At the joint conference of State Associations of Addiction Services (SAAS) and the quality improvement collaborative NIATx in Boston this week, Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement (IHI), told attendees that they need to stop looking at the problems in the healthcare system "only through the lens of their own specialty."
"Now is the time to put our patients and our communities back together," Bisognano said. "There are different ways to think about health and healthcare to close the gap in quality. And when you put the pieces together, you help put the patient together."
An important part of the process involves engaging patients in making key decisions—what she calls "turning over power to the patients" to introduce new avenues to save money and help patients realize "how full and complete their lives can be."
However, Bisognano realizes that there are significant challenges ahead, pointing to six goals in primary care that include making it: safe, effective, patient-centered, timely, efficient, and equitable.
"Many [providers] feel as though strategy is 'coming at them' and they're trying to make sense of it all," she said. "They feel like all these things are happening to them, and they are forced to respond in this chaotic environment."
But, what choices do we have? Do these challenges boil down to cutting costs and rationing care? In fact, Bisognano offers a better solution—one that involves "rethinking the design” of the entire system.
Using several personal examples—ranging from what a disabled patient has to do to replace a flat tire on their wheelchair, to a dialysis unit where patients have been trained to perform the procedure themselves—she explained how the healthcare system is capable of producing "better outcomes with less." That is, "if we do it a different way," she says.
Referring to a "Triple Aim" approach, which includes the health of the population, the experience of care, and the per capita cost, Bisognano said we not only need to understand the per capita cost, but also the cost of each patient's care—additional factors that add to the burden of cost.
This can be as simple as understanding patient preferences and implementing changes in care that reflect them, which Bisognano says can be an important piece in the journey to improve outcomes, as well as a driver to reducing costs.
To be able to start putting the pieces together, the first step is simple, yet at the same time incredibly difficult—to get everyone to think about health in a different way.
"It's going to be challenging," Bisognano said as her presentation drew to a close.
"It's going to take courage, and new leadership skills. We'll need new care models, new business models, new ways of thinking about what equity means, and new discussions about how we all work together."
But, she said before leaving the stage, "I know we can do it."