07 May Scenario planning can help prepare your organization for the IT-driven future of health care
If the future of health care is moving away from an activity-based model to one that is based more on value and quality of care, then heath care executives need to start anticipating the future through scenario planning, says Thomas Handler, a research director at Gartner Inc.
The essence of the health care scenario is to identify two factors that will emerge over the next decade, and understand how health care automation will need to respond to those alternative futures, Handler told a gathering of health care officials at the Digital Healthcare Conference 2009 in Madison, Wisconsin on Wednesday.
“You have to be prepared for that which you can’t possibly prepare for,” Handler said. “Don’t get bogged down in asking ‘does it really make sense?’ The signposts will tell you.”
The goal of scenaric thinking is to be better prepared to sense and act. Scenario planners at Shell Oil accurately predicted the downfall of the Soviet Union, as one of the critical signposts they identified was the rise of Mikhail Gorbachev. Because Shell anticipated this major world event, they were poised to capitalize on it.
Looking at how things might look 10 years from now, Gartner chose two uncertainties: the ways health care providers are actually paid, looking at the current model of activity-based care versus a potential future value-based model. On the other axis, Gartner planners analyzed the degree to which the delivery of healthcare is freed from the constraints of physical proximity and is delivered virtually as opposed to face-to-face.
In the herky-jerk care scenario, care delivery is activity based and delivered in local, face-to-face encounters. Payment occurs based on activities, with no attention to longer term value, with patient interactions based on optimizing utilization and controlling service.
In the convenient care scenario, care delivery has become substantially virtual, but remains largely activity-based. Consumers benefit from many more ways to gain access to healthcare through the Internet and sophisticated IT initiatives. But the health care consumer must coordinate his or her interactions with multiple providers of care, with minimal information as to the quality of care provided.
With centered care, delivery of health care is value-based, but still bound by the physical proximity of the provider and patient. IT priorities under this scenario focus on enhancing and streamlining the clinician and patient experience so that clinicians can spend more time with patients, and also on consumer analytics to better understand patient wants and need.
In the continuous care scenario, care delivery becomes more virtual, and provider payment incentives are more value-based. Patients are no longer tied to local practitioners, because so much care is handled remotely, and patients can make more informed decisions because so much health care provider quality data is available. In this scenario, IT priorities include offloading most of the busy work of patient monitoring and first-level interactions, managing a steady flow of clinical and administrative events about consumers, and providing clinical decision support.
Moving toward a value based model
Handler says the signals coming out of the Obama administration suggest that the U.S. is edging toward a value-based model for health care, and away from activity-based care.
A single payer system is best suited for a valued-based model, as it is easier to prod clinicians into doing things, Handler said.
“In order to be a halfway decent doctor, one has to have a certain degree of arrogance,” Handler said. “No physician believes they need the clinical decision support, even if they do. There is no business training in medical school. If you are trying to create templates, the physicians say `I can’t do this because I have my offices expenses and I have to take care of 43 patients today.’ I think they are able to it – we need to prod them to look over the horizon.
“If we look at technology from the clinician’s point of view, you have to ask: Does this make my life better?” Handler said. “And, nine times out of ten, it doesn’t, and that’s the fundamental disconnect we have in this country.”
Going forward, Handler says there are three IT systems that every health care organization needs to have in place: computer-based patient record systems, electronic medical records, and business intelligence.
“Put those in your short-term strategic plan while looking to see what you can add on,” Handler said.
Asked what institutions are on the leading edge of using IT to enhance the delivery health care, Handler mentioned Kaiser, and locally, Aurora Health Care in southeast Wisconsin.
“I think that academic medical centers tend to spend on those things,” Handler said. “They are on the cutting edge of using those technologies, but I am not sure I would point to them as shining lights of what the future might hold.”
Every organization needs to be agile, and needs to take a look at what the future might hold a lot further out – as long as 15 years, Handler said. If health care organizations do scenario planning at all, it’s generally for five years, he added.
“We have to build organizations that are really looking forward, not just to the next quarter,” he said. “But how are we going to prepare for that future, even if it’s zig-zag path?”
While time consuming, Handler says scenario planning analysis can be used to help prepare for what is coming, even if future specific events are not yet clear.
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