Our goal is to shift the business model from reactive sick care to preventive well care. Let's layer prevention with healthcare delivery outside of the hospital. Let's focus on providing integrated outpatient care to keep our patients out of the hospital.
Since 1996, Akron General has offered innovative outpatient services through a Health & Wellness Center model, which incorporates integrated outpatient clinical care, prevention and rehabilitation. At the three Health & Wellness Centers, patients have access to 24-hour, free-standing emergency rooms, ambulatory surgery, radiology, cardiac and pulmonary testing, sleep centers, intensive outpatient psychiatry and lab services.
The convenience of comprehensive outpatient centers is attractive to both patients and their physicians. At our Health & Wellness Centers, patients have access to the full spectrum of care from acute treatment in the emergency room, to surgery in the ambulatory surgical center, and, finally, to post-operative care in a short-term observation bed. Take the case of a 48-year-old woman who came into one of the Centers at 4:30 a.m. with appendicitis. Within three hours, a surgeon was on-site to performing a laparoscopic appendectomy. Following her surgery, the patient remained in the same Center recovering for four hours in a short-term observation bed before being discharged. She never left the Center.
"That is the way health care should be delivered. She never touched a hospital bed. The cost of that treatment, which could be done at a hospital, was a fourth of what it would have cost us at Akron General to do that at the Medical Center. But it takes 10 of those outpatient procedures to pay for the same procedure if it was done as an inpatient, and that is completely upside down," said Akron General CEO Dr. Thomas "Tim" Stover.
Continued integration of higher acuity outpatient services, like that of an emergency room and operating room, will become the trend as our population ages and providers – both insurers and practitioners – are forced to rethink payment and find creative ways to offer effective, value-driven healthcare.
Changing the Business Model
Unfortunately today, physicians are paid according to the sick care model, rather than the well care model, which means that their days are often filled with back-to-back appointments that only focus on the problem at hand – a cold, the flu or a virus.
"Akron General pioneered the health and wellness concept in northeast Ohio and we know from experience that wellness is not just about cost savings – it's about a better quality of life. But under the current healthcare system, acute sick care is where the money goes. And by the way, it's a lot of money – 14 percent potentially of our GDP," Dr. Stover said.
In order to shift to well care, Primary Care Physicians should have the opportunity to schedule wellness visits with their patients, instead of only seeing patients when they are sick. Wellness visits create the opportunity for education and collaboration between patients and their physicians that focuses on the patient’s overall wellness and lifestyle.
"The key difference in my mind is the difference between the sick care model and the well care model. I'm going to show you at the end of the day the wellness model is the only one that makes sense. It's the best way to hold down healthcare costs to keep people out of the hospital… I should be teaching my patients every day how to stay away from me. The problem is that we don’t have time to do that, and I’m going to tell you why."
To encourage wellness visits, healthcare payers should provide an incentive to those physicians for keeping patients out of the hospital.
"The biggest challenge is a transition from a volume-based healthcare system – from the sick care model to a well care model and that’s the take-away here today. Those who pay for and regulate healthcare must also shift their thinking and revise their own business model. They have to provide incentives to allow primary care physicians to help keep people well," Dr. Stover said.
The future of health care depends on how we choose to approach the problem. Can we be part of the solution?