Navneet Sharda, MD, C.E.O of Accountable Care of Nevada discusses the hope and possibilities for future healthcare in Accountable Care Organizations

Published on Wed, Feb 26, 2014 (5:38 p.m.)

Submitted by ACCOUNTABLE CARE OF NEVADA

As physicians, we dedicate ourselves to searching for cures and perfecting procedures that will maintain and improve the health of our patients. Over the last 50 years, we’ve made some remarkable progress. We’ve reduced the death rate from heart disease by 32.5% with a better understanding of primary and secondary prevention and advances in treatment. We’ve made similar progress in cancer care with better treatment options through radiation therapy, surgery, chemotherapy, and genomics. We’ve changed an HIV to a manageable, chronic condition.
These truly excellent accomplishments in medicine have been life-changing for millions of people. But is excellent good enough?
While we have made great strides in clinical care, Americans are more obese, more medicated and more in debt than any other nation in the world. One-third of our nation’s total health-care spending, about $750 billion per year, is wasted on unnecessary treatments, redundant tests, and uncoordinated care, according to the Institute of Medicine. Health Care Reform will have limited impact on this waste. While the rate of increase of health care spending has slowed in recent years, the United States still spends 2.5 times more than most developed nations on health care. U.S. health care spending is on track to reach $4.8 trillion in 2021, almost 20% of our gross domestic product.
This trend is tearing the fabric of the American dream. The total cost of health care for an average family now exceeds $20,000 a year. Now it is at 18 percent of the GDP. These are investments health care have taken away from education, the environment, and infrastructure. This insidious drain has to stop, and the trajectory in health care needs to change. This is the hope of the Accountable Care Organization, which was created with the rather large fanfare as a means to allow groups of healthcare providers the freedom to determine the best care for the patients with limited government interference. Rather than causing disappointment, the ACOs have the possibility to become a positive enabler for a better life – physically, personally, socially, financially and psychologically. Dr. Navneet Sharda states, as Physicians, we need the will and the resolve to declare that excellent is not good enough.
For the last 100 years in the United States, health care health care has been centered around the doctor’s office and hospital. Physicians practiced with minimal support staff and were the major source of health related information and advice. The problems physicians faced could be solved using the knowledge and skills they acquired in medical school. Patients went to the doctor’s office for all information on their condition and for treatment. That has certainly changed with the introduction of the internet and corporatization of medicine.
Today, health care is much more complex. There are now more medical journals than physicians could possibly read or digest on their own. What physicians learned in medical school is no longer sufficient. Often, patients have extensive information about their diseases from Google searches and online patient communities. In these instances, physicians play an important role as a trusted source by helping patients interpret the information and providing proper context in relation to the patient specific health condition so that patients and physicians can make informed decisions together. The information age of medicine has arrived. Let’s try to encourage this to information and help our patients cut down on MISINFORMATION. In order to be effective with patients in the current environment, we must optimize the use of information, technology, and teams. We are turning mountains of patient data, science, and clinical evidence into clinical knowledge. Physicians and the patient care teams should have clinical decision and panel support tools that put the latest evidence at their fingertips, and assists them to provide personalized care to each patient. The new paradigm in healthcare is that Physicians are accountable for a population of patients, whether the patients come in to the office or not.
Physicians need to understand and accept that the sea change has come. We can influence and accomplish a lot more for our patients by working together as groups. We need talented people who have deep expertise in specialized areas and at the same time an understanding of the broader impact of their actions. We need to incorporate expertise from any source and accept the collective knowledge from medical practice, pharmaceuticals, medical research; as well as from information technology, economics, engineering and politics. We can’t ignore and bull through this sea change, we must learn to adapt. Health care is becoming a community that embraces measurement, comparison, acknowledgement, learning, and improvement.
Dr. Sharda Continues to say, as physicians, we have every intention and believe that we are providing the highest quality care to our patients. When we measure and compare our performance we can see if we are truly providing the best possible care or if there are gaps in our preventive care and treatments. Once we have the appropriate data, we will be able to rationally discuss with government our concerns about food additives, and pervasive advertising that almost demands ill health behaviors and together we can develop clinical guidelines, and resources to engage patients and encourage healthy habits. We’ll have proof in what we all know: that we as Physicians can only do so much, but health is a global process that the entire community needs to take ownership. We must have openness, courage and spirit of collaboration to achieve this. We must be willing to confront poor government policy and communicate on both a grassroots level as well as in the highest levels of government our findings. As physicians, we often hear about the latest breakthrough treatments or procedures, but we are much less likely to hear how limiting the sugar consumption in the average American diet would have on the population health. Articles such as the most recent JAMA publication (Feb 2014) needs to be interpreted to our individual patient populations as well as brought to the direct attention of our governmental representatives.
By building a coalition through legal instruments such as the accountable care organization, we can learn from challenges and successes across the health care industry. The knowledge that can transform the health of our patients is available. We need to become rapid learners through connectivity, openness, discipline, collaboration, and a sense of curiosity. Accountable care organizations are popping up everywhere, and their efforts are gaining momentum. I would heartily encourage any concerned health care provider to study their environment and determine how they can be the most effective in this brave new world.