Few industries are as fragmented and in need of reform as health care. But with their emphasis on connected health care, a small group of high-performance providers is revolutionizing the way quality health care can be delivered. By William N. Higbie Outlook Journal, October 2005 Download this article [PDF, 525K]
PDF Help  Pick up a newspaper or magazine almost anywhere in the developed world and the message is the same: Health care costs are soaring while the quality of care and access to services is moving in the opposite direction. The situation is indeed alarming—but not everywhere. Through Accenture’s continuing research into the industry-specific attributes of high-performance business, we have uncovered some health care providers that significantly outperform their peers. Their approach to health care delivery may offer some lessons to other providers—and, if adopted, it could eventually help ease the looming crisis.
Health care spending already consumes nearly 10 percent of the GDP of most rich nations—and this percentage, by all projections, will continue to grow. While there have been many improvements during the past 30 years—including increasing life expectancy and decreasing infant mortality—health care costs continue to outpace inflation. We’re all living longer, and over-65s cost three to four times as much to treat as younger patients. What’s more, the disparity in medical costs between the older, health care-consuming public and younger taxpayers is widening as baby boomers approach old age. But skyrocketing costs are only part of the picture. Access to health care is suboptimal from Boston to Brisbane. In Western Europe, despite record amounts of government health care funding, waiting lists for some types of nonemergency surgery—hip and knee replacements and cataract removals, for example—stubbornly refuse to shrink. In parts of Asia, the number of patients in emergency rooms who experience long waits for admission has swelled significantly. In the United States, where 45 million people are uninsured, more than half of low-wage earners lack health insurance because they fall into the gap between a private system that primarily covers corporate employees and a public system focused on the elderly and the indigent. The funding and delivery models of developed countries' health care systems vary enormously. The United States is, for the most part, a private market. Elsewhere, health care services are largely publicly owned and funded, primarily through taxation (in countries like Canada, Britain and Sweden, for instance) or compulsory contributions (in Germany, France and the Netherlands). Yet the quality of care in almost all modern health systems is declining. Historically, modern medical care has been organized and delivered in silos based on profession, specialty and location. Look under the covers of most modern hospitals today and you will find byzantine complexities. For example, in one Australian hospital it takes 107 separate steps and 11 different people to book and manage an outpatient consultation, and 65 steps and 10 people to conduct a routine chest X-ray. Funding models based on individual patient-clinician interactions only serve to reinforce the complexity. Services are poorly integrated, and patient information is not widely shared. Breakdowns in communication are common, particularly when a patient is handed from one care setting to the next. The upshot: confusion, frustration and delays for both patients and care providers. Indeed, few industries are so fragmented. And reform remains elusive, which makes the handful of providers that Accenture characterizes as high performers all the more noteworthy.  Because of all these factors, identifying the high performers in this sector is also an exercise in complexity. Health care is one of the
few industries that defy Accenture's standard performance
measurement metrics, which in the past we have successively
applied to industries as diverse as banking, utilities, chemicals
and retail hypermarkets. The health care industry varies so much
from country to country that it is not easy to make international
comparisons, although we have created some metrics that offer
meaningful insights (see "About the Research"). Thus far, our
research strongly suggests that high performance in this sector is
best defined in terms of how well providers handle the intricate
handoffs of an extended "patient journey."
That journey begins, of course, with disease prevention and staying well. But it also encompasses the provision of primary care services, the management of acute illness and the transition through rehabilitation to recovery. While the concept of "patient-centricity" is not new, relatively few provider organizations—Vanderbilt University Medical Center in the United States, NSW Health in Australia and LBK in Europe are notable exceptions (see Case Studies 1, 2 and 3)—have successfully adopted this holistic approach to health care provision, an approach with the patient at its core.  Too often, reform efforts focus on specific episodes or professional specialties, reinforcing fragmentation within the system. The challenge is to systematize the entire patient journey, creating a framework for “connected health care.” New business and technology systems can better connect the overall flow, enabling innovative patient care models that pre-emptively target disease. In addition, these models can provide a level of management insight that better informs operating decisions, service integration and strategic investment. Within this framework we see the emergence of high-performance characteristics that are shaping solutions for the future.
 High performers' commitment to patient-centric health care rests on their mastery of four core capabilities. These capabilities are clearly interconnected, and they work together to support the various stages of the patient journey.
Pre-emptive care models are designed, in the first instance, to promote wellness and self-management, reducing the demand for more costly acute services. Key target populations are typically, but not exclusively, the chronically ill. Pre-emption involves proactively identifying high-risk patient sectors and customizing pre-emptive interventions and support to help patients and their families self-manage treatment at home or in a low-cost environment. The UK National Health Service, for example, runs breast and cervical cancer screening services and vaccination and smoking cessation programs that are administered and delivered locally, in the community.  High performers distinguish themselves through the sophisticated use of analytical profiling for chronically ill and at-risk populations, supported by coordinated care teams, contact centers and case management tools. They have found ways to shape their organization and funding models to enable integrated care and focused campaign management that delay or avoid the onset of acute illness.
Integrated clinical information architectures are essential to managing the patient journey effectively and establishing the systemwide technological infrastructure necessary for sustainable reform. The most prominent example of this trend is the emergence of electronic health record (EHR) platforms that connect and integrate a variety of legacy systems by setting up systemwide sources of clinical data that can be shared across the care continuum. A number of countries across Europe, North America and Asia are undertaking countrywide health information infrastructure programs, including Connecting for Health in the United Kingdom, the Canada Health Infoway, the US National Health Information Network and HealthConnect in Australia. At Vanderbilt University Medical Center, for instance, EHR platforms form the core of an applied information technology that supports and accelerates frontline clinical decision making. The best organizations have extended the use of traditional clinical applications, like results reporting and order management, into more sophisticated approaches that standardize care and eliminate the significant variations in clinical practice. High performers have used change management methodologies to develop technologies that clinicians want to use because they fit seamlessly into existing workflows. End-to-end patient flow and demand management, right across the patient journey, is a hallmark of high performance in this industry. It describes the ability to integrate and coordinate a range of clinicians and other staff, as well as community caregivers, across the complete care continuum. High-performance providers establish special units to manage the patient transfer process and to monitor the flow of patients between the services and facilities that mark the patient journey. Both LBK Hamburg and NSW Health, for instance, have set up special patient flow units that are supported by time management benchmarks to drive accountability. High performers develop more sophisticated scheduling and staffing systems that can more closely match health system supply with patient demand. As a result, patients have to spend less time on waiting lists or in emergency rooms waiting for hospital beds, they can be discharged more quickly to post-acute services, and readmission rates are reduced. Managerial insight and organizational excellence is a combination of strong change leadership, robust governance structures and performance management principles that align accountability for outcomes. These capabilities underpin all the others. High performers begin with a dedication to the data and the courage to promote transparency in making tough management decisions. They establish a culture of continuous improvement, and they support that culture with responsive systems for tracking patient flow, clinical quality and key cost indicators. They push this information out to frontline caregivers and empower new management structures to shape more responsive solutions. The patient-centric approach at the heart of all these capabilities is the key to health care reform. Patient-centered isn’t just a catchy political mantra. Given the scale of challenges facing providers, it’s fast becoming a necessity. By instituting reforms that reshape and connect services around the entire patient journey, health systems (both public and private) are providing better access and quality for a given level of investment. Over time, these changes will reset the standard for health systems globally and guide the broader transformation of this industry. About the Author William N. Higbie is the lead partner of the Accenture Health & Life Sciences industry group for the Asia Pacific region. Mr. Higbie, who has 20 years of health industry consulting experience, has an extensive background in operations reengineering, IT systems consulting and strategic planning to major health organizations across Asia, Europe and the United States. He is based in Melbourne. For more information, please contact us. Next: Health Care Providers II: In Need of Treatment
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