In Texas, meanwhile, Texas Health Resources lies in the center of what Varga calls "the Wild Wild West," where there is very little in the way of comprehensive clinically integrated physician networks. "If you were to describe the healthcare [market] in north Texas, you can say that it's very expensive with average quality [of care] and an average patient experience. And the healthcare system in north Texas is very rich," said Varga. "We are a byproduct of the demographics. Our population is growing rapidly now that a significant number of individuals are migrating to areas in Texas, due mainly to a lack of income tax. All of the drivers that everyone saw through the years to force integration of care has never existed in north Texas," he said, noting that one-third of the independent primary care doctors have no economic pressure to accept other patients, outside of those commercially insured. "So when you talk about meeting patients' increased needs and expectations, there’s no true imperative to enhance the care delivery model."
In central Massachusetts, Iitsuka said UMass Memorial isn't faring much better. "We are making low acuity situations more complicated so it fits us. We don't make it easier for our patients, and we don't use technology correctly," he admitted. "We need to look at patients and their families as our customers, rather than our doctors. Things such as outpatient clinics, technology, more access points for patients are where we have to shift our thinking towards."
Iitsuka additionally noted the desire to get the frontline staff to make the strong tactical changes that are needed such as getting patients' prescriptions filled before they leave. "Why aren't we providing that service? It's harder to set up a system in which someone goes up to the room, takes the prescription, and gets it filled," he said. "Our nurses said that we need to provide that service to improve the patient experience. For us, the frontline staff needs to drive that change because a top-down down approach won't work."
Even in the tech-heavy bay area, John Muir Health isn't embracing technology as much as it should be, though Sauter said the organization has worked with physician leadership to implement solutions such as an online treatement and diagnosis solution. That information is transmitted to the doctors who turn around verification and prescriptions within an hour during normal working hours, Sauter said. Additionally, in a month or two, the organization will add the option for patients to see physicians virtually, via online and video. "Our adoption rate was modest initially as our focus was only on existing patients, but we are in the process of making [the service] available to non-members," Sauter said. "To stand up against Kaiser and Sutter, who are are membership-based organizations, we have to compete in areas where they they don't."
Interestingly though, Sauter mentioned telemedicine provider Teladoc as "a tremendous threat to John Muir Health in being able to deliver consistent, integrated care across the continuum. He said that as a result, developing partners to keep patients in the community and keep care in the system is a necessity. "We are working with CVS in the minute-clinic setting. They have a nurse practitioner care delivery model, and they can expand access and share that clinical information with us and not [negatively impact] our delivery system," Sauter said. As such, disconnecting primary care physician compensation from production is one of the bigger things that John Muir Health did to adapt, he continued. "We segmented our population and created care models that were tailored to the individual needs of those patients. This allowed for virtual and online visits, and it's not coming out of the physicians' pockets to participate in these models."