By Robbie Hughes

Did you know that, despite being the most expensive in the world, the US healthcare system consistently underperforms compared to value-based systems in Europe, including the UK? According to The Commonwealth Fund, the US ranks last amongst the 11 nations studied, fails to achieve better health outcomes, and is last or near last in access, efficiency, and equity.

The US is slowly transitioning to a value-based system, but yet so many healthcare organisations are delaying the move; why? Because the transition is expensive, requires an overhaul of a decades-old business model, and, in some instances, the fee-for-volume model is still a profitable option. While US providers acknowledge that new IT implementations can be expensive and time consuming, they do recognise the return such investment can bring to the overall experience.

Armed with the desire to improve the patient experience and transition to a new business model, Care Pathway Management (CPM) is one way US providers can help expedite the transition to value-based care.


What is CPM?

Today, even the most automated of healthcare business processes are stitched together with people and paper. If you ask an organisation about its patient pathways, most will tell you that the current pathways have evolved organically, often with heavy administrative costs. In an effort to better manage this, providers have implemented an EHR/EMR, but these systems are disparate and siloed, which results in increased administrative time and less face-to-face time with patients.

Care Pathway Management provides a single, real-time view of the entire patient journey from referral to outcome. It integrates clinical and administrative systems, and gives providers the ability to design and automate their own pathway rules, so that each patient is automatically progressed through their personal care journey based on their individual data. It can be applied across different healthcare specialties, including radiology, oncology, ophthalmology, urology, and across outpatient environments, making it ideal for ambulatory surgery centres or outpatient clinics.

For providers, a CPM approach to healthcare delivery is measureable, predictable and eliminates variance. For patients, they see the right doctor or specialist more quickly because their referral is tracked and triaged electronically. They never have to repeat information and can also manage appointments online.

Providers interested in implementing a CPM approach should think about these 3 key steps.

Step 1: Ensure focus is on pathway thinking (vs. one-off steps) and the ability to map the process end-to-end.

Step 2: Use this process mapping to identify areas of complexity that can be automated with minimal risk but maximum   efficiency to deliver value early.

Step 3: Use automation to design new pathways to continually improve efficiencies across clinical and administrative processes.

The market shift in the US to value based care presents an opportunity for providers to significantly improve performance. By rewarding providers for improved results in terms of cost, quality, and outcome measures, patients will benefit from a better overall experience and providers will benefit from greater efficiency and cost savings. Care Pathway Management is one approach that healthcare providers can utilise in the immediate future to ensure that success.