Coordinating care by bucking the trend toward fragmentation
How to improve the health of your members without introducing more complexity
January 29, 2021
Shawn West, MD | Chief Medical Officer
There are a few themes in American healthcare that those familiar with the system know all too well. Others who are less aware of the inner workings discover these themes the hard way. The major themes are that healthcare is complicated (to say the least), health plan stakeholder incentives are often not fully aligned to the desired outcomes, and healthcare is “local.”
When Haven formed in January 2018, many wizened healthcare workers sincerely wished for their success to change and improve healthcare – hoping that if anyone can make a dent, it would be them – but they didn’t hold their breath. The fact that this undertaking scuttled highlights the challenges at hand.
So, why is healthcare so complicated? And why does healthcare lack the personalized feel that many other industries have mastered?
For decades healthcare has been built with an approach of one-size-fits-all. This approach obviously lacks customization or personalization. The future of healthcare strips out the one-size-fits-all mantra. Many attempted solutions have failed as they do not consider the local ecosystem, including specific employee and company needs. With this baseline knowledge, more applicable initiatives can occur that will make a difference within a specific population. Understanding the nuances of a local population cannot be overcome with money or technology. A sheer force of dollars, proprietary algorithms in the absence of clinical interpretation, and machine learning will only get you so far.
This local, personalized approach may seem more complicated than a national one. It does require a little more effort upfront to find the right partners, but it means only doing it once rather than adding more partners every year.
An employer typically has a few goals in mind related to their employee benefits program. As an example, the goals could read as such:
- offer enhanced, comprehensive health benefits,
- achieve better outcomes for their employees, and
- reduce overall costs.
To achieve this many employers bolt on more and more point solutions, attempting to address a small need of the healthcare program inadvertently adding complexity, and further fragmenting the delivery of care instead of coordinating care.
Even with high-functioning, effective vendors, fragmentation is likely to occur unless there is an intentional effort or insistence that these solution services are integrated with those providing and directing medical care. Without point solution integration care duplication is exacerbated and confusion among members increases. This approach has led to annual vendor summits and HR teams trying to manage 20 different companies instead of a few comprehensive partners.
Connecting employers with the healthcare providers to design and manage the employee benefits program limits fragmentation and increases care coordination resulting in a more comprehensive approach to care. This connection can be built through a clinically integrated network (CIN) which has the influence to shape the directives for the stakeholders involved: the employer and providers. A CIN brings the employer and providers together to evaluate the current vendors, identify gaps, and enhance the program integration structure with a local lens. CINs understand and acknowledge the shortcomings of traditional, one-size-fits-all healthcare and developed solutions to address them on a comprehensive level. Plus, clinically integrated networks are willing and able to offer services requested or desired by the employer through a single contract versus multiple point solutions reducing program complexity. A CIN is an ideal way to achieve the Triple Aim of affordable, consumer-driven, high-quality healthcare.