What Canada has in common with emerging U.S. care models

Dr. M. Turner Billingsley, chief medical officer, InterSystems CorporationThe American and Canadian healthcare systems share some challenges, including: communication and handoff gaps between providers, a clear need to reduce healthcare costs, a need to measure and improve outcomes, and meeting increasing consumer expectations. Two emerging care models in the U.S., and the technology to support them, present solutions that could be applicable to healthcare in Canada.The first is the patient-centred medical home (PCMH). The National Committee for Quality Assurance (NCQA) describes the PCMH as “a model of care that strengthens the physician-patient relationship by replacing episodic care with coordinated care and a long-term healing relationship,” The Patient Centered Primary Care Collaborative (a coalition of employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, clinicians and others) has established principles for PCMH that include a personal physician, physician-directed medical practice, whole-person orientation, coordination of care across the healthcare systems, enhanced access for patients, and payment models that recognize the added value provided to patients. NCQA has established a certification program for physicians and practices, and payers are creating payment models for PCMH. Substantial data supports the PCMH model, with demonstrated improvements in quality, patient satisfaction, costs and outcomes.The second model is the accountable care organization, which in many ways is an extension of the PCMH model across all settings of care. U.S. payers, notably the government payer CMS (Centers for Medicare and Medicaid Services), have begun to develop this model, which seeks to realign payments to healthcare providers and systems from a “fee-for-service” to an “outcome- based” model. This model requires accountable care organizations to provide comprehensive services to a defined population of patients. The concept includes both “shared risk” and “shared rewards” – rewarding organizations that provide the most cost-effective and highest quality care. In the CMS model, accountable care organizations must establish a legal structure, sign a minimum term agreement, and define processes by which they will promote evidence-based medicine.These care models point the way to cost-effective care improvement. But they require levels of information sharing and care coordination that is extremely difficult when care delivery is fragmented over different caregivers and locations. Even with electronic medical records, differences between systems may impede information aggregation, sharing, and analysis. InterSystems addresses these issues with a strategic healthcare informatics platform. A strategic platform is a unified system that can connect across the entire continuum of care to aggregate and normalize (make consistent) all patient data. It also has the power to analyze structured and unstructured data (such as in clinical notes) on a real-time basis to deliver meaning and insight for informed actions and for up-to-date feedback on care quality. This technology can also be used for sharing clinical results, secure messaging, direct provider-to-provider referrals (with appropriate sharing of patient data), and proactive identification and management of patients at high risk.View Turner Billingsley’s slidesListen to his presentationBack to index

What Canada has in common with emerging U.S. care models

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