By Matt Phillion
Today’s care coordination is often a manual and time-consuming process that depends on hard-copy patient lists, notes, and other physical documentation. Improving this state of affairs has historically involved throwing people at the problem—dedicating hours and staff to tasks like closing care gaps, securing referrals, placing follow-up calls, and more.
Even before the COVID-19 pandemic, those hours and people were a high-cost solution. Now, exacerbated by the pandemic, there’s a real lack of qualified people to dedicate to care coordination efforts. Loading up the few available employees with demands above and beyond their other job responsibilities can lead to dissatisfaction, stress, burnout, and increased opportunity for human error.
All of this can contribute to the worker shortage as burnout climbs and people abandon their careers for other pastures. And, needless to say, patient outcomes suffer massively.
The impact of the labor shortage “is a disaster, and it’s going to get worse,” says Robbie Hughes, CEO of Lumeon, which makes a care orchestration platform. “We have more demand for care than the ability to deliver. We have a staffing shortage that has been decades in the making.”
Not only do we face an aging workforce, Hughes says, but healthcare workers are at their wits’ end with the demands placed on them. And, he notes, there’s a recruitment and retention problem that isn’t going to be fixed just by looking at the numbers going into nursing colleges today.
“This idea that there’s a wave coming to replace the people leaving is not going to happen,” Hughes says. “It’s a profound and persistent shortage in the workforce, specifically in nursing but [also] among caregivers in general. And it’s not something money or pay can really fix—it’s going to be a generational problem, and it’s going to get worse.”
The U.S. is undergoing massive shifts that will likely have economic impacts on who pays for healthcare and how. “We end up with a compounding set of circumstances that could ultimately require a change in how we think about a social safety net,” says Hughes.
The messy reality of care delivery
A lot of care delivery is noble, and yet it’s highly variable in execution, says Hughes. It’s one thing for a doctor to make a diagnosis or treatment plan, but another for that plan to be successfully and reliably executed.
Hughes describes the challenge as a funnel. At the top of the funnel is identifying who needs care in the first place, in the middle is determining the correct care for each of those patients, and at the bottom is executing that care reliably and repeatably. Every job along the way has its own set of challenges.
When a patient presents to the ED or office, for example, “in a fee-for-service construct you can afford to apply more care than you need, as you’ll get paid. You can afford to be inefficient, and you’ll make more money,” says Hughes. “Historically this is managed through over-care.” But over-care only works if you have the people to throw at the problem. Otherwise, it simply exacerbates the issue.
“If you take out the ability to add a huge number of people to each of these problems, then each issue caused by failure to address the issue at one part of the funnel becomes a tax on the next part of the funnel through a remediation tax,” says Hughes. “If a patient presents on the care delivery side, and there’s a wait to be seen, if they’re coming in for surgery and have a three-month wait for that surgery, it won’t happen. They’ll leave. But the need won’t have gone away; it will likely have got worse.”
If over-applying care isn’t an option, the right answer is to provide the exact needed care for each patient. This becomes a quality problem, Hughes says. “Previously, you could get away with it by throwing more wood on the fire, but now irrespective of cost, you don’t have enough wood to do that,” he says. “At the bottom of the funnel you have the same problem. You’ve got to make sure only the right things are happening, because you don’t have the bodies to supply the excess.”
So how do we deliberately, specifically ensure the right patients are getting the right care at the right time when they need it? This is where care coordination is pivotal.
“The answer is to use algorithmic care coordination to proactively identify the patient, predict exactly what needs to happen, and use automation to ensure that this happens every single time,” says Hughes. “This is beyond the capability of mere mortals today, but it is possible using the right technology. And the effect is like magic: It creates a lift for the patient experience, quality, and safety unlike any single technology on its own. It creates harmony from discord.”
Breaking the problem into manageable silos
Many tools available today can help synthesize the story of a patient from the medical record. The challenge, Hughes says, is how to read the patient’s story in real time at the point of care.
“Say you’re coming in for surgery. There’s a chart review. What do I have on file for this patient? Typically, what will happen is you’ll get to the point where it’s taking so long to go fishing for what you need, it’s easier to repeat” items like previous tests, he says. “This is a symptom that creates more work, more over-care, but the bodies aren’t here to deliver it so you’ve created more demand on a team that isn’t there.”
Immediate synthesis is not easy, says Hughes. “Anyone can do it with enough time to churn through stuff, but that’s not good enough: What do I do right now? That’s the pinch point, and that’s what’s hard. And frankly there’s a lot of opportunity there. It’s not something where automation has traditionally excelled.”
Automation is great for revenue cycle and intake forms, but less so for determining a specific patient’s care needs, he says. It’s a problem that will persist “until you can solve the conundrum of data synthesis in real time to determine context and personalization.”
Lumeon defines quality as consistent decision-making and execution that allows providers to dynamically personalize care. An example: One customer identified a performance issue with a care team member. Using the Lumeon system, the organization was able to trace not only their staff’s overall productivity, but also where the staff were deviating from the organization’s standard of care. They were then able to have the conversation: Was this deviation making care better or worse?
“They saw it as an improvement and updated their best practices to drive performance improvement to where it needed to be,” says Hughes. “Time to competency goes down. We had a customer in the UK who had previously needed six weeks to onboard and got it down to four hours.”
Reinforcing the standard of care—and evolving it, when necessary—helps with another aspect of burnout and talent loss: It enables caregivers to practice at the top of their licenses by removing mundane tasks of care coordination. “It frankly enables them to do what they got into caregiving to do in the first place,” he says. “We want to make sure they have best practice care by default.”
The organization sets the standard of care, and caregivers are free to disagree but should have a good reason for doing so. However, if they follow the established standard of care, they’ll know they’re providing the right care by default.
“From a safety-netting perspective, that’s incredible,” says Hughes. “It’s not stopping people from thinking or making their own decisions. It’s giving them the safety net to know that the worst that can happen is the right thing for the patient. You may have a different opinion and that’s OK, but from a quality of care point of view, it’s a phenomenal place to be.”
Improved care coordination tools also surface the right information for the patient at the right time, eliminating the need to repeat tasks and tests in the name of efficiency. This wasn’t possible just a few years ago, Hughes says. Systems, electronic health records, and data collection have begun to catch up to the needs of the industry.
“It’s not disrupting the system of record. It’s respecting it for what it is and adding a layer on top to move your organization forward safely and proactively according to the standard of care you’re able to set,” Hughes says.
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at firstname.lastname@example.org.