Episode Details

Late in May of this year, three-ish months ago, I did an inbetweenisode that explores the "why with the no collaboration" amongst healthcare stakeholders and what the lack of collaboration signifies. That episode got a lot of traction and engagement.

This episode that follows is a pretty good approximation of a presentation that I made at the MTVA (Moving to Value Alliance) symposium that happened in Connecticut this past June. If you listened to the earlier show about collaboration, this one is slightly different, shorter, and more to the point.

So, let's start here: When you listen to any patient with a chronic condition talk about their challenges with the healthcare industry—and yes, if a patient has a chronic condition, more often than not, that is what they will talk about, their challenges …

I went on Twitter just now, and it took me literally 13 minutes to collect what I'm going to say are 300+ Tweets written by patients and their caregivers complaining about their chronic care journey. That's the sad part. I don't mean to kick this off talking about problems; however, if you're gonna solve for something, it is important to understand what problem you are solving for. You do not want to be a solution looking around for a problem.

So, let's fix this, this rampant problem problem that chronic care patients seem to have.

Many of the patient challenges in the 300 Tweets that I just collected can be grouped into two major categories. And these two major challenge groups can really only be solved for with collaboration amongst healthcare stakeholders. So, let's dig in here.

The first major patient challenge is what I'm gonna call the care gap problem.

I was talking to someone at a provider organization the other day, and she had 8000 known care gaps with patients and [insert overwhelm here]. And these were just the care gaps that showed up on somebody's radar because they added up to a quality metric, which is sometimes the definition people use for what is a care gap.

But if we think about all the other holes in patient care, the typical care gaps that are identified probably come not even close to the total number of actual care gaps: patients who can't see their specialist because they can't get ahold of their records from the local health system or no coordination of care. Coordination is probably another synonym for collaboration. This is a huge deal. People literally die because their clinician cannot get their biopsy results or whatever from somebody else. That's a care gap as deep as a grave.

Or patients who keep showing up in the ER because they aren't getting the help or the meds or the accurate diagnoses or the treatment plan that they need to stay out of the ER ... My grandfather had heart failure. At the end of his life, he was probably in the ER once a month. It was sad and painful and expensive and totally unnecessary. But his PCP didn't seem to be collaborating with the specialists, and the ER I don't think was telling anybody what was going on. Right? Or patients who can't get a drug they need approved by their insurance, so they wind up in crisis. Crappy prior auth processes create care gaps. All of these things are gaps in care.

Carly Eckert, MD (EP361), was on the podcast; and she made a crucial point for me. In fact, I tried to get her to come on the podcast originally to talk about care gaps and closing care gaps; but she categorically refused. Chronic care management, she said, should not be a game of whack-a-mole. It may be better than nothing, a game of whack-a-mole; but it is certainly not ideal.

Chronic care management by care gap is like cooking with a fire extinguisher. If we want to eliminate care gaps for reals, let's just not h