Coordinated Care: It’s All About that Face

By , Former Chief Medical Officer and Vice President of Informatics and Analytics of Transcend Insights
Health IT

Coordinated Care: It’s All About that Face

By Thomas J. Van Gilder, MD, JD, MPH, chief medical officer and vice president of informatics and analytics

The 2015 Southern California State of Reform Health Policy Conference recently convened with the purpose of breaking down silos and fostering dialog across the full spectrum of care. During the conference, I was given the opportunity to speak in a panel discussion focused on delivering coordinated patient care. During the discussions, I noticed a common theme emerging around the fact that our patients are more than a number, each patient has a FACE. My biggest takeaway from the conference was simple: ‘face’. By ‘face’, I mean associating a specific individual with their care and care team, putting the individual at the center of care delivery; and creating and supporting face time between individuals and their care team…all critical components to improving population health.

Putting a Face on Care

During Bruce Goldberg’s keynote address and throughout the conference, the epicenter of discussion was around the importance of knowing the people you are trying to help and tailoring your solutions to meet their needs. In my years of outbreak investigations with the Centers for Disease Control and Prevention, I found the balance of public health measures and the individuals served to be quite challenging. While designing interventions that were scalable and sustainable for the future, focusing on the individuals first affected by a disease outbreak was critical to successful population health management. This is just one example where the individual should be at the center of the care we deliver and the care delivery systems we design.

Putting the Face in the Center

DaVita Health Care Partners℠’ Dr. Donald Rebhun focused on the importance of putting the individual at the center of care and the efforts necessary to design a more coordinated care system. In contrast to today’s disconnected, episodic, treatment-focused healthcare processes, we need to create a system that is connected, continuous and prevention-focused. To get there, we need to keep the individual at the center, and not just on the assembly line being acted upon. When caring for patients, I find it too easy to slip into thinking about my healthcare system and my role, rather than thinking about the system from an individual’s perspective. As described during this panel, a coordinated healthcare system needs the right technology, not just a complete solution, but a tool that helps physicians and other care team members keep the individual at the center of their care to deliver a more consistent and complete experience throughout the healthcare ecosystem.

Creating and Supporting Face Time

Technology is a wonderful tool that can help advance population health management and support coordinated care—but it is just a tool. Even effective tools can get in the way of our work sometimes. For example, electronic health records are remarkable tools but in their current form often interfere with the physician-patient relationship. In my own experience, I have found that my eyes can quickly become glued to the screen, looking for and entering in relevant information that will help with an individual’s care, but not meeting the gaze of my patient. A critical piece to a meaningful, clinical encounter is meeting face-to-face, not face-to-the-back of the head. Technology needs to create and support face time, not disrupt it. Health policy, with input from across the spectrum of care—from community and home health workers, to individual clinicians and other care teams—is necessary to develop and support coordinated care. Remembering the face of the individual being served, putting that face in the center of care delivery, and keeping personal encounters face-to-face are all critical elements of coordinated care. It really is all about that face.

How does your organization deliver coordinated patient care?