Parata's COVID-19 Response

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The Changing Model of Care

Part 4 of our Emerging Rx series

This eLearning series addresses the changing healthcare environment, the importance of technology as a tool to achieve improved care and efficiency, and the opportunities for pharmacists to play new strategic roles.

So far, we’ve discussed the challenges, gaps and missing factors in our traditional healthcare model. Last week, we stated that we have the resources and expertise to provide great patient care. We just need to address the gaps in the system.

Today, we’ll look at some emerging care models that aim to do just that.

Part 4: The Changing Model of Care

Spurred by the Affordable Care Act (ACA), the healthcare system is working towards coordinated, patient-centered care with a focus on value — not volume. Healthcare providers are creating models that bridge gaps in patient care, improve care coordination and use resources more appropriately.

In new models, care is centered around the patient. Patients are engaged, involved in decision making and have a say in their own care. And members of their care teams work together to improve their patients’ experience and outcomes.

The primary care physician, who develops a patient’s care plan, acts as the hub of the medical team. The physician shares information with other team members and should be easily accessible.

Information isn’t the only thing the team shares. In new models, team members also share risk. Every provider on the healthcare team has a gain or cost share. If the team, as a whole, meets established quality and cost goals, the team members share the savings. If the group falls short of those goals, the team members split the loss.

Many of these emerging “team” models are based on one of two strategies:

Consolidated Networks
In a consolidated network, a single system “owns” patient care. For example, Kaiser Permanente employs all members on a patient’s healthcare team — from doctors to surgeons to pharmacists. Patients stay in the same system for all their healthcare needs.

About 70 percent of hospitals are consolidated networks.

Collaborative Networks
This system involves smaller players who create informal, flexible relationships with other healthcare providers. They do not own other entities in their network, but they do share information with one another.

These powerful collaborations generally do not have contracts or risk and reward systems. They are community-based, tied to a local neighborhood, and founded on personal relationships and trust.

Consolidated and collaborative networks are different in structure but similar in concept. Both are about improving patient care and outcomes while lowering costs.

Next, we’ll look at why pharmacists are a critical part of an integrated patient care team. Check back next week for Part 5: The Emerging Role of the Pharmacist.

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