Message from the Guest Editor
Although the U.S. healthcare system is the most robust in the world in the areas of drug and technological innovation, it falls short in delivering quality, outcomes, cost, and equity. A study by Donald M. Berwick and RAND Corporation analyst Andrew D. Hackbarth estimated that five categories of waste consumed $476 billion to $992 billion, or 18 percent to 37 percent of the approximately $2.6 trillion annual total of all health spending in 2011. The categories of waste include: failure of care delivery, care coordination, administrative complexity, overtreatment, and fraud and abuse.¹
This less than promising picture receives additional illumination from The Institute of Medicine (IOM) report, “Crossing the Quality Chasm”, which describes the U.S. healthcare system as decentralized, complicated, and poorly organized, specifically noting “layers of processes and handoffs that patients and families find bewildering and clinicians view as wasteful.”² In this study, researchers estimate that inadequate care coordination, including inadequate management of care transitions, was responsible for $25 to $45 billion in wasteful spending in 2011 through avoidable complications and unnecessary hospital readmissions.
In light of this continuing situation, the complex challenges of the U.S. health care system demand a comprehensive approach in which value-based models offer a focus on efficiency and collaboration among acute, post-acute, and community care providers. Toward that end, envision a world where individuals with brain injuries or catastrophic injuries have access to a provider team with a team captain that helps navigate them through the often complex and byzantine healthcare maze.
Health care organizations and individual providers alike have come to recognize that effective care can best be delivered by collaborative teams of clinicians, with each member playing an interrelated and vital role. Creating the bridges from acute care to the community setting requires a renewed commitment to overcome the traditional model of fragmented care. It also requires shared goals, agreement about the outcomes that matter to all stakeholders (patients, families, providers, hospitals and payers), and a dedicated team with the agility and flexibility to help individuals navigate across the continuum of care as new challenges arise. At the same time, and as an integral part of this patient centric approach, the accompanying financial model must reward all of the stakeholders as equitably as possible in order to be sustainable.
Because health care is complex and constantly changing and because one model or care pathway does not apply to every individual with brain injury, an important key to this effort is the effective acquisition and evaluation of data. Whether health related, delivery process-related, or financial, the data have to be collected, analyzed and shared for managing care, improving processes, and generating knowledge. Without these fundamental changes, health care will continue to underperform, cause patients unnecessary harm (from fragmentation of care and delay to treatment), and potentially bankrupt personal and governmental resources.
What we can reliably anticipate is that the efforts expended in designing, planning, and executing improvements in how we take care of our patients will not come without sacrifices and a considerable amount of hard work. Innovation inherently involves experimentation and learning from experience in general and trial and error in particular. Accordingly, the contributing authors to this special issue have worked tirelessly to understand, diagnose and redesign the delivery system they’re part of with the goal of providing better care for individuals with brain injury over the course of their lifetime. Simply put, they recognize that part of the healthcare system as “sick” and in need of special care.
I am honored to be the Guest Editor for this special issue for the Brain Injury Professional in which “Values” and “empathy” are central themes. We are presenting perspectives and examples of ongoing collaboration to redesign health care to better meet the complex needs of individuals with brain injury. The featured article by professors Elizabeth Teisberg and Scott Wallace titled “Value for Patients” frames the important concept of “value” in the specific context of brain injury care. The accompanying article, “Outcomes and Empathy”, is a provocative look at examining whether or not we are asking the right questions about outcomes. It is our hope that these two articles will help direct our readership to reflect on the “why”, before getting into the “how” of healthcare re-design.
We also highlight innovative models of collaboration between academic systems, as well as recent creative partnerships such as NeuroNet, developed specifically to address the long term and complex needs of individuals with brain injuries across the continuum of care. Finally, we look at the emerging and successful concierge model of care and integrated practice model for worker compensation as concepts could be highly relevant in designing services for individuals with brain injuries.
Once again, I am pleased to be part of this special issue of the Brain Injury Professional and trust the information provided will be both of interest and value. I would like to extend a special acknowledgment to Tom Emswiller for his assistance with this issue.
Featured open access content
Value for Patients
By Elizabeth Teisberg, PhD and Scott Wallace, JD, MBA
Initiatives Toward Creating A True Value Equation for Brain Injury
By Richard V. Riggs, MD and Pamela Roberts, PhD
Modifying Post-Reform Care Delivery Models for Workers Compensation
By Randall D. Lea, MD, MPH
Content currently available in print only
Measuring What Matters: Connecting Excellence, Professionalism and Empathy
By Scott Wallace, JD, MBA and Elizabeth Teisberg, PhD
Neuro-Net: A Continuum of Care Pilot for Persons with Catastrophic Injury
By Ann Perkins, MA, MFT and Debra Braunling-McMorrow, PhD
Getting What You Pay For: Concierge Medicine
By Tim Nguyen, MBA, Voltaire Escalona, Paul Hunter, Spencer Jaffe and Benton Giap, MD, MBA