We propose the Wellness-Plus Solution, which is based on the sensible premise that — regardless of the financial methods used for cost-control — sustained improvements in healthcare safety, effectiveness, efficiency, affordability, timeliness, and availability can only be achieved by:
  • Knowing each person’s health risks and needs thoroughly
  • Knowing the most efficient and effective ways to prevent, treat and manage each person’s health problems
  • Consistently using this knowledge to promote each person’s health and well-being.

This wellness[1] and prevention model helps overcomes the shortcomings of all other proposed healthcare solutions as it presents a wise strategy for ever-increasing and sustainable improvements throughout our healthcare system.

Overview


The Wellness-Plus Solution focuses primarily on creating health, as well as treating disease, through learning and knowledge. It stresses the:
  • Open, honest and cooperative creation, development and sharing of knowledge
  • Validation, evolution and use of this knowledge for continually improving healthcare decisions and outcomes.

While this model does not recommend particular consumer-directed healthcare strategies or performance incentives, it is synergistic because it presents a way to increase and assess stakeholder knowledge and competence, which are critical components to both the HSA and P4P models. Used in conjunction with fiscal-based cost-control methods, the Wellness-Plus Solution helps increase healthcare quality resulting in lasting economic gains for all stakeholders and greater wellness for all people.

A Sensible System


The Wellness-Plus Solution describes a rational, compassionate, knowledge-based, consumer-centered system benefiting all stakeholders. It is consistent with the principles of The Commonwealth Fund, a private foundation that aims to promote a high performing healthcare system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.[2] Our solution focuses on accomplishing the following:
  • Top quality care and affordable health insurance would be available to everyone.
  • People would stay healthier longer and get well more quickly. Not only would people’s physical health be important, but so would their emotional well-being and quality of life.
  • Wellness programs would be readily available to help prevent illness and dysfunction.
  • Providers would make few errors and omissions, would perform fewer unnecessary tests and procedures, and would consistently deliver the most cost-effective care to each patient.
  • Evidence-based guidelines and decision tools would aid patients and their providers in determining and implementing the best treatment plans.
  • There would be less absenteeism at work and greater productivity because people would be healthier and have a greater sense of well-being.
  • Emergency rooms wouldn’t be crowded with people the uninsured seeking routine care.
  • Dangerous drugs would be identified more quickly and removed from market.
  • Self-destructive lifestyles and behaviors would diminish through education and counseling.
  • Pandemics, bioterrorism, natural disasters, and other health emergencies would be managed in a timely and effective manner.
  • Providers would have time to spend with their patients, and they would be paid to collect comprehensive clinical data and collaborate with researchers to develop and use practice guidelines.
  • Consumers and purchasers would have the information they need to make better decisions.
  • Patients’ preferences would be considered in plans of care. Providers would be able to communicate with each other to discuss difficult cases and share their ideas and experiences.
  • Innovations would we encouraged and supported financially.
  • Learning and knowledge-building would be a primary objective.
  • Patients’ genetic, psychological and medical information would be carefully guarded and never used against them.
  • Efforts to promote continually improving care would be international.
  • Malpractice insurance rate would decline dramatically because fewer mistakes would be made.
  • Medical schools would include courses on bedside manner.
  • Healthcare information technology would be affordable and useful to providers in everyday clinical practice and to all other stakeholders, and would continually evolve based on their feedback.

Mission


Help make the world a healthier, happier place for all people.

Goals


Gain and use knowledge in a way that continually improves healthcare quality, including:
  • Increasing the physical and emotional health and well-being of all people everywhere by improving the safety, effectiveness, efficiency, affordability, timeliness, and availability of treatment and prevention
  • Reducing healthcare costs.

Strategy


The Quality though Knowledge strategy focuses on the use of collaborative, knowledge-focused, patient-centered tactics that enable stakeholders to make decisions and take actions that lead to continually improving wellness and prevention for everyone. Unlike strategies limited to the exchange of patient data, which can leave people over fed with details yet undernourished of knowledge, this approach goes a crucial step further to transform data and information into useful knowledge supporting decisions by translating scientific research, business intelligence, and lessons learned into action steps.

Objectives


  • Increase the percentage of patients/people who:
    • Are better after receiving care than before care was rendered
    • Fare better long-term compared to how they would have done without the care
    • Take better care of themselves.
  • ...where "better" means:
    • Reducing the frequency, severity and duration of a person’s physical, emotional, and behavioral problems
    • Increasing a person's sense of well-being and quality of life (e.g., having a more positive emotional state, having greater physical comfort, being more productive, being able to act more independently, etc.)
    • Not adding new problems that worsen a person’s well-being/quality of life (e.g., medical mistakes, medication side effects, adverse effects of surgery, etc.).
  • Reduce the cost of healthcare by continually:
    • Reducing the number of unnecessary, inappropriate and ineffective tests, treatments and other interventions
    • Decreasing the number of expensive tests, treatments and other interventions that have lower-priced yet equally effective alternatives
    • Increasing the efficiency by which care is given
    • Improving people’s ability to avoid illness and to manage their health problems.

Tactics


Patient-Centered Care in which healthcare stakeholders continually improve the health and well-being of all people by:
  • Collaborating to build and use an evolving knowledgebase of evidence-based practice guidelines and educational materials
  • Collaborating to build and use evolving software tools to collect, share, analyze and discuss comprehensive healthcare data, information and models
  • Using knowledge services to help them establish collaborative learning networks that enable new knowledge to emerge and evolve as people share and discuss their experiences and ideas, and develop evolving practice guidelines and educational materials
  • Developing more rational methods of competition and payment.

Being a solution for profound and lasting benefits, it requires meaningful changes in today’s healthcare system, including policies and practices focusing on:
  • Understanding each patient’s healthcare needs clearly and completely by focusing on the important details for a whole person view — providing knowledge of the person’s body, mind, and environment.
  • Using this comprehensive knowledge of the person, together with complete knowledge of the scientific research and the experiences of providers in everyday practice to (1) make the best possible treatment decisions, (2) delivery the best possible care efficiently and effectively, and (3) enable all consumers to be competent, proactive, informed participants in the healthcare decision process and in promoting their own health by educating them about treatment alternative and by monitoring their lifestyle changes and giving them feedback about what their actions and how it affects them.
  • Continually growing, evolving, and disseminating this knowledge, so healthcare decisions and actions continually improve.
  • Giving payers and purchasers the information needed to make knowledgeable decisions.
  • Expanding quality improvement (QI) programs, which use change models to accelerate improvement healthcare processes and outcomes by establishing, testing, and disseminating evidence-based practice guidelines.[2a]
  • Promoting patient education and wellness programs.
  • Improving the “fidelity” of care by making changes in the healthcare system to allow all patients to receive the precise interventions they need, properly delivered at the time they are needed.
  • Handling widespread health emergencies (e.g., pandemics, bioterrorism, natural disasters) in a timely and effective manner.
  • Assuring patient data is survivable and accessible during a crisis.
  • Changing the way providers compete, ally, and are compensated for their services.

Four Categories of Care


Note that these tactics may vary depending on the category of care a patient needs: Preventative, catastrophic, and end-of-life care.

Preventative Care


The goals of Preventative Care are the prevention of serious illness by:
  • Providing primary prevention, such as doing health screenings and generating health risk appraisal profiles on a regular basis to identify potential problems early, so they can be addressed before becoming chronic or life-threatening conditions.
  • Educating and helping motivate consumers to live healthy lifestyles (e.g., good eating habits, exercise, stress-reduction, etc.).
  • Providing instruction, tools, case management, etc. enabling patients to manage/control chronic conditions thereby warding off complications (e.g., controlling diabetes to avoid blindness and amputation).
  • Treating non-catastrophic health problems (both physical and psychological) cost-effectively in outpatient settings, so they do not become catastrophic problems requiring lengthy or expensive treatments, or destroy a person’s quality of life.

As such, prevention includes regular office visits to a primary care physician (PCP), dentist, eye doctor, etc. for routine health check-ups and treatment of non-catastrophic health problems. It also include outpatient visits to physicians, mental health practitioners, chiropractors, dieticians, wellness counselors, etc., that focus on improving patients’ health status and well-being through preventive care, treatment for relatively minor health problems, and ongoing maintenance for chronic conditions to ward off complications.

Costs for prevention are relatively low and predictable; and it has the potential to yield substantial gains in people’s health status and quality of life, as well as reduce overall healthcare expenditures by helping to keep people healthy longer and get better more quickly.

Catastrophic Care


Catastrophic Care involves treatment of accident victims and people with serious medical conditions, ranging from inherited diseases and treatable cancer to inpatient care for serious mental health problems (e.g., schizophrenia and suicidal depression) and debilitating substance abuse.

Catastrophic Care focuses on both:
  • Acute health problems characterized by sudden onset and short duration, which progresses rapidly and require urgent care, such as acute myocardial infarction (heart attack) and serious accident victim are examples.
  • Subacute health problem distinguished by abrupt onset, but it has longer duration or changes less rapidly than acute problems, such as post-operative care, complex wound management, and rehabilitation for stroke.

While catastrophic care has predictable needs (e.g., we can estimate how many will have accidents or get cancer), the costs are generally very high and continually rise. New technologies and care in emergency rooms and other hospital departments are very expensive. This is as much a moral/ethnic issue as an economic one.

Chronic


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. Care for chronic conditions focuses on preventing complications and improving quality of life through self-management, decision-support, and other activities.[3]

End of Life Care


End of Life Care is for people who have no hope of recovering (they will only get worse and die), such as senile dementia, terminal cancer, etc. Providing complex medical care to these patients to keep them alive even a short time is extraordinarily expensive. Our society has to determine how much we are willing to spend to prolong a life beyond the point where there is any hope of recovery. Is it enough to keep someone as comfortable as possible (e.g., with pain medication) and with home care, or should we do everything possible to keep a dying person alive for as long as possible regardless of the cost and qualty of life? This, too, is as much a moral/ethnic issue as an economic one.

Blog links:
» Discussing HSA, P4P and a Personalized, Whole-Person, Coordinated Care in a High Fidelity System

Next: Benefits of the Wellness Plus Solution


Footnotes and References

[1] Wellness is a state of good health and well being in the people’s physical, psychological (mental, emotional, social), and spiritual lives, which is reflected by a positive quality of life.
[2] Gauthier, A., et al. (March 2006). Toward a High Performance Health System for the United States. The Commonwealth Fund. Available at http://www.cmwf.org/usr_doc/Gauthier_high_performance.pdf
[2a] Berwick, D.M. & Leape, L.L. (Oct 16, 2006). Perfect Is Possible, MSNBC-Newsweek. Available at http://www.msnbc.msn.com/id/15173079/site/newsweek
[3] See, for example, the chronic care model on the Improving Chronic Care web site at http://www.improvingchroniccare.org/change/model/components.html

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