Personalized Health Care

Personalized Health Care, an approach being developed at Duke University, focuses on patient-centered health care, personalized health planning (PHP), and patient engagement. It seeks to remedy spending on chronic care by encouraging healthy behavior and planning. Patients are given the opportunity to engage with their own health by identifying areas in their life where they are motivated to make changes for their health. In initial visits, physicians assess the patients’ risk including family history, genetic markers, lifestyle habits, and other biometric data during the appointment. Then, the physician and patient work to create a timeline for health improvement. Health coaches and nurses monitor the patients’ progress and help them meet their health goals.

An essential component to understanding the importance of personalized health care is the Inflection Curve.

Personalized health care is based on three key principles: personalized health planning, coordination of care, and rational reimbursement.

Dr. Snyderman gives an overview of personalized health care at the 2016 Personalized Medicine World Conference in Silicon Valley.

Personalized Health Planning

The personalized health care plan (PHP) is the key feature of personalized care as it anticipates the individual’s specific health needs and develops a coordinated means to achieve them. The PHP is developed collaboratively by the provider and the patient and utilizes comprehensive health risk assessment as the basis for both enhancing health and well-being and mitigating and tracking disease over time. Greater collaboration between patient and provider replaces the traditional physician-dominated dialogue with more effective patient-physician partnerships. The patient’s own needs and goals for health, wellness, and disease mitigation drive the planning process and nature of the plan. The PHP framework provides an operational care model for delivering personalized, proactive, patient-driven care to individuals with a diverse range of needs.

PHP Model

 

Coordination of Care

Coordination of care includes collaboration among all relevant providers as well as continuity of care over time. Patients with one or more chronic disease often need care from different medical professionals, including doctors, nurses, pharmacists, physical therapists, or mental health providers in various care settings. With a larger team of health care providers and locations, there are inevitable transitions or transfers that occur between hospitals, nursing homes, small outpatient clinics, and the home. Studies have shown that such transitions can jeopardize the quality of care delivered and, in some cases, can jeopardize patient safety as a result of lack of communication, inaccurate or incomplete transfer of relevant health information, and poor follow up plans for patients after leaving the hospital. Researchers have estimated that inadequate care coordination was responsible for $25 to $45 billion in wasteful spending in 2011 through avoidable complications and unnecessary hospital readmissions. Coordination of care is a key component of a prospective and preventative approach to health care that saves money, fosters optimal outcomes, and creates a better health care experience for the patient.

This video from UnityPoint Healthcare provides a short introduction to the concept of coordinated care as a means to improved health outcomes.

Rational Reimbursement

A rational reimbursement system that supports personalized health care planning and coordination of care across providers and time are a necessary component of this approach. A significant barrier to developing innovative ways to meaningful health care reform has been the perverse incentives of the reimbursement system which rewards complex interventions rather than the more labor intense solutions needed for health promotion and coordinated care.  This current model for reimbursement, commonly referred to as fee-for-service, has created incentives for providers to focus on interventions and diagnostic testing that create the greatest margin, rather than the more holistic needs of the patient to manage their disease.The impact of changing health care reimbursement to facilitate better outcomes is beginning to stimulate interest in coordination of care and the development of best cost effective practices. Nonetheless, given the magnitude of the health care provider industry and its dependence on fee-for-service methodology, the conversion to a reimbursement system that rewards best practices will not emerge overnight.