Collaboration is Key to Effective Care

Collaboration has always been an integral component of U.S. healthcare, constrained only by the ability of patients, doctors and other providers to communicate. In the digital era, it's at the center of an increasingly popular practice model that promises to improve clinical outcomes while cutting costs, but challenges still exist.

The collaborative care model positions the primary care physician as the quarterback in the middle of a line of healthcare participants. With the patient at one end and all the relevant specialists at the other, participants work together to provide care and monitor progress, relying on video, voice and data technologies to communicate and collaborate. Patients themselves are active members of the team, with full access to all the available information, and an unprecedented level of input and interaction in their own care.

"Collaborative care has always been a goal," says Sarah Hensley, a senior solutions architect with Merlin International. "The one thing that's changed is the explosion of IT such as mobile, cloud computing and the emergence of concepts such things as the Internet of Things. Ready access to technology has completely changed peoples' ideas about how collaborative care can be delivered," she says. With the patient data collected through electronic health records (EHRs) now easily stored and shared.

A Centers for Medicare and Medicaid Services (CMS) report concluded a collaborative care model could have significant impact on treatment of particularly complex conditions, such as mental illness. Depression and other disorders are both common and disabling the report states, and are associated with high health costs and losses in productivity. Yet only 25 percent of patients with these disorders receive effective care. More than 70 random trials showed collaborative care for these common mental health issues to be more cost effective than silo-ed care across diverse practice settings and patient populations.

In July 2016, CMS proposed changes to many of its Medicare fee schedules, including payment for specific behavioral and mental health services that use the collaborative care model. The Affordable Care Act also contains a specific provision for states to establish what it calls Health Homes, responsible for coordination of care for people on Medicaid that have serious and chronic physical and mental health problems.

Several levels of technology are required for collaborative care, says Spencer Hamons, chief information officer for NetApp's healthcare division. Basic communications is the first key requirement, including the ability to exchange data on a reliable network connection. The next is middleware, software that lets various health systems communicate and understand each other.

"Years ago, when EHRs started to communicate with each other just within single hospitals, communications were point-to-point and that was soon found to be inadequate," he says. "Then interpretive engines and interfaces were used, and that's now standard operating procedure."

Almost every healthcare organization today has that basic level of connectivity. Other components, such as integration platforms to handle sharing across disparate systems and the data normalization required for sharing, are far less commonplace.

Hensley believes the biggest point of failure in most collaborative care solutions is the lack of a well-designed user experience. "Every solution you deliver (for collaborative care) is unique to a particular user," she says. "I think the IT industry, even as it relates to Health IT solutions, generally has been slow to accept the idea of user experience as a primary driver for solution requirements, and is lagging in the development of the skills and solution constructs needed for this." Having IT deliver a positive user experience is the common denominator for a successful collaborative care program.

The good news is while there are still cultural and organizational barriers to overcome; the technology required to make collaborative care a more practical option is now available, improving communications and outcomes.