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Patricia Montoya, MPA, BSN - Director New Mexico Coalition for Healthcare Value, HealthInsight has not set their biography yet

Uncertainty in Health Care: A Snapshot as of January 2017

Nurse with questions

With as much focus on effort and resources that have been spent in working to transform health care over the past decade, there has never been as much uncertainty about the direction that health care should go as there is right now: January 2017!

Tremendous strides have been made over the past decade with improved technology – adoption of electronic health records, creation of health information exchanges, implementation of all payer claims databases, widespread use of video visits, expansion of telehealth use, and development of new drugs that provide definitive relief for some diseases if not cures. In addition, health care coverage is more accessible than ever for those who have been uninsured – particularly those with pre-existing conditions.

Yet, we find that many health care professionals are very anxious right now. Hospitals are restructuring to provide less inpatient care while remaining a viable part of the delivery system. Ambulatory care providers are dealing with staffing shortages while working to provide care to more people, developing team-centered care, and adapting to new payment systems. Public health is struggling to find its path in the midst of all the change and contending with, in most states, reduced funding. These are only a few examples of the complexity of transforming the health care system. The implementation of electronic health records across delivery systems has supported and encouraged more comprehensive and coordinated care; however, this hasn't been the panacea that everyone thought it would be. Even with the implementation of the technology, we have not seen widespread improvements in the quality of health outcomes, although this is moving in the right direction. We have spoken about transparency regarding quality and cost, yet we are only just beginning that journey in most markets to achieve the Triple Aim of improved care in a more efficient manner, with better outcomes and lower costs.

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Complexity Theory of Fixing Health Care

Nurses

When I speak to students I relay the story of graduating from nursing school in the mid-70's and the faculty telling us we were going into a new health care system, it had been fixed-managed care was the answer. Well now 40+ years later I am saying my career has been focused on improving and fixing health care, and guess what we are not there yet!! Don't get me wrong - we have improved longevity in this country, improved diagnostics, technology and treatment, and yes we may even be closer to finding a cure for those long unsolved diseases such as cancer and Hepatitis C. However, this has all come at a cost without evaluating and redirecting the money flow within the health care system. I guess now the question should be will it ever be fixed? At this point I would say no, it will never be totally fixed, we may come up with solutions and address some of the problems but health care is such a dynamic environment and continues to evolve that, quite frankly, I believe we should look at it as a journey rather than a problem to be solved. So pack your bag and be prepared for the long journey (depending on where you are in your career)!

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Identifying the Tipping Point and Meeting Stakeholders Where They are is Critical to Success

Handshake

People have been asking me what the catalyst or tipping point was that motivated the employers in our community to lead and establish the New Mexico Coalition for Healthcare Value, the new employer led multi-stakeholder organization. I have given the question much thought and I believe it has to do with collaborative leadership, creating community ownership and meeting stakeholders where they are. Let me be clear this takes time and does not happen overnight. The other major ingredient I believe, is to provide something that stakeholders find of value, something that helps them, as we call it "the value add" and can also be seen as meeting them where we are.

Now don't get me wrong, there is no doubt we wouldn't have had the success of being able to transition to the new organization without having had another critical ingredient , a strong backbone organization; in our case that organization was HealthInsight, who was working on the Robert Wood Johnson Foundation (RWJF) Aligning Force for Quality Initiative (AF4Q) at the time. Having the backbone organization allowed us to move quickly in the early days of the AF4Q initiative, which allowed us to focus on the task at hand instead of focusing on building or sustaining the organization in the very beginning. We were able to focus on the initiatives, show some early positive results, and that success then provided the synergy and energy for moving ahead at full speed. This also created a sense of pride and success from which we were able to build. HealthInsight was necessary to incubate, grow and nourish the community collaborative, much as we do our children, but ultimately there comes a time when they are ready to leave the nest and go out on their own. I think the role of a backbone organization is critical but we must also keep in mind that if we are successful, those collaboratives or initiatives will take on a new life and eventually move out of the umbrella of the backbone organization. This is an especially critical concept to understand both for funders, as well as for the backbone organizations. To be successful there is also a need for a long-term strategic vision and committing for the long-term in initial funding, in order to allow the foundational work to be done and supported.

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The Importance of Transparency in Health Care

Stethoscope with money

Imagine yourself in a supermarket, under some considerable distress. You are hosting a big party and you have waited until the last minute to stock up on the necessary provisions. You find yourself in the middle of a long aisle with half a dozen shelves on each side, stacked with hundreds of nondescript goods. Unlike a typical grocery, there are no labels; you are unable to compare the quality of products. Even more troubling, the prices are nowhere to be found.

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Value-Based Purchasing: Why Does it Matter?

Doctor with Patient

The increase in costs of health insurance benefits has progressively impacted the bottom line of employers, and poor health care quality impacts employee health and productivity. Employers are seeing that they can have a more significant impact on their bottom line when they engage in what is happening in health care today.

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Partners in Health Care Transformation: The New Frontier

Collaboration

As we navigate the highways of health care transformation, it has become increasingly apparent that a critical stakeholder we need to engage more fully in this work is the employer community. We have had many employers in New Mexico involved in the Chamber of Commerce or the Association of Commerce and Industry, but these organizations were not meeting their needs as major health care purchasers.

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Regional Health Collaboratives Are Key to Healthcare Transformation

iStock 000003937940MediumEven though health policy may be set at the national level, health care is provided and received at the local level. Every community and region across the United States has a different culture, different values, different needs, and different strengths and resources. Each geographic area has different ways of getting things done due to the various business strategies and politics that influence how things work (or don’t work), diverse approaches to operationalization, and disparate resources. To make an impact at the local level, there must be an all-inclusive and neutral group that understands the local culture, can work with systems in place, and leverage relationships to make positive changes in the local health care system. This is where regional health collaboratives play a critical role across the country to implement and execute health care transformation at a local level.

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