Sunday, September 27, 2009

Accountable Palliative Care Organizations - Mayo style?

As hard as health insurance reform is, compared to health care DELIVERY reform, that’s the easy part, Mayo Clinic CEO Denis Cortese said at a recent presentation to the National Press Club. Mayo has been frequently cited as a model for health care delivery reform by President Obama and others, but the question of Mayo’s value as a model for overall reform has also generated considerable discussion from both sides.

Cortese cited the significant regional variation in medical practice documented by researchers at Dartmouth (and discussed periodically in this blog, see here and here ) , and he listed several factors common to institutions and regions that produce what he called "high-value care": patient-centric cultures; high levels of physician engagement in leadership and change; much higher levels of teamwork, collaboration, and coordinated care; more "connectivity" and sharing of electronic medical records and information; and much greater use of "the science of health care delivery," meaning systematically looking at how patients flow through an organization in order to reduce waste and standardize processes to reduce errors.

These factors, it occurred to me, are similar to the attributes possessed by Accountable Palliative Care Organizations (see here, here, and here). Producing "high-value care" , whether for an acute episode, in an ambulatory setting, or for late-life care, is a formidable challenge. And it is why, if palliative medicine physicians can incorporate into their practices those skills requisite to success in these emerging delivery models, their practices will be highly sought after.

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