It’s no secret that the transformation of U.S. healthcare will take a considerable amount of time (measured in terms of generations of people) and resources (both financial and human) to accomplish. But what we need to understand as an industry is that the best way to work toward accomplishing this goal is by transforming the health of individual communities one by one, learning from our successes and failures to make improvements for our neighbors. From there, we can allow the “snowball effect” to help us reach our ultimate goal: improved health for the entire country. Quite frankly the timeline is irrelevant – we must begin making changes now, beginning with the local healthcare delivery system.

There is substantial variation in how healthcare is organized and delivered from one community to another. For example, in some communities there is vigorous competition between organized provider systems, and in others providers are fragmented and unorganized. Hospitals and physicians collaborate well in some communities, while they compete in others. Healthcare access and delivery also varies tremendously between urban and rural areas. Other examples of these variances include:

  • Fully integrated healthcare delivery and financial systems led by well-known organizations – i.e. Kaiser Permanente, Group Health of Puget Sound and Intermountain Healthcare.
  • Strong multi-specialty group practices – like the Marshfield Clinic in Wisconsin or others – have developed strong single-specialty groups with affiliated ambulatory diagnostic and surgery centers.
  • Integrated delivery networks that contract with multiple payers, such as Sutter Health.
  • Academic medical centers as the core of integrated delivery system – like Partners HealthCare System in Massachusetts, the Mayo Clinic in Minnesota and Dartmouth-Hitchcock Medical Center in New Hampshire and Vermont.
  • Physicians organizing into ACOs – such as HealthCare Partners in Southern California.

The point is that we need to avoid a “one-size-fits-all” approach, as many differences exist in local delivery systems. We need to test and optimize a number of different local healthcare delivery system models if we are going to make broader transformation a reality. Before any progress can be made, each community needs to understand the population it serves and their unique needs for healthcare, as well as differences, such as the types of insurance they have. For each segment, baseline measures of health status, utilization and costs should then be compared with best practices to establish specific health improvement objectives.

In order to make a transformation happen at the local level, we need to look at all information available from each healthcare constituent in the local community – including clinical, self-reported, claims and satisfaction data – so that providers can implement programs to achieve the objectives that make the most sense for each community; payers can align incentives and reimbursement with these provider initiatives, and can design insurance solutions that encourage patient engagement and adherence to provider initiatives; all parties can monitor emerging results; and finally providers can optimize programs and initiatives, redeploying enhanced programs where needed to the populations they serve. By necessity it will be an iterative process.

It’s tempting to focus on the country as a whole and look for ways to make monumental change across geographies, but a local approach to transforming the delivery and financing of healthcare is critical if we’re going to make positive change. We need to keep evolving, learning and improving one community at a time to achieve our goals on a national level, rolling-out and repurposing learned best practices from one like, local community to another. The “yellow brick road” to a nation of sustainable health communities is paved with the local healthcare delivery system!

Joel Hoffman