Integrating sick-care and well-care is an essential tactic for transforming American healthcare to a value-based system providing high-quality, cost-effective care.

Defining Sick-Care with the Sick-Care Delivery Tree


The Sick-Care Delivery Tree figure (below) depicts key components of a patient-centered, evidence-based, personalized sick-care strategy.
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Following is a description of the tree (from bottom up).

Roots = Health Problems of Population


The first component of the proposed sick-care approach is represented by the roots, which comprise six categories of physical and psychological problems, including diseases, illnesses, dysfunctions, and traumas:
  1. Acute health problems characterized by sudden onset and short duration, which progresses rapidly and require urgent care. An acute myocardial infarction (heart attack) and serious accident victim are examples.
  2. Subacute health problem distinguished by abrupt onset, but it has longer duration or changes less rapidly than acute problems. Examples include post-operative care, complex wound management, and rehabilitation for stroke.
  3. Chronic health problem of indefinite duration, which may persists with virtually no change over time, or which may lead to complications. Diabetes, depression, congestive heart failure, hepatitis and asthma are examples.
  4. Physiological health problems consist of illnesses and dysfunctions in any part of the body.
  5. Psychological health problems consist of emotional, mental, or behavioral disturbances and disorders.
  6. Mind-Body (Biopsychosocial) health problems are related to the interaction between physiological and psychological factors.

Trunk = Sick-Care Delivery Models


The next component encompasses the five sick-care delivery models, which are represented by the Sick-Care Delivery Tree trunk; the:
  1. Inpatient Care model focuses on treating patients in hospitals, nursing homes, and other inpatient facilities.
  2. Outpatient Care model focuses on treating patients in providers’ offices, clinics, and other outpatient facilities.
  3. Medical/Bodily Care model focuses on delivery of (a) emergency medical care (e.g., accident victims, infections, poisoning, etc.) and (b) non-emergency medical and non-medical bodily care (e.g., elective surgery, chiropractic, dental, vision, etc.).
  4. Psychological Care model focuses on delivery of medical/psychiatric and non-medical/psychological care for mental, emotional, cognitive, and behavioral problems.
  5. Biopsychosocial/Integrative Care model focuses on delivery of integrative (mind-body) care for problems having physiological and psychological causes or consequences.

Branches = Categories of People and Places


The branches of the Tree depict the people and place involved with sick-care:
  1. Patients and their Families are the recipients of the care.
  2. Healthcare Professionals, including providers and researchers across the entire healthcare continuum, deliver the care or study the outcomes.
  3. Places Sick-Care is Delivered includes hospitals, clinics, primary care physicians’ offices, specialists’ offices, laboratories, and any other place sick-care is rendered.

Flowers = Sick-Care Processes


Sick-care delivery processes focus on diagnosing and treating health problems.

The flowers represent the inpatient and outpatient sick-care processes:
  1. Inpatient care processes for physical and psychological health problems including (a) emergency room/trauma center care; (b) obstetrics; (c) tests and examinations; (d) elective surgery; and (e) psychiatric care for severely disturbed patients.
  2. Outpatient care processes physical and psychological health problems including (a) tests and treatments for physical and psychological problems during primary care during office visits to primary care physicians and specialists, as well as to ambulatory clinics and other such facilities, and (b) coordinating care for patients requiring multidisciplinary teams can work together effectively.

Under the proposed solution, these processes are patient-centric and utilize evolving, evidence-based practice guidelines to:
  • Improves outcomes continuously
  • Empower the healthcare consumer to make knowledgeable decisions about their own care by being active participants in a shared decision-making process
  • Treat the “whole person,” both physically and psychologically
  • Tailor care to each person’s specific needs and preferences
  • Coordinate care and facilitates cooperative communications across all providers
  • Foster collaboration between practitioners and researchers
  • Maximize safety and efficiency
  • Assure patient privacy.

Bees = Health Information Technology Supporting Sick-Care


The bees illustrate the health information technologies needed to support sick-care. Important software include tools for (a) diagnostic decision support; (b) treatment selection and plan-of-care generation decision support; (c) plan-of-care execution assistance via reminders, prompts, and alerts helping to avoid errors and omissions and optimize workflows; (d) care coordination across multiple providers, including case managers; (c) outcome data collection and analysis; (e) research, clinical and finanacial model development, and knowledge management; (f) business intelligence; and (g) protecting populations in emergencies such as epidemics and bioterrorism.

Defining Well-Care the Well-Care Delivery Tree


The Well-Care Delivery Tree figure (below) depicts a community collaboration approach for improving health outcomes and reducing cost through consumer education and wellness programs, which help: (1) Prevent serious illnesses and complications and (2) Increase people’s well-being and quality of life.

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This well-care approach complements and augments sick-care.

Roots = Health Status of Population


The roots of the Well-Care Delivery Tree represent the five well-care populations:
  1. Healthy populations have no identified health risk.
  2. At-Risk populations are people who are at risk of becoming ill due to their physical condition (e.g., obesity), behaviors and lifestyle (e.g., smoking, alcohol consumption), genetic predispositions, or living and working environments.
  3. Chronic populations are people with chronic conditions, such as diabetes, for which there is ample potential for complications and worsening health.
  4. Catastrophic illness populations are people who have received emergency treatment (e.g., accident victims, infections, poisoning) or inpatient treatment of serious medical (including psychiatric) conditions.
  5. End-of-Life populations are people who have no hope of recovering; they will only get worse and die.

Truck = Well-Care Delivery Models


The four well-care delivery models are represented by the trunk; the:
  1. Preventative Maintenance model focuses on (a) delivery of primary prevention -- such as physical activity, nutrition, stress relief, vaccinations, etc. -- that help people avoid health problems, as well as promoting peek performance, and (b) secondary prevention for at-risk persons to prevent recurrences of health problems, such as avoiding recurrent coronary artery disease events in a person with a history the illness.
  2. Recovery/Rehabilitation model focuses on adherence (compliance) to doctors’ orders to foster recovery, rehabilitation, and complication avoidance for patients having chronic or catastrophic health problems.
  3. Compassionate Home Care model focuses on making people near end of life as comfortable as possible in a supportive environment where they have dignity and family support.
  4. Fraud Prevention model is used for all populations and focuses on assuring that the well-care programs are compliant with regulations, and that care is rendered with integrity.

Branches = Categories of People and Places


The branches depict the people and place involved with well-care:
  1. Consumers (Patients) and their Families are the recipients of well-care.
  2. Healthcare Professionals are those who deliver well-care — including wellness coaches, such as specially trained physician assistants, nurse practitioners, home health aids, personal trainers, and other practitioners — as well as researchers who study care outcomes.
  3. Places where Well-Care is Delivered include well-care facilities, community-based organizations, workplaces, and primary care physicians’ offices.

Flowers = Well-Care Processes


The flowers represent the well-care delivery processes, which are associated with the well-care delivery models:
  1. Recovery/Rehabilitation and Preventative Maintenance models includes processes for (a) ongoing risk and health status assessments; (b) ongoing generation of personal health plans identifying any risk factors people may have, as well as primary and secondary prevention plans of action (i.e., health directives); (c) health education presenting concrete, understandable action steps and psychological counseling for dealing with physical problems and psychological stressors; (d) compliance motivation involving encouraging and reminding people to do the things that will help them improve their own health; (e) access to health coaches for health information and advice; (f) outcome studies used in continuous quality improvement feedback loops; (g) coordinating care for patients with catastrophic health problems, so multidisciplinary teams can work together effectively; (h) promoting environmental and workplace safety; and (i) encouraging lifestyle and attitudinal changes for peek performance.
  2. Compassionate Home Care model includes processes for helping individual obtain home care nursing and homemaking assistance; arrange for transportation to and from doctor appointments; and address the psychological, social and spiritual well-being of patients and families.
  3. Fraud Prevention model has processes that help detect fraud by analyzing the services rendered in light of the health status assessments and outcomes.

Bees = Health Information Technology Supporting Well-Care


The bees illustrate the health information technologies that support well-care. The software applications needed include tools for: (a) collecting and analyzing data from health risk assessments and health status monitoring; (b) personal health plan creation using evidence-based well-care guidelines; (c) personal health plan execution assistance via reminders, prompts, and alerts to improve compliance with preferred interventions; (d) community health plan development showing how organizations and neighborhoods can support the health of individuals; (e) research, clinical and financial modeling, and knowledge management; and (f) business intelligence.

Integrating Sick-Care & Well-Care


The basic components of sick-care and well-care have now been defined according to the solution we propose. We can therefore turn our attention to the issue of integration.

Instead of viewing sick-care and well-care as two separate avenues in the road to health, the solution we propose calls for delivering both in an integrated care delivery system. This process involves a new kind of coordination and collaboration between (a) medical and related sick-care practitioners focused on the diagnosis and treatment of health problems and (b) well-care practitioners focused on prevention, recovery and well-being, as well as peak performance. It requires a biopsychosocial (“whole-person”) approach to care, where body, mind, spirit and environment are all considered important and handled accordingly.

This integrated care strategy promises to improve people’s health and reduce healthcare costs to a greater degree than either sick-care or well-care alone. The reason is, it provides a sensible way to keep people healthier longer, recover from illness and dysfunction more quickly, and avoid complications of chronic disease. It is therefore a crucial component for solving the healthcare crisis by reducing overall expenditures. Having a patient profile that includes a full mind-body work-up, along with an individual plan of care focused on keeping the individual healthy, supply essential information that enables the sick-care practitioner to better understand and treat the root causes of acute, sub-acute and chronic ailments using conventional (allopathic) approaches as necessary. In addition, this information helps the well-care practitioner work with clients to prevent health problems and recurrences using economical complementary and alternative (non-allopathic) interventions.

Bottom line: By integrating sick-care & well-care as per the proposed solution, the result would be a reduction in overall healthcare costs, an improvement in health outcomes, and an increase in people’s quality of life and productivity. This is a vital step toward solving the current crisis.

Next: Tactic - Reform Current Economic Models

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