Jason Helgerson, former director of New York State's Medicaid programme, explores four key factors needed to move the dial on collaboration across health and social care.
Collaboration. On both sides of the Atlantic, health and social care providers are trying to collaborate. The idea is very simple – if providers work well together, they can improve the health and social care experience for patients and help ensure they get the care they need in the most cost-effective setting possible.
As the theory goes, collaboration leads to a true ‘win-win’, with patients getting better care and unnecessary healthcare cost being avoided. Simple, right?
While our systems are different, both our countries face similar challenges. We are both ‘siloed’, which means that patients with mental and physical challenges vex us because we still don’t see the whole needs of people. In addition, neither of us spends near enough to address the true cause of many patient problems – the social determinants of health. While we are different, we share many similar traits and hence our mutual desire for more collaboration.
Various versions of collaboration are being tried across the US and within the NHS in England. While we may use different acronyms – ACO, ACS, PPS, CCO, IDS, etc – each attempt at collaboration is rooted in the same theory of action that collaboration will produce the win-win. While it’s easy in theory, it’s much more challenging to implement in real-world settings around the world.
In New York, we are in the fourth year of the journey toward collaboration. Many lessons have been learned as over 90,000 providers from across the state have formed into 25 collaboratives we call ‘Performing Provider Systems’ (PPS). Overall, the state is showing measurable improvement in key metrics, with the state passing four key milestones at the end of year three. It is reassuring to see that collaboration can work in a place as large and diverse as New York.
While the state as a whole is achieving, each PPS has had its own journey and in my past and current roles, I have had an opportunity to both observe and help these innovators struggle and succeed in their efforts to achieve true collaboration. I think we are now far enough down the road that it’s time to seriously consider how to build off the successes of the recent past and begin the move to what I am now calling ‘Collaboration 2.0’.
In the first wave, collaboration providers grappled with some very challenging issues. They had to decide who to partner with and how to govern themselves once they picked partners. Next, they had to decide what they would do differently, so at to ensure different outcomes. Next, they had to figure out how to share information and ensure that individuals on the health and social care frontlines had the information needed to begin to change how care is actually provided so that patient outcomes could improve.
Each PPS in New York struggled to address these initial issues. Some have pretty much overcome them and have moved on to second-tier issues, while others still struggle. As I said, each PPS has had its own journey.
While we could sit back and celebrate the successes of the past and simply consolidate gains, I say the next step in New York and anywhere else that has demonstrated some success in collaboration – I mean you, Tower Hamlets – is to see the need for even deeper and more systemic change in order to achieve the true vision offered by effective collaboration.
Here are my suggestions for what deep collaboration should mean and what it will take to get to Collaboration 2.0:
Sustainable collaboration is only possible if partners are willing to give up some power/autonomy and institutionalise their relationships. While this will eventually require changes in legal structure, you can start by formalising committees, signing Memorandums of Understanding or other agreements and formally dedicating staff to the collaborative.
In the US context, this means forming a new legal enterprise sooner rather than later. Usually, that is either an accountable care organisation (ACO) or an independent physician association (IPA). Formal mergers or acquisitions are also an option.
Without institutionalisation, partnerships become ‘person dependent’, which is never sustainable. Long-standing relationships need structure. I’m not sure how this will be achieved in England, but it’s an important question to ask.
End payment linked to service
End it! I mean end it! Providers that have formal partnerships and serve large numbers of patients can and should receive their revenue in a manner de-linked from service units.
Providers should embrace the freedom this will offer to re-engineer processes and eliminate paperwork not related to patient care. While I can hear frontline providers cheering you must remember that with freedom comes accountability for results. That is the deal you will be offered. I suggest you embrace it and figure out how to make the most of it.
Revolutionise the patient journey
Healthcare providers around the world are now ‘mapping’ the patient experience and figuring out ways to improve it. While incremental improvement is nice, health and social care needs bolder changes if we really want a patient/person-centred system of care. Technological advances are opening new doors and other economic sectors should inspire us (see retail and how it puts the customer first
When payments are aligned, providers collaborate and technology is leveraged, we have the opportunity to be bold. In the NHS in England context, I would focus on waiting times and how the patient journey and care experience can be re-engineered to reduce/end waiting times.
Perhaps you could start by figuring out how to increase virtual consultations. In the US, I suggest we end the need to visit a doctor’s office for primary care unless that is what the patient wants. Regardless of where you start, find a patient journey that needs an overhaul and get to work.
Yes, you read that correctly. Measure happiness and be willing to be held accountable for overall community happiness. Health and social care providers should see themselves as being in the happiness business. We should see every interaction with the people we serve as an opportunity to practice empathy and figure out what we can do to help them become happier people.
Wouldn’t it be a wonderful world if at least one ‘system’ we interact with actually focused on our happiness? While I’m not saying health and social care can do it alone, our sector should lead the way and be the first to embrace the truest measure of the human condition – happiness.
Well, that it. Simple stuff, I know! While this may seem like a long way in the future for those of you who are in the very early days, or even the ‘dog days’ of your collaboration, I think it’s important to think longer term and contemplate what the fruits of your labour could be.
While you and your new partners will struggle, I hope you will remember that truly collaborative health and social care will offer the community a radically different value proposition then what is found around the world today.
Dare to dream! Dare to envision a radically different world. Don’t settle for incremental improvements, but embrace what is possible when you reach Collaboration 2.0!
Jason Helgerson is chief solutions officer of Helgerson Solutions Group and former New York Medicaid director. Follow him on Twitter @policywonk1