OPINION -- All of us and everything around us simultaneously participate in many networks and systems. Technology has extended what we refer to as a system, but the idea of connecting people, tools and resources to achieve a purpose is ancient. The system’s anatomy is its network of elements and interconnections. Managing the network to achieve its goals means aligning decisions and actions to its purpose.
The current traditional management paradigm in healthcare naturally wants its networks to provide stability and control. In an industrial environment, this is the path to consistent and better process leading to high quality and low cost. If healthcare were building Toyotas, we would already be home.
Our problem is that healthcare is a Complex environment with a dynamic and unknowable variety of circumstances to deal with. It is never stable. As earlier articles in this series illustrated, managing a complex environment needs a system as adaptable as the environment in which it operates.
The productivity and scalability of the Internet – which is a complex distributed network - stands in stark contrast to Healthcare’s centralized control based networks. Understanding and implementing the lessons of distributed networks will help us move from traditional centers of control to responsive self-organizing systems.
Four goals for a new healthcare delivery system
- Adaptability that keeps pace with the environment it serves.
- Self-organizing behavior that solves problems
- Distributed cognition and the development of collective intelligence
- A platform for financially sustainable insurance and business models
A very high level overview of a new kind of clinical network
The network follows a distributed model. This means no central point of rigid command and control is required Rather, network management involves adjusting underlying system parameters to ensure the system acieves its purpose. The actual network structure will adapt to need and opportunity.
The network is open to all healthcare services that contribute to the purpose of heathcare in ways that are measurable at the point of care and accept the system’s rules and constraints. This includes a wide variety of service providers such as hospitals and other institutions, insurers and other payers, clinics, independent practioners, care management organizations, digital service providers, decision support, standards organizations, clinical research and more.
The system and network are defined and bounded by purpose. Unlike the internet where freedom far exceeds responsibility, this network is defined by responsibility and freedom is allowed as it serves the system’s purpose.
Purpose is measured as outcomes within a specific clinical context and cost delivered at the point of care. Specialized clinical languages and network protocols will produce and capture adaptive solutions that deliver higher quality and lower cost.
Value is delivered and measured at the point of care. Network service providers are part of the supply chain that supports the point of care. Their value depends on actual results.
There are no standard metrics to align. The clinical languages used for protocols also define outcomes, process, and the basis for real-time outcome based analytics. These validate evidence based practices to actual experience. This allows innovation to happen anywhere and to reconcile that innovation and outcomes to national benchmarks.
This will open new opportunities and markets. Because the point of care has full access to the entire network, success --- whether cost reduction or quality improvement --- will spread rapidly. This is a new model that yields continuous learning, better approaches and accelerated innvoation.
Payment is based on outcomes, not process or simple coverage. There is a transition period but little by little, the paradigm will change to favor payment for outcomes at the point of care. Payments for the supply chain will also be modified based on the ability to deliver why healthcare exists in the first place.
Payment based on outcome opens the door to new business and insurance models. These will provide a sustainable healthcare delivery system.
This article described a new delivery system model. The details of how this is accomplished will be available from Curandi. This delivery system model is the platform necessary for new insurance and business models that create new value and bring sustainability to healthcare. We’ll describe those insurance and business models in the next article in this series.
This article is the third in a five-part series about a new model for sustainable healthcare delivery. The last article “Ashby’s law and the first step to affordable healthcare” explained why we need delivery networks as adaptable as delivery’s environment.
Dr. Rohwer is a founder and former CEO of PH Tech. He is the current Executive Director of Curandi, a not-for-profit organization working to heal healthcare. He can be reached at [email protected].
