On Monday morning, May 21, during the Health IT Summit in Philadelphia, sponsored by Healthcare Informatics, Katherine Schneider, M.D. CEO of the Delaware Valley Accountable Care Organization (DVACO), based in the Philadelphia suburb of Villanova, offered attendees a bracing view of the challenges facing patients and their families as they navigate the U.S. healthcare delivery system.
Under the session title, “Patient Engagement Is Not an App,” Dr. Schneider illustrated her theme through a complex, multi-partite personal story about her family’s experiences with well-coordinated and poorly coordinated care.
Cleverly, Schneider contrasted the experience of family member “A”—a family member who had experienced very well-coordinated, patient-friendly care for an urgent condition—with that of family member “B,” who had experienced extremely uncoordinated care delivery that was frustrating to “B” and to the entire family. After going through the experiences of both family members, she revealed to the audience that “A” was her family’s dog, and “B” was her husband, who also happens to be a physician.
In the case of her husband, she noted, “His symptoms involved some scary visual defects, including blurred vision. Since he did not have a regular ophthalmologist, he went online and looked for an ophthalmologist who took his insurance and was convenient. The ophthalmologist saw him, and referred him immediately to a world-class retinal specialist who was able to see him quickly. It was determined that he needed surgery,” she said. “He was told to get a cardiology clearance, told to get a physical with his primary care physician, and to get some lab work done. All of those things followed no practice guidelines,” she noted. “His outpatient surgery was so low-risk physically that he didn’t even have to take off his socks and shoes.”
Katherine Schneider, M.D.
Further, Schneider said, speaking of her husband, “He tried to get in to see his PCP for a preop physical. His regular physician wasn’t available, and he saw a wonderful covering physician. But when he went to get the bloodwork, there was some confusion because it was a covering physician, and so he had to do it twice. There was no clarification around what a cardiology clearance meant. And these are all wonderful docs. But he had to make 15 phone calls and scramble to get care coordination. He was given a wonderful educational sheet explaining his problem at a sixth-grade-type level, but of course, he went on Google to find everything out.”
Schneider went on to say that “My husband wants you to know that all his care was wonderful. He was very brave for having his stuff sucked out of his eyeball. He’s an MD-JD. But he had to do his own care coordination. But you can imagine if we were an elderly couple with some cognitive impairment.” What’s more, she said, “With my dog, I felt I was embraced, and I didn’t have to worry about anything. It was a wonderful experience. Some people would say, well, that’s because one of these is insured and one isn’t. So is the dog’s experience better because it involves an elective, out-of-pocket experience? I would argue that that’s not the case. Why can’t we provide a nice, well-coordinated experience for people?”
So, Schneider said, “Now, we can talk a bit about the framework. Neil used the word ‘friction,’” she said, referring to Neil Gomes, chief digital officer and senior vice president for technology innovation and consumer experience, at Thomas Jefferson University and Jefferson health (Philadelphia), who had spoken immediately prior to Dr. Schneider, on the topic, “The Digital Future Now: How We Can Build a Transformative Digital Future for Health and Learning Today.”
“The goal is to reduce the friction in healthcare. That’s where people get frustrated, and there’s a lot of waste,” Schneider said. “And this word ‘engagement’ is probably the most overused word in healthcare now. And, if you do a Google search, you can ask, how often does a word appear in common language? It was actually quite common in 1800, because it referred to battlefield engagements,” Schneider noted. “It also means engagement in terms of mutual promise or engagement. We sometimes feel in healthcare that it’s like battlefield engagement; we hope it doesn’t have to be at a marriage level. We hope that it’s about patients feeling like they are a part of this team, and probably the most important part, in terms of patients engaged in their own health. Sometimes, we use the term in terms of loyalty—we want patients to be loyal. But that’s peripheral to how we can engage patients better to be part of their own care team.”
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