By Thomas Rosenthal
Health care has been, for too long, fragmented and uncoordinated. Many would agree that it is duplicative, uneven and wasteful and has paid little attention to the patient experience.
As medicine has increased its ability to manage chronic diseases, the doctor-patient relationship has become a partnership spanning years. Diabetes, for example, requires monitoring and adjustments best accomplished in the context of a team that includes the patient, physician, diabetic teaching nurse, dietician, trainer and family, executed over the patient’s life.
Many Western New York health care providers, including Kaleida Health and the new Optimum Physician Alliance, are implementing programs that put the patient at the center of a supportive care system.
The February 2013 issue of Health Affairs described several initiatives that have successfully adjusted the behaviors of physicians, patients, hospitals and health plans based on the best scientific evidence, physician opinion and patient values, beliefs and preferences.
When faced with a new medical problem, some patients quickly and fully engage in the adjustments required to regain health. However, some patients get stuck in denial. They may not understand alternatives or they may not see value in changing behaviors. Patients are unlikely to change if they feel their preferences and perspectives are not respected. Support, education and encouragement need to be added to the technology of health care.
On the physician side, concerns about frightening patients can result in patients receiving incomplete information. Time pressure can falsely suggest that an immediate decision is required or that the physician’s treatment preference is the only option.
The next model of health care must be a dynamic collaboration between a proactive, integrated health care team working in an effective system with activate and engaged patients. Quality health care requires an intense focus on the patient, an informed and active participant in the care.
The Optimum Physician Alliance and other evolving models embrace the inclusion of a nurse case manager with time and resources to address the barriers unique to each patient. Certified nurse case managers provide personalized coaching, address psychosocial and medical barriers and assure open channels of communication.
As science has increased the availability of treatments, we physicians have allowed the personal “hand holding” side of medicine to diminish. Health reform in our region is proactively re-creating hands, in fact a team of hands, to engage the patient as an active and informed health care recipient. We welcome this type of reform and encourage patients to embrace this new model.
Thomas Rosenthal, M.D., is chief medical executive of the Optimum Physician Alliance.