15 December 2015

Value-Based Care and Population Health: The Anesthesiologist’s Role

By Dr. Adam Blomberg, National Education Director, Anesthesiology Division

In a recent article in the Wall Street Journal, Geisinger Health System CEO David Feinberg shared some very useful insights into how his health system approaches population health. Chief among them were the importance of integrating care delivery with one's insurance plan and taking a data-driven approach to patient care. I agree with all of Dr. Feinberg's ideas in the article, but wanted to add one important point: in addition to integrating care delivery and insurance, hospitals must also better integrate their staff to ensure they're operating as efficiently as possible.

Dr. Adam Blomberg, National Education Director, Anesthesiology DivisionWhen it comes to care coordination, I would argue that overall, healthcare has a long way to go before we see a truly integrated healthcare delivery system. While many systems in the United States – such as Geisinger – are effectively integrated, there remains a critical disjoint between the different levels of care throughout most of the industry. Within the hospital, there are often dozens, if not hundreds of process flaws resulting in reduced coordination, rework, increased costs and reduced patient safety. While efforts have been made to address these issues at the department level, what is needed is a comprehensive evaluation of the community’s needs relative to the existing infrastructure. This appraisal is a key part of delivering value-based care and managing population health.

As value-based practices advance, a few core medical specialties (PCPs, hospitalists, intensivists, anesthesiologists, and others) will take the lead in coordinating patient care efforts across the continuum. In my experience, one of the most critical players in achieving this integration is the anesthesia team – and, in particular, their management of the perioperative process.

One universal opportunity for improvement is the preoperative testing process, including the multitude of moving parts involved in safely “clearing” a patient for surgery. Regardless of whether the patient is scheduled for elective (IP or OP) or emergency surgery, the provider must ensure that the patient is physically able to cope with the stress of anesthesia and invasive surgery. It is the duty of the anesthesia care team in coordiation with the surgeon and patients PCP to make the final decision – but in many cases, the methods they have for communicating this information to both patients and teammates are inadequate.

At Sheridan, we address this challenge using ClearPATh, our proprietary pre-admission testing framework. ClearPATh facilitates value-based care by helping anesthesiologists reduce or eliminate unnecessary testing, consultations and preoperative visits. Most importantly, it gives them the tools to coordinate all the aspects of patient care that they touch, which increases efficiency and frees up other OR resources. For example, PCPs spend less time coordinating with the hospital and anesthesia team, allowing them to see other patients; likewise, hospital providers are freed from performing numerous unnecessary evaluations to clear their patients for surgery.

If we think of the healthcare system as an assembly line, with each element contributing to end product (population health), we recognize that the details and incremental improvements matter at least as much as the overall strategy. Dr. Feinberg gets the big picture parts of value-based care right, but it's important to remember that the little details can matter just as much.

If you'd like to learn more about how Sheridan uses ClearPATh to help anesthesiologists at our partner hospitals deliver better care, check out this blog.

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