The Future of US Healthcare Part II: Care Coordination – the key to sustainable healthcare

care coordination the key to sustainable health care the challenges of ensuring sustainable high quality health care for our nation must not be underestimated this highly complex system with current expenditures exceeding two point six trillion dollars per year cannot continue in its present state the system is clearly broken while our nation expends more than 17 percent of its gross domestic product on health care our global ranking in comparison to other health systems is deplorable there is no future for a poorly ranked health care system that drives us to a frightening degree of deficit spending our fee-for-service approach coupled with fear of malpractice claims undoubtedly generates unnecessary procedures and resultant expenditures it's also a fact that 19.1 percent of Medicare patients are readmitted within a month of hospital discharge 56 percent are readmitted within six months approximately half of the patients with chronic conditions like heart disease or asthma actually either miss doses or don't take their medications as ordered non adherence to medical regimens accounts for a great deal of wasted spending and potentially avoidable costly admissions and furthermore ignoring the challenges of caring for our burgeoning elderly population is as unrealistic as setting off on a cross-country trip with only enough money in your pocket for a single tank of gas be assured you are not going to get very far the real question is how and where we should begin essentially we have two distinct options the first is a purely economic solution slicing and dicing the overall healthcare delivery system cutting back on payments to physicians and hospitals while limiting access to costly treatments and medications while overall expenditure reduction is assumed to be immediate the prolonged negative consequences are both far-reaching and unsettling the second option includes novel strategies designed to improve care coordination prevention and personal engagement in health and well-being let's focus our attention on a novel care coordination strategy let's begin by getting back to our roots or where our nation's health care actually began hospitals were originally founded by community volunteers who were intent on taking care of their neighbors in need in a similar manner our patient centric strategy is based upon what we refer to as a community care network or a CCN I know what you're thinking it's just adding another layer of cost and complexity to an already overburdened system I assure you that's not the case the CCN is actually a cost-effective extension of a community hospital that operates seamlessly with other local health agencies to support the ongoing needs of its patients through a patient directed coordinated care approach consider it an all-encompassing health care system without walls or a patient-centered medical home on steroids we actually like to refer to it as a patient-centered medical condominium the CCN is effectively run by the hospital it's comprised of a physician directed interdisciplinary team of nurses counselors social workers nutritionists and ancillary support personnel the CC ends mission is to provide the highest quality continuum of compassionate outcomes based patient centered culturally sensitive health care each patients choice is highly respected and our quality measures our outcome rather than process based we adhere to a no discharge policy we will not abandon people in the sea of seemingly overwhelming health care challenges where they struggled to stay afloat our commitment extends beyond the confines of disease management addressing socio-economic educational psychosocial and behavioral factors as well as each person's adherents potential our quest is to identify and eliminate medical errors care gaps and obstacles to receiving health care whenever possible our CCN also focuses on reshaping healthcare behaviors and promoting early interventions to prevent the development of ambulatory care sensitive conditions AC SCS and unnecessary complications hospitalizations or costly readmissions now I know what you're thinking it must cost a fortune to deploy the army of individuals needed to accomplish these lofty goals for a community surprisingly it doesn't due to the fact that we are engaging a rather unique workforce through an unprecedented collaboration between medval Medical Center and Allegheny College pre-med students are engaged in a formal credit based training program that enables them to serve as health coaches supervised by the CCN interdisciplinary team how is that possible the answer is rather straightforward students are formally trained by a faculty comprising physicians a nurse coordinator social worker psychologists nutritionists and ethicist and even a health care attorney through a formal semester long didactic interactive college course upon completion these extraordinary students begin a practicum by shadowing members of the interdisciplinary team and are thereafter progressively deployed to serve as health coaches within our community under team supervision each health coaches primary responsibility is to inspire and motivate our patients to become more actively engaged in their health and well-being health coaches work with CCN health professionals to reduce what ultimately falls through the cracks and escalates into the realm of costly often overwhelming problems on many levels examples include missed appointments medication reconciliation errors misunderstandings and inability to adhere to prescribed health regimens in this CCN based health coach model everyone wins our patients benefit from a reliable dedicated patient-centered continuum of care our physicians receive the support they need for helping to care for patients with a myriad of challenges in multiple domains our community realizes enhanced overall health and well-being our student health coaches benefit from real world experiences one of the most important life shaping determinants of success for our evolving healthcare workforce too good to be true you might be thinking too expensive to justify for the average Hospital while these are good questions we have great answers first our dedicated healthcare faculty is not paid they donate their time to our formal training program in fact while we only ask that they present for one lecture often five or more of our faculty members work together for each class next our health coaches do not get paid either they receive college credits for their participation in both the didactic session and practicum in effect we are vastly expanding the workforce with minimal cost other than supervision finally we believe that the program cost can be justified by the overall savings generated by the CCN coupled with improved outcomes and the reduction of proposed penalties associated with excess readmissions in conclusion this innovative hospital based culture shifting healthcare strategy is effective affordable and sustainable from a humanistic perspective it is the right thing to do when properly implemented it has great potential to serve as a giant step toward radically reshaping our nation's healthcare for this and successive generations you


  1. Great QI program and it's honorable that you Hospital is doing this for free. The problem is that here in California several QI programs that are supposed to be provided by the contracted HMO's are falling short. The Hospital's,PCP's and specialist are taking cuts and being forced into joining HMO's. The HMO's and County funded HMO's that where created over 10 years ago are not showing the quality improvement. This is transparent now so why is the State and County still contracting and using public funds to pay for failing HMO's and failing programs. The money needs to go to patient care and those on the front line providing the patient care and proving this with outcomes, not promises.

  2. Dr. Bittman,
    I have been working on healthcare solutions for the communication company I work for over the past year. I have gained some knowledge of the issues through the conference I have attended such as IHT2, Care Continuum Alliance as well as some work with the US Dept Health ONC. Your summation of the issues and challenges we face are spot on. Great job with this video!

  3. Thank you. I like your idea of a healthcare coach. Non-compliance to meds and appointments is an issue because patients may be uneducated and/or stubborn to think that there is a problem until an emergency happens, and then they call the 911, raking up bills from the ambulance company, hospital, doctor visits, and the procedures and meds used to save their life just because they aren't encouraged to take care of themselves.

  4. yes, the facts are mostly right…but still there are some companies that want to make a change for the better, for example my healthcareinsurance company is quite fair and affordable.
    Take a look at a few offers just as an example …

    Link : cpaway.afftrack. com/click?aid=25579&linkid=B46­846

    (it worked for me)

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