CAP Releases Delivery System Reform Blueprint
By Josh Seidman | Popularity: 100%The Center for American Progress (CAP) released a new “Blueprint for Reform” that focuses on how to fix the delivery system. This well-constructed document and provocative forum was spearheaded by CAP CEO John Podesta (former Clinton White House Chief of Staff) and Jeanne Lambrew.
There are a few things that really show good progress in the national debate. First, the fact that CAP has chosen this critical time at the precipice of the national health care reform debate to focus attention on reforming care as well as coverage will be helpful to facilitating that discussion in 2009 policy debates (they, of course, support coverage initiatives as well but those aren’t addressed in this document).
Second, the quality and thougtfulness of the work and recommendations is high. Not surprising given the exceptional collection of authors with each chapter co-authored by a physician and a policy expert. These include: Don Berwick, Tom Lee, Judy Hibbard, David Blumenthal, Bob Berenson, Paul Ginsberg, Steve Schroeder, Dora Hughes, Chiquita Brooks-LaSure, Karen Davenport, and Katherine Hayes.
Finally, it was encouraging that CAP identified patient activation/second-generation consumer engagement as one of the six domains (chapters) that must be addressed in a reformed delivery system. The authors define second-generation consumerism as “engaging and activating patients to better manage their health,” which represents an important step beyond just throwing information at them and making them financially accountable for their health care spending–which, as the authors point out, research has shown doesn’t really accomplish the things we want.
What I would like to see CAP do more of in the future is better integrate that patient activation component into the infrastructure section (not surprisingly, much of what the IxCenter works on). To be specific, many of the opportunities for engaging and activating patients need to be better embedded into the health care delivery system infrastructure. That means not just giving consumers access to personal health data via electronic tools, but actually creating them in such a way that they allow consumers to engage and enhance activation.
Hopefully, that detail can be built into future CAP work and next year’s health care reform debate.
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November 4th, 2008 at 1:47 pm
Thanks for covering this and advocating for IT tools that reflect consumer engagement and activation.
It is interesting that Hibbards work around the stages of patient activation seem to mirror the transition we are seeing in HIT. As we move from a focus on data delivery to information sharing through knowledge into behavior change at the individual and community level we are starting to see this same evolution in the tools and more importantly the health care culture.
The first PHR’s gave patients a simple limited view of their data (labs, etc); some leaders like Group Health Cooperative in Seattle recognized the value very early of an exchange of information and provided patients will full online access to their providers that allowed them to create shared knowledge. Now in Health 2.0 we are seeing the addition of community but we are still determining which factors contribute to behavior change .
Much of the innovation in Health 2.0 eco-sphere occurs on the boundary between the sharing of information and the creation of community but I often still hear the PHR referred to as a static Personal Health “Record”. The physical infrastructure and tools (PHR’s, twitter, social networking) we create (versus give) consumers will be secondary to the cultural change that those tools will help being about.
A PHR was originally a “personal health record” that held data. That evolved into a “portal health record” that allowed us to share information with providers and then into a “personalized health community” to collaboratively create knowledge. What I would advocate that some consumers really want is a “personalized health relationship” and the tools (IT, community, shared values) to obtain it.
I assume that there will be a physical infrastructure that supports how we store, move, and collect the data, that is appropriate to our individual levels of activation but it will be a shared set of values and policies that will allow us to transform that data, and information into knowledge and finally behavior change that result in healthy outcomes and lives.
We don’t want to simply be partners who participate in the outcomes but co-creators (with providers as our subject matter experts) in the “system of care of our health” (vs health care system) itself.
Sherry
November 5th, 2008 at 5:57 pm
The goal of information therapy is to keep the consumer front and center by providing the right information to the right person at the right time. Part of the beauty of intersection between Health 2.0 and information therapy is that consumers are able to align themselves within streams of information relevant to their condition or health concern, as well as further align themselves with others who are at the same moment in care as they are.
I agree that consumers need to co-create their health care experiences. It is true that the consumer, not the system, actually drives change.
One of the challenges is that the traditional health care system is driven by incentives that are not in tune with what consumers want or need. One of the goals of the Center for Information Therapy is to build patient-centered health information standards into the existing health care infrastructure.
At the same time, the Health 2.0 movement is gaining ground and possible US health care reform is around the corner. As a matter of fact, the next Health 2.0 conference will be a joint conference between Health 2.0 and the Center for Information Therapy. The conference will explore the relationship and overlap between the Health 2.0 and information therapy movements.
Can Health 2.0 be built into existing care delivery systems? Can the potential of Health 2.0 be maximized without traditional care delivery structures? How does information therapy help bridge the gap between existing systems, the Health 2.0 movement, and the current health care system?
These are questions we hope to answer on April 22 and 23, 2009 in Boston.