Longitudinal patient-centered care plans gaining momentum, expert says

But building the new model of care plans is a difficult task, Mass General geriatrician Terry O’Malley says.

February 06, 2018

03:25 PM

The healthcare sector is experiencing a paradigm shift in how doctors treat patients today. That’s according to Terry O’Malley, MD, an internist and geriatrician at Massachusetts General Hospital.

The healthcare system has shifted from the old model in which patients with acute illnesses landed in the hospital and were treated until they recovered enough to be discharged.

“That’s how healthcare was set up. It really revolved around severe acute illness,” O’Malley said. “That’s really the old model.”

The new approach, however, calls for longitudinal, person-centered care. People are playing an increasingly engaged role in what their healthcare looks like. They are setting the priorities for what they expect – what is most important to them.

“It’s a very complex balance,” he noted. “Think of people being distributed on a Bell Curve. There are some people who want someone else to do everything. There are other people at the other end of the Bell Curve that say ‘nothing is done without me, and I insist everything goes through me.’ And there’s every color of the spectrum in between.”

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These plans are developing – and there’s a really good business case for them, O’Malley said. For anyone providing services under a value-based payment model, one of the things they’re responsible for besides quality and customer satisfaction is the total cost of care.

That’s a huge change.

In order to manage the care of really complex individuals, O’Malley noted, there has to be a care plan that addresses what they feel are the most important parts of their care. That’s where it starts.

“Building and maintaining a longitudinal, person-centered care plan is really hard work,” he added. “It takes a lot of resources. No healthcare provider is going to do it if it costs them more to do the plan than the benefit they derive from it.”

What’s more, as soon as you add a second provider – a specialist – to that mix, you now have a three-way conversation, and when you add a second specialist, it becomes a four-way conversation, and so forth.

“Most of those frail, complex elders who need the care plan have 10 providers,” O’Malley said. “It becomes this daunting task to try to coordinate what’s going on.”

The hardest part: Care plans have to be built to address specific issues – those that are meaningful to the individuals and to the service providers, otherwise they won’t get used.

O’Malley and Evelyn Gallego, CEO and founder of EMI Advisors, are teaming up for the HIMSS18 session, “Embracing Longitudinal Person-Centered Care Plans,” at 11:30 a.m. March 7 in the Venetian Murano 3304.