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How care pathway management is helping cut the cost of healthcare delivery

Robbie Hughes
Robbie Hughes, Chief Executive Officer, Lumeon

Despite being the most expensive in the world, the U.S. healthcare system consistently underperforms compared to value-based systems in Europe, including the UK. According to the latest report by The Commonwealth Fund, the U.S. ranks last among the 11 nations studied, fails to achieve better health outcomes, and is last or near last in access, efficiency, and equity.

The market shift in the U.S. to value-based care presents an opportunity for U.S. healthcare providers to significantly improve performance. By rewarding providers for improved results in terms of cost, quality, and outcome measures, patients will benefit from a better overall experience and providers will benefit from greater efficiency and cost savings.

The timing is right for the U.S. to move to a value-based system, so why are so many healthcare organizations delaying the move? Because the transition is expensive, requires an overhaul of a business model, and, in some instances, the fee-for-volume model is still a profitable option. While U.S. providers acknowledge that new IT implementations can be expensive and time consuming, they do recognize the return such investment can bring to the overall experience. In a recent survey which looked at patient and provider perspectives on healthcare experiences, 73 percent of U.S. providers believe overall patient experience is better and patient satisfaction is improved with the right technology.

Armed with the desire to improve the patient experience and transition to a new business model, Care Pathway Management (CPM) is one way U.S. providers can help expedite the transition to value-based care.

What is care pathway management?

Today, even the most automated of healthcare business processes are stitched together with people and paper. If you ask an organization about its patient pathways, most will tell you that the current pathways have evolved organically, often with heavy administrative costs. In an effort to better manage this, providers have implemented an EHR/EMR, but these systems are disparate and siloed, which results in increased administrative time and less face-to-face time with patients.

Using a care pathway approach, healthcare providers can automate administrative processes, personalize the care journey and create better experiences and outcomes for individuals. Traditionally, care pathways have focused only on the clinical side of a patient journey, but today’s care pathways must expand to integrate both clinical and administrative processes to get a complete view of the patient journey.

Care Pathway Management provides a single, real-time view of the entire patient journey from referral to outcome. It integrates clinical and administrative systems, and gives providers the ability to design and automate their own pathway rules, so that each patient is automatically progressed through their personal care journey based on their individual data.

For patients, this means they see the right doctor or specialist more quickly because their referral is tracked and triaged electronically. They never have to repeat information and can also manage appointments online. All stakeholders (including physicians, patients and other providers) can also be updated in real-time via text, email or web-portal. Administration is personalized, automatic, timely and accurate.

For providers, a CPM approach to healthcare delivery is:

  • Measurable – both in terms of efficiency and outcome
  • Predictable – demand is visible and can be anticipated
  • Controlled – variance is eliminated

Care pathway management helps ophthalmology group achieve 80 percent reduction in cost 

A UK provider of specialist eye care services who works with time-critical eye conditions such as glaucoma, leveraged CPM to reduce treatment and waiting times, and schedule and triage appointments efficiently.

The provider designs workflows that blend key clinical decisions with administration processes. Important clinical data is captured about each patient early in the process, either by administrators or via online forms filled in by patients. Smart workflow rules guide optometrists to move patients through an appropriate care pathway, automatically screening out those not suitable for scan and highlighting those at risk.

Leveraging a custom reviewer portal, diagnosis and necessary treatment is accelerated, allowing each patient’s diagnostic images to be reviewed remotely by senior ophthalmologists; the ophthalmologists’ time can be scheduled more effectively and the provider can leverage a wide network of senior professionals.

With CPM, the provider has reduced patient appointment times from 4 hours to 1 hour, reduced Ophthalmologist review time by 88 percent, and reduced treatment costs by 80 percent.

Looking forward

As providers continue the move to a value-based system, innovative approaches to improve the process will become key to success; however, providers will need to assess any new technologies to ensure that they are compatible with their current implementations. Care Pathway Management is one approach that healthcare providers can utilize in the immediate future to ensure that success.  

care pathway management, Qinec, value-based care