Fostering Rapid Advances in Health Care Learning from System Demonstrations (2003) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-16
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The committee is recommending a substantial portfolio of demonstration projects: 10-12 chronic care demonstrations, a primary care demonstration with 40 participating sites, 8-10 information and communications technology infrastructure demonstrations, 3-5 state health insurance coverage demonstrations, and 4-5 state liability demonstrations. As a set the demonstrations address key aspects of the health care delivery system and the financing and legal environment in which health care is provided.
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. Many insurance programs fait to provide coverage for services that are critical to the care of the chronically ill, such as outpatient prescription drugs, patient education and support services, and interactions between health professionals and patients via e-mail and telephone (Anderson and Knickman, 200 lb)
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The committee also believes that special attention should be focused on building stronger information and communications technology (ICT) infrastructures to support care delivery and many other important priorities, such as bioterrorism surveillance, public health, and research (Institute of Medicine, 2001b, 20026; National Research Council, 2000~.
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policy makers Broad base of support Recognizes and addresses barriers Builds on existing competencies ~1 1~ Chronic Care: Reducing the Toll of Chronic Conditions Demonstration projects in this category are intended to improve the quality of care provided to the chronically ill and to reduce the burden of disease and disability in a community. Nav~gatBOX ES-2 Five Categories of Demonstrations Chronic Care: Reducing the Toll of Chronic Conditions on Individuals and Communities Primary Care: 40 Stellar Community Health Centers Information and Communications Technology Infrastructure: A "Paperless" Health Care System State Health Insurance: Making Affordable Coverage Available to All Americans Liability: Patient-Centered and Safety-Focused, Nonjudicial Compensation
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, chronic care registries, and medication order entry systems. Benefits, Copayments, Provider Payments, anal Accountabili~Demonstration sites should be given the flexibility under Medicare and other insurance programs to innovate in such areas as benefits coverage, beneficiary copayments, provider payments, and accountability.
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~ B Implement new morels of care ~le1tivery Demonstration sites would be encouraged to experiment with systemic approaches to care delivery that would make use of interdisciplinary teams, ICT support, enhanced communication, lay health workers, new roles for patients and their families, and enhanced coordination across other health care settings and with social and other community-based services (e.g., mental health, housing, education and training, and employment)
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: . In the area of safety, the availability of computer-based clinical information at the time of care delivery, together with clinical decision support systems, such as those for medication order entry, can prevent many errors from occurring (Bates et al., 1997, 199S, 1999)
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Health care providers should commit to making the necessary financial investments in support of ongoing maintenance and enhancement of the ICT infrastructure, and to redesigning care processes to take maximal advantage of this infrastructure. Public and private purchasers should offer the appropriate financial incentives to encourage and reward providers for making ongoing investments in ICT (e.g., higher feefor-service payments or reduced regulatory burden for providers with computer-based records)
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Demonstration projects should be 10 years in duration. DHHS would need to make this extended commitment to encourage states to undertake the very significant efforts envisioned in the areas of building public-private partnerships, developing ICT infrastructure, and redesigning public insurance programs.
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This approach would replace the existing tort liability system with an alternative system for compensating patients who have experienced avoidable injures, allow quicker payments to be made to many more injured patients, and reward providers who put effective programs in place to reduce medical .
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Communities that are currently more advanced in terms of ICT infrastructure might be ideal locations for multiple demonstrations, such as a hybrid demonstration encompassing the chronic care and uninsured categories, aimed at establishing highly effective e-health rechanneling these resources to cover the uninsured. The committee envisions that by 2005, the nation should have instituted the first generation of 2ISt-century community health systems, and by the end of the decade, should have made a decisive advance in reinventing health care delivery.
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As noted, the benefit and payment policies of many health insurance programs fait to recognize and provide compensation for various e-hearth delivery modes (e.g., e-visits, e-consultations, remote monitoring of intensive care units)
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Profound cultural changes are necessary to allow patients to play as active a role in treatment decisions as they desire and to engage in effective self-management of chronic conditions. Such involvement will require a supportive environment—one that offers ready access to reliable and understandable sources of cTinical knowledge and actively encourages health literacy by providing relevant information to patients (e.g., a primary care practice that forwards the most up-to-date information on practice guidelines, medication options and risks, and self-management to its patients with asthma)
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1998. Effect of Computerized Physician Order Entry and a Team Intervention on Prevention of Serious Medication Errors.
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11, 2002 . Insurance Crisis Hits Nursing Homes / Spiraling Costs Push Texas Facilities to Drop Liability Coverage.
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2002. Does National Regulatory Mandate of Provider Order Entry Portend Greater Benefit Than Risk for Health Care Delivery?
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