Solutions for a Broken Health Care System

Many believe our current health care system is expensive, complicated, and dysfunc­tional; some may describe it as broken. The “system” may need overhauling, but that is a tall statement, given that most issues result from various sub-industries attempting to advance technology, improve the quality of care, and optimize clinical outcomes indepen­dently. As a result, the US health care system spends far more on health care than other high-income nations while scoring poorly on many critical health measures, including life expectancy, preventable hospital admissions, suicide, and maternal mortality.

In this issue, our Transformative Employer Trends column (page 43), Vogenberg discuss­es how employers react to current health care trends as they implement their 2025 health benefit offerings. Current benefit coverage policies and payment methodologies are not working effectively or efficiently. He cites employers are taking an approach to employee health akin to holistic care that involves treating the “whole” person by looking at preven­tion strategies and biological, behavioral, social, and environmental factors to improve over­all wellness instead of just focusing on an illness or diagnosis. Vogenberg further cites that care pathways must be more comprehensive, addressing all the patient’s health care needs from a clinical, social, and environmental aspect.

Similarly, the evaluation of patient’s perspectives and needs is discussed by Wilson et al in our Perspectives article (page 20). As we are in the initial phase of the Centers for Medicare & Medicaid Innovation (CMMI) Enhanced Oncology Model program, practices will have greater accountability for focusing on assisting patients with all their health care needs from all aspects, including health disparities. Practices must develop capability to collect patient reported outcomes (PROs) data, and screening for health-related social needs, which are implemented in a decision support tool (DST). Wilson et al attempt to learn and describe how patients who are living with a cancer diagnosis seek to understand their condition and their level of desire to participate in the treatment decision-making process. Data and learnings from the first two phases of their work, combined with an in-depth analysis of the current phase addressing patient priorities and values, will lead to the development of test prototypes of DSTs for this target population. It is anticipated that, as a result, patients will be better able to become true partners in the decision-making process.

Another Perspectives article (page 36) seeks to determine the end users of clinical path­ways, especially in physician shortage and practice consolidation. Riley and Vogenberg con­ducted a survey, collecting data from nurse care managers to assess their knowledge base regarding clinical pathways, how they use them, and whether they thought they had any in­herent benefit in providing patient care and management. A majority of survey respondents worked in a community, academic, or medical center setting, with the remainder work­ing in a variety of other settings like health plans (including administrative services only), employers, or government entities. The majority of the care managers responded that they knew clinical pathways; however, the application of the pathway was in clinical arenas be­yond oncology, including most chronic care conditions and most common disease states in real-world care settings. Their conclusion was that as the team-based and patient-centered care strategies continue to develop, the expansion of care decision-makers has led to more nonphysician users of clinical pathways, especially as we move more deeply into patient-centered care models.

The Journal of Clinical Pathways is always open to receiving your submissions highlighting your work and research in the space throughout the year. Submissions can be submitted at JCPonline.com.