Thanks Dave for pointing me to this article.... we need more more more of this thinking.
A prevelent tone through US health systems is: "we can't deliver better healthcare until we start getting reimbursed for delivering better (not more) care". While I agree we need payment reform in a major way, this article and countless examples of high-performing health care systems in the US show that high quality, good experience, low cost health care can be delivered today--we only must learn from the systems that are doing it.
In our primary care "microsystem" world, similar common themes can be described from high-performing primary care practices. In the next few months, two reports are being issued that will profile these "best of" practices-- one funded by the RWJ and the other by ABIM Foundation. I will post them when they are available, and I hope everybody has a chance to note their own common themes. Of course, I'll give you a teaser below, borrowing language from Richard Bohmer's article:
1, Specification/planning: In the primary care of yesterday, any individual being seen by a PCP automatically gets slotted into a 15-minute face to face visit. Whether they are sick or healthy, old or young, in need of behavioral therapy or just here to get a form filled out. High-performing practices tailor primary care delivery to the needs of each individual or groups of individuals.
2. Infrastructure design: This category encompasses two large assets, non-clinical managers (http://primarycareprogress.org/groups/videos/29/101
) and team co-location. These two assets can not be understated; keep these in mind as you read about innovative practices.
3. Measurement and oversight: Data Data Data. More than collecting data... and then feeding back data... at each high-performing practice there is a "culture of data and quality improvement".
4. Self-study: I'll stray out of the US for a moment here, all the way to Jonkoping, Sweden. In this county in Sweden, there lives what is widely regarded as the best health care system in the world. One of the crucial tenents of this system is the Qulturum (http://www.lj.se/infopage.jsf?nodeId=31736
), essentially an innovator's think tank headquarters for quality improvement. I bring it up in regards to US primary care, because for high-performing primary care systems, the Qulturum has served as the model for "self-study" and even non-self study. Their full-time job is innovation and improvement... imagine if your system had that!
In summary: stay tuned for more on this front...