I suspect any family
therapist reading this question would quickly say, "Yes, of course we add value
to health care”. From a health care
policy perspective value is not a simple intuitive concept. Value is quality divided by cost, and today
every health care system is focused on becoming value driven.
That the U.S. spends
way too much money on health care is well known. Our health outcomes place us low in the world
even though we spend twice as much or more on health care as other
industrialized countries. Our spending
is not sustainable, especially in Medicare with the influx of the Baby Boomer
generation. We have to figure out how to
spend less money.
|A new IOM report
indicates that we spend 700 billion dollars in health care every year that is
of no benefit to patient care. These
include unnecessary tests and procedures, overly expensive drugs when generics
would do fine, and excessive treatment, especially at the end of life. Rather than just squeeze this money out of
the system, the potential is here for transforming the system to provide value
– actually improve the quality of care while we reduce costs.||"The most important
of family therapists today
is to make the case for
being vital members of
PCMH practice teams."
technology makes much of value driven care possible. For the first time we can look at populations
of patients in detail and make proactive strategic decisions to improve their
health efficiently. Diabetic patients
who are well controlled are much less expensive than ones who are out of
control and develop complications. Through
internet applications, we can communicate and care for patients at minimal
costs compared with face-to-face visits.
So what role do
family therapists play in this? We know
that psychosocial problems are frequent in health care and usually are masked
by physical complaints. Addressing the
psychosocial problems early creates great efficiency rather than waiting until
every physical evaluation has been done, only to show the patient is "simply”
anxious or depressed. Yet this obvious
situation remains hidden from the strategic planning to too many health systems.
systems committed to becoming value-driven are joining the Accountable Care
Organization (ACO) movement. Developed
by the Centers for Medicare and Medicaid Services (CMS), an ACO is committed to
the Triple Aim:
1. Improving the individual experience of care
2. Improving the health of populations
3. Reducing the per capita costs of care for
Health systems know
the future of health care financing will be directly tied to achieving these
aims with their care, and information systems are able to measure it. At the patient care level, teams will operate
in ACOs using the principles of the Patient Centered Medical Home (PCMH). PCMH practices have advanced information and
communication technologies and are able to provide continuous access to strategic,
proactive care rather than the tradition of simply reacting to patient
appointments. Patients become activated
to play an active role in the own care, ordering desired tests and treatments,
according to accepted guidelines.
The most important
work of family therapists today is to make the case for being vital members of
PCMH practice teams. Working alongside
physicians, nurse practitioners, pharmacists and others, family therapists will
ensure that patients receive true biopsychosocial care from the beginning. Independent private practice is rapidly
becoming a thing of the past. Organized
and integrated health systems are the future.
Family therapists are not automatically included in this discussion in
most settings, so becoming knowledgeable about ACOs and PCMHs is critical
today. Assertive inclusion of family
therapists in demonstration projects around the country is needed to ensure the
proper composition of team practice in the future.
Reference for more
detail on ACOs, PCMHs and the Triple Aim:
Patterson J, Vakili S, Scherger JE.
Healthcare Policy in the United States: A Primer for Medical Family
Therapists. Comtemp Fam Ther (2012)
Joseph E. Scherger, M.D., M.P.H., is Vice President for
Primary Care & Academic Affairs at Eisenhower Medicine Center in Rancho
Mirage, California. Dr. Scherger is Clinical
Professor of Family Medicine at the University of California, San Diego School
of Medicine (UCSD), and at the Keck School of Medicine at the University of
Southern California (USC). Dr.
Scherger’s main focus is on the redesign of office practice using the tools of
information technology and quality improvement.