Transforming Healthcare E-Book

Morey Menacker

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 111

Veröffentlichungsjahr: 2022

Beschreibung

A startlingly insightful discussion of the problems facing American health care providers and consumers and their solutions In Transforming Health Care, expert physician Dr. Morey Menacker explains how the United States can contain the world's leading collection of superlative health care practitioners, technologies, treatments, research, education, and hospitals while simultaneously failing to provide care to many of its citizens. The author walks you through the past, present, and future of American health care, showing you how the United States got to its present state and offering practical solutions to improving access and affordability for millions of people. In the book, you'll find: * Insightful commentary about how to maintain the stellar quality of care found in the United States while expanding health care affordability and access * Discussions of how to reduce the cost and complexity of US health care * Explorations of the latest research and data as seen through the eyes of a physician who has spent their entire career working in the American medical system A can't-miss resource for US-based physicians and allied health care professionals, Transforming Health Care will also earn a place on the bookshelves of regulators, administrators, and lawmakers with an interest in the American health care establishment.

Leseprobe

Table of Contents

Cover

Title Page

Copyright

Foreword

About the Companion Website

Introduction

1 How Did We Get Here?

2 Bending the Cost Curve

3 Goals in Transforming Healthcare

4 Quality, Efficiency, Outcomes, and Access

5 Overcoming Inertia

6 Patient Accountability

7 Changing Behaviors

8 Moving the Needle

9 How Do We Pay for This?

References

Index

End User License Agreement

Guide

Cover

Table of Contents

Title Page

Copyright

Foreword

About the Companion Website

Introduction

Begin Reading

References

Index

End User License Agreement

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Transforming Healthcare

An Insider’s Look on Why and How

Morey Menacker

Copyright © 2022 by John Wiley & Sons, Inc. All rights reserved.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey.Published simultaneously in Canada.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per‐copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750‐8400, fax (978) 750‐4470, or on the web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748‐6011, fax (201) 748‐6008, or online at http://www.wiley.com/go/permission.

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Library of Congress Cataloging‐in‐Publication Data applied for:

Paperback: 9781119902522

Cover Design: WileyCover Image: © leowolfert/Adobe Stock Photos

Foreword

I have had the past good fortune on several occasions of meeting certain persons for the first time, who, after hearing them speak cogently for only a few minutes, have become my instant and durable friends. One such colleague is Dr. Morey Menacker, former President and Chief Executive Officer of the highly successful New Jersey‐based Hackensack Alliance Accountable Care Organization, and well qualified author of this brave new book, Transforming Healthcare. Given his very extensive experience as a master geriatrician and seasoned senior healthcare executive, the best three words I can think of to describe Morey are as “The Doctor's Doctor”.

More than twenty years ago, the Institute of Medicine (now known as the National Academy of Medicine within the National Academy of Sciences) published an urgent “call to action” for the American Health System in its seminal Crossing the Quality Chasm. This consensus‐based work defined quality of healthcare through six very important aims: Care that is simultaneously Safe, Timely, Efficient, Effective, Equitable and Patient‐Centered. In this regard, Transforming Healthcare continues to fire on all of these cylinders as the vision of the future is presented.

One of these aims is “Efficiency”, which the IOM originally defined as “avoiding waste, including waste of equipment, supplies, ideas, and energy”. I emphasize this definition often when discussing the time‐honored topic of “Cost of Care”, because it helps gets at heart of the economic mindset that is necessary for realizing what's at stake throughout this book. Yet, today's determinations as to what constitutes optimally efficient healthcare depends on which lens the many diverse stakeholders among the US healthcare system use for their own internal deliberations. And, as Dr. Menacker rightly points out, major challenges to overcome this resultant inertia stand in the way to achieving timely consensus‐based solutions for improved health status, such as redirecting resources towards improved patient‐centered primordial prevention efforts and away from our traditional delivery of downstream “sickness treatment”. Yet, at the end of 2021, the market cap of the healthcare industry exceeds $5 Trillion and per capita healthcare costs total $4.5 Trillion. Unfortunately, the Cost Curve is bending in the wrong direction, i.e. concave up, not convex down.

An important and illustrative example to denote in the context of Transforming Healthcare is cardiovascular disease (CVD), which is the leading cause of death, not only in the US, but for the entire world. CVD (including acute myocardial infarction, heart failure and other patients with coronary atherosclerosis), when combined with stroke account for four of the top 10 expensive conditions treated annually in US hospitals. Most major local and regional US hospitals provide comprehensive acute care services to patients with major acute cardiovascular events (MACE), including well‐staffed medical and surgical intensive care units, sophisticated state‐of‐the art technologies and procedure rooms for acute high‐definition imaging and multimodal revascularization interventions, and specialist physicians, nurses, pharmacists and other healthcare professionals with advanced training credentials. Well paid and incentivized traditional health system service line senior executives skillfully juggle day‐to‐day operations, complex and interdependent supply chains, ever‐evolving information technologies, challenging workforce requirements, managed care negotiations and increasing capital allocations. Chief Executive Officers and their governing boards prioritize the “strategic” intention of these service lines in order to realize substantial future revenue growth through increased market share and reimbursement and competitive advantage for being recognized regionally as “cutting edge and ahead of the curve”.

In contrast, High Blood Pressure (HBP), a major risk factor for MACE, results in billions of dollars of waste from reduced worker productivity and absenteeism as well as significant increased per capita healthcare costs. Clearly, reducing the risk of major cardiovascular events by controlling HBP, and thereby improving health‐related quality of life, can significantly lower attributable excess annual per capita health costs. High quality scientific evidence from large scale population‐based studies published in the 2017 Hypertension Clinical Practice Guidelines of the American Heart Association (AHA) and the American College of Cardiology (ACC) documents the significant blood pressure lowering effects from six specific critically important lifestyle modifications: tobacco cessation, regular physical exercise, restriction of dietary sodium, dietary intake of potassium, moderate alcohol consumption and a “healthy heart” diet. Assessments of Social Determinants of Health (SDoH), Shared Decision Making (SDM) conversations between patients and their physicians, and Team‐Based Care (TBC) delivered by nurses, pharmacists and other health professionals are now known to result in significant improvement in BP control and other health risk reduction targets through effective, evidence‐based lifestyle modifications.

Nonetheless, recent data reveals that over 115 million Americans have diagnosed or undiagnosed HBP, and that more than half are inadequately controlled to guideline‐based BP targets published by AHA and ACC. Worst of all, blood pressure is almost always measured incorrectly, resulting in innumerable inaccurate readings obtained in both health care settings and at home. Inadequately controlled HBP is but one of many major unmet public health challenges that can be directly traced to the diffuse health system inertia so elegantly addressed by Dr. Menacker in Chapter 5 of Transforming Healthcare that is at the heart of this matter. No doubt, the healthcare delivery infrastructure for the care of major acute and chronic CVD is vastly different than what is needed to achieve health promotion, maintenance, and prevention necessary to reduce MACE and hence the need for acute care.

I recently asked some health system senior managers, governing board members and primary care physicians to informally describe the barriers to achieving optimal BP control. Their comments were remarkably consistent and focused on time and resource constraints, process limitations and a general lack of urgency regarding HBP as a top organizational priority. The clinicians described control of HBP as "just another metric" within constantly expanding externally imposed quality requirements. Administrative demands remain overly burdensome, leading to too many "clicks" to add home BP readings to the electronic health record (EHR). In addition, the team is understaffed and overworked, leaving no time to properly address Social Determinants of Health (SDoH) and effective lifestyle modifications. Traditional practices do not ensure consistent and accurate BP measurement technique with validated and certified devices in accordance with standardized guideline‐based scientific methods. Patients often present other pressing concerns, which can lead to deferment of BP control until the next annual examination or ignoring it altogether. Not surprisingly, control of HBP for patients and employees is nowhere to be found as a key performance indicator on any governance or managerial accountability “dashboards”.

Of course, it is certainly much easier for us to describe these “wicked” problems like control of HBP than to find and implement cogently clear pathways to solving them. And while Dr. Menacker's strong recommendation for global payments to health systems to simultaneously manage the associated clinical and financial risks is not new, it comes at just the right time in our history. What is urgently needed today to achieve the goals outlined in this book are stronger health system alliances and congruent alignment with insurers, employers, public health, community health safety net organizations, large and small biopharmaceutical and device firms, digital health Information technology companies and governmental health agencies. “Moving the Needle” of improved health status of the US population will require a major reprioritization of both capital and human resource allocation by all of these stakeholders. Transforming Healthcare is henceforth our Call to Action.

Principal & Founder, IPO 4 Health (Improving Patient Outcomes4 Health)Associate Professor of Medicine, Rush Medical CollegeSenior Associate Editor,

American Journal of Medical Quality

Donald E. Casey Jr

MD, MPH, MBA, FACP,

FAHA, CPE, DFAAPL, DFACMQ

About the Companion Website

This book is accompanied by a companion website.

    www.wiley.com/go/menacker/transforminghealthcare

    This website includes:

Test Banks

PowerPoint Lecture Slides

Introduction

One may ask, “Why would a physician who has worked for years in our current healthcare system want to transform said system?” While there is no easy answer, I will try to explain. My postgraduate training took place in an inner city environment, where the majority of patients were hospitalized due to complications of their environment. This included drug addiction, poorly controlled hypertension, diabetes, hyperlipidemia, food insecurity, homelessness, and trauma. It became obvious early in my career that prevention was infinitely cheaper, and more rewarding, than treatment. The conundrum was in developing a method to pay for prevention.

It is imperative that those of us who work in a particular field, and benefit financially from that work, must give back in some way as gratitude for the opportunity, and to preserve these opportunities for future generations. It is also much easier to comment and suggest change in a field that has defined your entire life. We all have a responsibility to leave this world a better place than we found it.

It is common occurrence that when an international celebrity, or a wealthy foreigner, becomes ill, they automatically fly to the United States for their healthcare. These individuals would not come here if they thought the medical care was inferior. However, we are constantly bombarded by the media with tales of inadequate care, greed, malpractice, and refusal to provide needed services. Is it possible for these two disparate stories to both be true? The answer is a resounding YES. We are blessed with the best technology, the best treatments, the best research, the best hospitals, and the best physicians, yet the care provided can be disjointed, inadequate at times, cost prohibitive, and occasionally inappropriate.

This book attempts to explain how we got to this place and how we can get better.

1How Did We Get Here?

A common theme at healthcare