation
of care
care
of
catalyst.nejm.org
Unlocking the Opportunities for Health Care Delivery Transformation
FOR INTEGRATED CARE TO BE
SUCCESSFUL, THE INDUSTRY
NEEDS TO MOVE TO MORE
VALUE-BASED CARE, GRACE
SAYS. “RIGHT NOW, IT’S A
VERY SCHIZOPHRENIC
ENVIRONMENT.
DAVID GRACE, MD
David Grace, MD, Chief of Internal Medicine at
Atrius Health’s PMG Physician Associates in
Plymouth, Massachusetts, says his practice is
fortunate to have good access for urgent
psychiatric needs, but follow-up care for longterm psychiatric needs is still lacking.
Urgent consultations are handled by a hospitalbased outpatient psychiatry practice, which “has
made itself very accessible for primary care
health,” he says. “Where it breaks down is when
the patient needs chronic care.” Oftentimes, the
psychiatric practice, which can’t deliver rapid
8
turnover, rapid access, and long-term panels all at once,
will refer patients to other independent practices in the
community, but, according to Grace, they don’t get the
same kind of quality and access. “We need urgent and
long-term care going forward,” he says.
The Swedish health services experience is similar.
“We pick up initial intake, triage, a few visits,”
Dale says, “but then how to navigate to longer-term
behavioral health, the handoff, the scope of services,
requires more thoughtfulness.”
catalyst.nejm.org
Unlocking the Opportunities for Health Care Delivery Transformation
Grace believes the industry-wide move away from
primary care toward specialty medicine over the
years has created fragmentation and contributed to
the increase in the cost of care. “We’ve tried as an
industry to develop a team approach, but we’ve
actually become more siloed in care delivery with
specialists upon specialists,” he says.
DAVID GRACE, MD
Chief of Internal Medicine at
Atrius Health’s PMG Physician
Associates, Plymouth, MA
“WE’VE TRIED AS AN
INDUSTRY TO DEVELOP A
TEAM APPROACH, BUT WE’VE
ACTUALLY BECOME MORE
SILOED IN CARE DELIVERY
WITH SPECIALISTS UPON
SPECIALISTS.”
Roberts agrees. “It’s redesigning primary care to be a
primary care rather than a referral service. We want
people to not have to use hospitals. We haven’t been
completely explicit in that message and we need to
be,” she says.
Grace would like to see a restructuring within
primary care as well, where the physician
leads the team at the top of his/her licensure.
“Doctors should see the complicated patients,
and a physician’s assistant or nurse
practitioner can see the not-so-complicated
patients,” he says.
9
He would like physicians to be rewarded instead on
quality, outcomes, and keeping medical expenses
under control.
One disruptive approach to improving health
care would be to redesign care delivery
so that patients can receive care without
actually entering a health system’s facility,
according to Dale.
“We haven’t offered people the dominant solution
yet – the better thing for less cost,” he says.
“Consumers and health systems want the best
overall health with the least amount of burden.”
For integrated care to be successful, the industry
needs to move to more value-based care, Grace says.
“Right now, it’s a very schizophrenic environment. We
have a capitated system where revenue is prepaid and
based on quality measures; and a system based on
productivity, so we get paid for patients we see.”
catalyst.nejm.org
Unlocking the Opportunities for Health Care Delivery Transformation
10
The Role of Technology in Transformation
“EMPOWERED CONSUMERS
ARE GOING TO BE BETTER
FOR COST OF CARE AND
ENGAGEMENT.”
JOANNE ROBERTS
Digital innovation is an essential part of improving
health care. Technology can support increased patient
engagement without intense provider participation.
As an example, Dale points to the Circle mobile app,
which was developed by the digital innovation team
at Providence St. Joseph Health and was acquired by
Wildflower Health in June 2018. The app, aimed at
delivering care to mothers more effectively, enables
patients to access content, tools, and trackers about
the mother’s and baby’s health, and is integrated into
the health system’s EMR.
“The Circle app was really driven by consumers and
dispatched direct to consumers,” Roberts says. “I
would love to see more apps like that dedicated to
patients with chronic diseases such as diabetes,
heart failure, and COPD.”
“Or Google. Think of everyone on their [cell phones],
or any mobile device, becoming a medical device
along with all the data that comes off of them
informing next steps and care,” Zane says.
To boost the profile of health technology, Roberts says
the industry must move away from the traditional
mindset of patients physically engaging with
hospitals and care delivery systems and accept
a more virtual posture.
“The hospital model is not sustainable.
Many clinic visits will become obsolete. Not
everything [that happens in health care] is
going to go through the system. There won’t
be health care systems or care delivery
systems anymore – only health systems,”
she says. And in those systems, “empowered
consumers are going to be better for cost
of care and engagement.”
catalyst.nejm.org
Unlocking the Opportunities for Health Care Delivery Transformation
“A LOT OF THESE PARTS OF
11
What are the top three barriers to applying design thinking to health care problems?
KU
ynamreG
anihC
adanaC
a
aeroK htuoS
Australia ailartsuA
South Korea
a
Canada
China
Germany
aUK
Australia
South Korea
Canada
China
Germany
UK
MEDICINE CAN BE DONE
WITHOUT HUMAN
INTERACTION,” WHICH
WOULD FREE UP RESOURCES
FOR MEDICAL PERSONNEL
WHO CAN WORK TO THE
TOP OF THEIR LICENSURE.
BEATA SKUDLARSKA, MD
52%
limited buy-in from
decision-makers
47%
limited understanding
of design thinking
More robust technology will help eliminate the middle steps
that can make health care seem complex, Skudlarska says.
Much like the travel industry enables consumers to
directly book their travel, she expects to see more
health systems encouraging patients to schedule
appointments and procedures through a portal or
mobile app, reducing the need for dedicated schedulers.
“A lot of these parts of medicine can be done without
human interaction,” she says, which would free up
resources for medical personnel who can work to the
top of their licensure.
Over the next few years, Roberts says Providence St. Joseph
Health expects to concentrate more on digital innovation
and new models of care, all driven by design thinking with
heavy input from patients. Design thinking, as our survey
on this topic shows, has great applicability to health care
32%
insufficient training in
design thinking
(according to 95% of respondents) but faces obstacles in
respondents’ organizations due to limited buy-in from
decision-makers (52%), limited understanding of design
(47%), and insufficient training in design (32%).
Digital innovation is just one driver of change at
Providence St. Joseph Health. “We plan to go from a
hospital-based system of 51 hospitals to hospitals being
just one-sixth of our business units by 2022,” Roberts says.
Community partnerships, digital access,
behavioral health prevention (including behavior
change management), and wellness will be at
the forefront of the redesigned system.
“Our new intention is what happens outside of the
hospitals,” she says. “The idea is to find the resources
before or at the emergency room door and put a whole
lot of energy there.”
catalyst.nejm.org
Unlocking the Opportunities for Health Care Delivery Transformation
“TECHNOLOGY IS LITERALLY
BECOMING PART OF THE
PATIENT’S CARE TEAM.
TECHNOLOGY CAN HELP YOU
DELIVER BETTER CARE FROM
ONE END OF THE SPECTRUM
TO THE OTHER.”
RICHARD ZANE, MD
12
UCHealth has put a stake in the ground in technology
and virtual health with its Virtual Health Center and
Virtual ICU, which care for patients throughout the
entire continuum of critical illness (inpatient, urgent
and emergent care, and skilled nursing and home care),
Zane says.
Inpatients, including ICU patients across the system,
are centrally monitored by experienced critical care
nurses and intensivists who watch cameras as well as
vital sign readings for indicators of decline. If they
detect anything, they notify local nurses, and when
appropriate, the Virtual ICU physician can intervene.
“Technology is literally becoming part of the
patient’s care team,” Zane says. “Technology can
help you deliver better care from one end of the
spectrum to the other.” UCHealth also plans to
equip patients headed home from the hospital
with remote monitoring tools to monitor vital
signs, movement, and symptoms so that typical
reasons for readmission within the first few
days, such as medication compliance, wound
care, and heart issues, can be closely managed
and patients can safely stay home.
catalyst.nejm.org
Unlocking the Opportunities for Health Care Delivery Transformation
13
Community-Driven Change
JONNATHAN BUSKO, MD,
MPH, FACEP
Emergency Department Medical
Director at St. Joseph Hospital in
Bangor, ME
RURAL COMMUNITIES ARE
“THE TRUE DISRUPTORS. THEY
ARE THROWING AWAY ALL THE
OLD MODELS. INSTEAD OF
SAYING, ‘WHAT DO WE HAVE
AND HOW DO WE APPLY IT?’
THEY ARE SAYING, ‘WHAT
SERVICES DO WE NEED AND
HOW DO WE GET THERE?’”
Jonnathan Busko, MD, MPH, FACEP, Emergency
Department Medical Director at St. Joseph Hospital in
Bangor, Maine, would like to disrupt business-as-usual in
the emergency department but finds it difficult under the
current reimbursement model. “Most of the things that
would be disruptive within the emergency department
are anathema to success in fee-for-service,” he says.
As a result, he’s working to make an impact
through partnerships with the rural communities
that the local hospitals and health systems
serve. These communities in crisis, hit hard by
opioid addiction, loss of health care services,
providers, and traditional jobs, as well as aging
infrastructure, are “the true disruptors,” he says.
“They are throwing away all the old models. Instead of
saying, ‘What do we have and how do we apply it?’ they
are saying, ‘What services do we need and how do we
get there?’” Busko says.
Care providers must acknowledge the critical
differences between urban/suburban and rural care.
Respondents to our survey on rural health say the two
biggest barriers to providing excellent care in rural
settings are distance/travel time to facilities (49%) and
“
What are the top two biggest barriers to
What are the top two biggest barriers to
providing excellent care in rural settings?
providing excellent care in rural settings?
”
49%
Distance/travel
Distance/travel
time
to facilities
time to facilities
Recruitment/
Recruitment/
retention
retention of
ofphysicians
physicians
49%
recruitment/retention of physicians (49%).
catalyst.nejm.org
Unlocking the Opportunities for Health Care Delivery Transformation
“IF PAYERS ARE SPECIFYING
BOTH OUTCOMES AND
PROCESS – OR OTHERWISE
THEY WON’T PAY FOR IT –
THEN THERE REALLY CAN’T
BE INNOVATION.”
JONNATHAN BUSKO, MD, MPH, FACEP
Busko finds that many people living in rural areas
will travel to a larger town for primary care visits,
often scheduling multiple appointments and
other errands at once, but are looking for access
to urgent and emergency care in their own
communities. These patients are pushing back on
health systems to invest more heavily in the
types of services they need, he says.
For instance, one rural community in
northern Maine is evaluating the disruptive
move of having specially trained Community
Care Paramedic Practitioners perform some
aspects of urgent care under the remote
oversight of a physician, including wound
management and administering certain
medications beyond routine Emergency
Medical Services care.
14
Payers have to unshackle providers and health
care systems so they can innovate, Busko says.
Recently, he was exposed to a bat and needed a
series of rabies vaccines. While the vaccinations
cost only $700, the insurer required the shots to
be administered in an urgent care or emergency
department, increasing the total cost to more
than $5,000. “I could have had a home health
nurse come to my house for $150 and give me the
shots,” he says. “If payers are specifying both
outcomes and process – or otherwise they won’t
pay for it – then there really can’t be innovation.”
This dramatic change would require intense
physician oversight, telemedicine infrastructure,
and payer buy-in. “Will payers reimburse the
physician who oversees these providers? Will they
pay Community Care Paramedic Practitioners to
provide urgent care?” For the program to succeed,
these questions have to be answered, he says.
catalyst.nejm.org
Unlocking the Opportunities for Health Care Delivery Transformation
15
Tackling the Social Determinants of Health
The local community also is instrumental in
promoting behavior change and understanding
social determinants of health, Brodsky says.
IRWIN BRODSKY, MD, MPH
Medical Director for Diabetes at
Maine Medical Center, Portland, ME
“THE LOCAL COMMUNITY
IS INSTRUMENTAL IN
PROMOTING BEHAVIOR CHANGE
AND UNDERSTANDING SOCIAL
DETERMINANTS OF HEALTH.”
MaineHealth’s evidence-based program
Let’s Go! was created to battle and
prevent childhood obesity.
In partnership with government, schools, health
care practices, and community organizations,
MaineHealth branded the “5-2-1-0” message:
five or more servings of fruits and vegetables,
two hours or less of recreational screen time,
one hour or more of physical activity, and zero
sugary drinks.
Brodsky says Let’s Go! is a way to tap into a
child’s social network, including parents and
teachers, to apply healthy habits and “create an
environment for success.” He understands that
providers are a big part of the equation, which
the NEJM Catalyst Insights Council also agrees
with, indicating that time investment by the
health care team (66%) and provider adoption
(59%) are the top two barriers to social networks
being used to incent better health, according to
our survey on the topic.
What are the top three biggest challenges
in scaling social network tools for health
What are the top three biggest challenges
cin
are
delivery?
scaling
social network tools for health
“
”
care delivery?
@
@
47% 59%
Patient
Patient
adoption
adoption
Provider
Provider
adoption
adoption
@
66%
Time
Time
investment
investment
by health
health
by
care team
care
team
catalyst.nejm.org
Unlocking the Opportunities for Health Care Delivery Transformation
UNDERSTANDING THE
BARRIERS AND OPPORTUNITIES
WITHIN YOUR OWN
ORGANIZATION WILL HELP
DETERMINE WHAT STEPS ARE
POSSIBLE NOW AND DOWN
THE ROAD.
RICHARD ZANE, MD
Obesity in particular requires innovative ways to
engage patients of all ages. Our survey on the
topic finds that lack of patient perception of obesity
as a problem/health issues (39%) and difficulty
sustaining weight loss (39%) are the two biggest
barriers to getting patients into treatment.
Skudlarska, who treats patients diagnosed with
dementia or impaired memory loss, is hoping for
innovation in social networks. For her part, she
leads group visits where patients, families, and
other caregivers engage in collective discussions
and share resources such as patient care.
16
She expects emerging technology, including mobile
apps, to facilitate even more support for patients and
their social networks through forums and chat groups.
And although she finds health care to be far behind in patientfacing technology, she optimistically says, “the sky’s the limit”
in putting devices and apps to good use going forward.
Understanding the barriers and opportunities within your
own organization will help determine what steps are
possible now and down the road. “Unequivocally, we will
end up with a fundamentally transformed health care
system,” Zane says. “The time frame could be six months
or 60 months, but it’s going to happen.”
What are the top two biggest barriers in engaging patients in treatment for obesity?
39%
Lack of patient perception of obesity
as a problem/health issues
39%
Difficulty sustaining weight loss
catalyst.nejm.org
We’d like to acknowledge the members of the NEJM Catalyst Insights Council. It is through
their voice and commitment to the transformation of health care delivery that we are able
to provide actionable data that convene a collaborative dialogue about moving the
industry forward in a positive direction. Insights Council members participate in monthly
surveys and the results are published as NEJM Catalyst Insights Reports, including
summary findings, expert analysis, and commentary from NEJM Catalyst leaders.
To join your peers in the conversation, visit join.catalyst.nejm.org/insights-council.
About NEJM Catalyst
NEJM Catalyst brings health care executives, clinical leaders, and clinicians together to share
innovative ideas and practical applications for enhancing the value of health care delivery.
From a network of top thought leaders, experts, and advisors, our digital publication,
quarterly events, and qualified Insights Council provide real-life examples and actionable
solutions to help organizations address urgent challenges affecting health care.
catalyst.nejm.org
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