CAH Blueprint for Performance Excellence

Kami Norland, Community Specialist II

I have the privilege of traveling across the country to visit critical access hospitals (CAHs) serving as the Community Specialist for The Center. Through my adventures, I have observed how CAHs face the challenges of being successful in the current payment system, while preparing for the new value-based payment structure, all the while striving to achieve the Triple Aim of,  “better care, better health, at a lower cost”. Managing the complexities of these changes is not easy, so The Center assembled national rural hospital experts in a Summit meeting this past June to begin the creations of a CAH Blueprint for Performance Excellence modeled after Baldrige, which is a comprehensive systems-based management framework.

This CAH Blueprint for PerformanceExcellence includes critical success factors in the seven Baldrige components and outlines how each component is inter-linked: 

Use of a systems-based performance excellence framework, as such, provides CAHs with a formula for not only achieving sustainability in this rapidly changing health care environment, but it enables facilities to flourish when meaningful work is accomplished in each of the seven components. As one Summit participant noted, “There is no cohesive vision of what a future rural hospital needs to look like. We are in a perfect storm. We can’t go back, but we can’t go forward by staying the same.” It is important that CAH leaders begin to identify the key strategies necessary to bridge the gap between where they are presently and where they will need to be in a value-based health care system. The Blueprint can help do just that.Challenges and strategies faced by CAHs are also identified in this Blueprint, acknowledging that as a rural hospital leader, you may feel daunted or overwhelmed in keeping up with all of the ongoing changes, but do note that this Blueprint and The Center are here to support your transition in achieving the Triple Aim.

Can We Make Personalized Medicine...More Personal?

Personalized medicine (PM) is in vogue.  As discussed in Eric Topol's book, The Creative Destruction of Medicine, most use PM  interchangeably with designer drugs.  However, these customized drugs are expected to based on your genetic code, and presumed to more effectively treat cancer and other chronic conditions with fewer side effects.    

I support this approach.  Today drugs are made for the masses.  They are not the most efficacious, nor the least risky.  But they can treat most people most of the time. Limited risk allowing allows for a scalable go to market strategy.  However, custom drugs are not the same as risk free drugs.  There is no free lunch in life, and healthcare.  Complications will continue even with the most tailored therapies.  In some sense, PM is just another expression of medicine "American style," suggesting if you throw enough technology at a problem, the problem will go away- if only.

Another version of PM looks to measure the patient.  Though a series of devices, from Fitbit to blue tooth scales for obesity and heart conditions, the "quantified self" can learn, change and improve.  Customized intervention is presumed to follow.  Except for a few medical conditions (CHF and COPD, ...not diabetes), this approach has not been a viable business model.  Most of the devices have been relegated to the Super-fit, a small, selected and (to most of us more sedentary) annoying sub-population of triathletes and overall smiley do gooders.  The market is largely based on income for luxuries rather than related to healthcare.  I have always been surprised how one biometric, well-being, has largely been ignored.  How the person feels (are they in pain, are they depressed) could be gathered via texting or automated phone calls.  These issues have as much to do with health and long term value as blood pressure or weight.

Ultimately, truly personalized medicine requires the patient (or even better, the person), to make a choice about their care.  Today, choice is visibly absent.  A risky and painful therapy may be right for someone wanting to see their daughter wedding, but completely wrong for another.    Even codified issues of medical consent remain murky.  Before surgery, how many of us truly understand are options and the predicted outcome of each choice?  Most physicians have typically arrived at a decision before offering consent.  The process becomes more of a legal requirement rather than an opportunity for choice.  These small decisions lead to an unintended destinations so pervasive in healthcare. Patient satisfaction suffers, while simultaneously utilization increases with little perceived value.

The dialogue around personalized healthcare is needed.  However, let's not make it simply an extension of the current techno-medicine culture.  There will always be pain and suffering- and ultimately (say it ain't so in America) death.  To truly personalize medicine, a relevant discussion about the risks and benefits of every drug, every surgery, every choice would put the "P" in PM.