Healthcare systems globally face huge challenges in delivering high-quality, accessible, and affordable care, often to populations that are increasingly aging and have a growing prevalence of long-term conditions. What are health systems and providers doing to address these challenges via evolving the model of care? What can other systems learn from successful approaches?
Meeting healthcare’s evolving needs
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Our discussion paper, “How new care models can ensure a step change in quality of care, access to services and efficiency,” explores the ways that healthcare systems are delivering high-quality, accessible, affordable care via transforming the model of care. The good news is there is emerging consensus around the healthcare services that new care delivery models need to provide a greater focus on primary prevention, an enhanced model of primary and community care that meets the different needs of complex patients, a fundamental shift in performance to ensure consistent adoption of best clinical practices, a far greater emphasis on delivering care in the most efficient way, and a focus on outcomes rather than inputs. New care delivery models need to meet these demands both in and out of hospitals.
Out-of-hospital delivery models
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Proactive, systematic, and intensive care for people with long-term conditions and complex health needs. Over the past decade we have seen a rapid rise in the number of people living with long-term conditions, driven by increasingly unhealthy lifestyles and aging populations. All healthcare systems must find a more proactive way to manage these patients in the community and in the home. In the United States, ChenMed delivers holistic care for older individuals with multiple long-term conditions via a one-stop shop where patients have access to expanded primary care together with a range of specialists. ChenMed has not only improved patient outcomes for its predominantly Medicare Advantage population (for instance, older and poorer patients), but also reduced hospitalization rates by 18 percent, readmissions by 17 percent, and cholesterol levels for people on statins by 22 percent. In addition, Chen Neighborhood Medical Center in Miami-Dade County had just 1,186 hospital days per 1,000 seniors in 2013, significantly below the US average of 2,420.1
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Local access to urgent medical care 14/7. A key challenge for every health system is how to avoid unnecessary admissions in hospital emergency departments. Early evidence from the United Kingdom and elsewhere suggests that easy access to high-quality primary care has a real impact. For example, the introduction of general practitioner services seven days a week in Central London has reduced emergency attendances by 8 percent, predominantly on weekends, but also during weekdays—and especially with patients older than 65.2
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Local access to care for children. Many healthcare systems are redesigning local services for children to provide high-quality care supported by a network of specialists available when children and their families most need it. A review of pediatric services in six countries found the typical model to be one inpatient unit per one million people, with a network of pediatric assessment units supported by 14/7 access to high-quality primary care children’s services.3 These services could include same-day telephone consultations for children with a primary care professional, a telephone hotline for these professionals to contact a consultant pediatrician for advice, and outreach clinics to treat children with complex health needs and thus avoid hospital referrals.4
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Alternatives to acute hospital admission. Hospital admission rates (especially emergency admission rates) vary considerably around the world. New models of care aim to identify individuals who are more likely to be admitted to hospitals, and implement alternative support and resources to avoid admissions. This approach has proved particularly effective in the area of mental health—for example, the provision of a comprehensive 24-hour crisis service can dramatically reduce inpatient bed use.5
New hospital delivery models
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Specialist centers of excellence. The UK’s National Health Service has built at-scale specialist centers for stroke, cardiac, cancer, and major trauma services, and has some of the best outcomes globally.6 In other specialties, scale is achieved through a chain or a franchise arrangement across multiple sites. Moorfields Eye Hospital, for example, provides Moorfields-branded ophthalmology services at 22 locations in and around London. Its success rate on drainage tube surgery for intractable glaucoma is 98 percent compared with 80 percent at other providers, and it is a pioneer of innovative services such as nurse-led intravitreal injections.7
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More efficient models of planned elective care. Narayana Health in India is one of the global pioneers of low-cost, high-quality elective care: the organization was set up to provide cardiac care for all, and has used lean processes, new workforce models, and a high-throughput approach to drive down costs while achieving outcomes on par with many developed-world hospitals. One analysis found that costs at Narayana were 4 to 15 percent of those at a sample of US hospitals (when correcting for wage differentials), and that its 30-day post-surgery mortality rate for coronary artery bypass procedures at its Bangalore hospital was below the average of the sample hospitals.8
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Viable models for smaller, community-based hospitals. Examples of viable smaller hospitals abound, but succeeding with such a model requires creative thinking on workforce together with a recognition that not every hospital has to have a full range of acute services. After public consultation, Trafford General Hospital in the UK became a smaller, community-based hospital, moving more acute emergency services to other sites. These offerings have been replaced by a consultant-led urgent care center and an emphasis on planned day case surgery at a new orthopedic center.9
Common characteristics of successful care models
Our analysis of new care models has identified a number of common characteristics which can drive improved quality, access to care, and efficiency:
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Rigorous process management. This includes the standardization of clinical and operational processes, extensive use of new technologies and analytics (for example, for patient self-management or remote monitoring), and robust performance management.
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Attention to people. Many healthcare systems are adopting more innovative workforce models—ensuring that highly qualified clinicians work “to the top of their licence,” while less-skilled tasks are taken on by new types of staff, such as health coaches. At the same time, successful organizations are continuing to provide strong leadership and to implement effective people-development processes.
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Focus on patients. This includes empowering patients to take a more active role in managing their own conditions, while enabling greater differentiation of services based on needs and desired outcomes.
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Building scale. Increasing operating scale helps healthcare providers in a number of ways: it supports the expansion of services, leads to improved asset and staff utilization, and enables increased investment in IT, performance management, and new ways of working.
These characteristics can help healthcare systems meet the needs of their populations more effectively, and deliver significant improvement in the quality and affordability of care. The promising news for healthcare systems is that there a multitude of models that have been proven to make a difference; the challenge now is closing the gap between what we know and what we do and delivering the type of care that patients need and want.