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Regional Hospital Innovation Unbundled: A Real Change Declaration


This post first appeared here in a LinkedIn HIMSS group on the topic, “What will drive the next wave of healthcare innovations?” In that LinkedIn topic, the willingness to “envision possibility” is excellent as a theme for systemic change (Note: on 2013/03/13, a paragraph was added below on “How about region-wide protocols…”). However, much energy along the “envision” line looks to me to be very narrowly incremental within the boundaries of current regional operational and payment frameworks. How about workshops to “envision possibility” along new lines of inquiry as below to provide a “health supply chain” boosting regional health, labor productivity, and economic betterment?

For example…

How about serious energy for regional and population-wide health systems that address linking walk-in sites, primary care, and hospital care, where regional hospitals act as the head or heads of a regional health supply chain infrastructure, by applying a regional health resource based on the nation-wide patient- and practitioner-oriented VistA resource (largest VistA enabling firm is Medsphere), possibly even partnering with people like a reoriented VHA team to build a regional “supply chain” of regional health services?

How about funding the regional system with the aggregated health budgets of all regional private and public employers and also the disbursements by regional CMS and state Medicaid?

How about a region-wide ACO structure that included a funds aggregation and episode or capitation disbursement function (possibly with FFS for diagnostics) to handle the above funds flows, using the administrative processing resources currently offered under contract by health insurance firms?

How about chartering the regional ACO body to move toward cross-silo, distance-enabled health teams that reach from hospitals to the walk-in centers so that people can check “yes” on a walk-in HIPAA screen to snap down a health recap from the Electronic Health Record (EHR) in the regional hospital infrastructure so the walk-in staff of MD-DDS supervised NP-PA-RN-PharmD-therapist pods can see in the health recap the morbidity profile and trended vitals-labs-meds, coupled with the ability to upload the results of the walk-in visit based on local event closing, networked upriver cross-silo tele-support, or upriver primary or hospital triage?

How about leveraging the walk-in infrastructure already forming mostly outside traditional hospitals by pharmacy-based retail health clinics (RHCs), and even more substantially by partnership franchises for urgent care centers (UCCs), community clinics (FQHCs), and employer-located front-line care facilities?

How about region-wide protocols coordinated through the regional ACO and regional health system for regional care coordination, patient navigation, meds management, and structured scalable care transitions for unit and organization transfers-discharges-followups involving any service areas within or between any regional health and wellness facilities?

The above notions are not to ignore the serious work fostered at the recent HIMSS13 conference.  However, exploring putting into motion regional health frameworks as sketched above seems the real meat and potatoes of a genuinely transformative and systemic patient-centered regional healthcare innovation process. In the most respectful way possible, I’d suggest asking if the current wave of activity is not mostly focused on optimizing islands of traditional physician-centered hospital and primary practice within the traditional health and intermediated funding infrastructure that costs too much and delivers too little.

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