By Piali De
During last week’s roundtable conference, I had the opportunity to engage with a variety of influential and thoughtful individuals on the topic of providing care for people with the most complex health concerns. I want to thank those participants for joining with me in what became a rich conversation on this topic that we all care about and for their immense contributions to the discussion.
The participants included Mr. Nick Toumpas, Commissioner of the Department of Health and Human Services in New Hampshire; Jessica Maurer, Esq., Executive Director of the Maine Association of Area Agencies on Aging and Chair of Maine Council on Aging; Dr. Chip Teel, Chairman of the Board of the ElderCare Network of Lincoln County, Maine; Dr. Richard Goldstein, President of the Central Maine Medical Physicians Group; Ms. Ellen McCahon, Healthcare Management Executive and Principal of Helms & Company; Mr. Darryl Millner, Assistant Director of the Division of Developmental Disabilities in South Dakota; Ms. Elaine Roberts, Executive Director of the South Dakota Parent Connection; and Mr. Cullen Ryan, Executive Director to Community Housing of Maine. Of course, I want to specially thank Dr. Soeren Mattke for agreeing to co-moderate this event with me and for all of his hard work in orchestrating the discussion.
Although many ideas were touched upon that we will continue to think about as we move forward, for our immediate concerns the conference solidified the importance of seeing into the “black box” of daily-living activities. It became clear that understanding a person’s habits, their health baselines, and how their day-to-day activities impact their health is crucial to figuring out what support they need to best manage and improve their health. Most of the participants in the roundtable, a great range of government officials, ACO leaders, healthcare consultants, doctors, and nonprofit leaders, gave personal anecdotes of times when they felt frustrated at the lack of a concerted effort around the patients’ entire health concerns and at the complexity of finding the right level of care for someone with complex health needs.
A common theme of the conversation, and one that I have previously touched on, was the idea of putting the patient in the center of the care team and empowering them to drive their own health. This requires an engaged, informed patient who is focused on optimizing self-care, and smart technologies are essential for enabling this. Patient-centered care also requires a health care partner who will help the patient navigate the health care system to get access to the right care at the right time; once again, technology is a key enabler.
It dawned on me during the discussion that in the future, chronic care is going to look more like a team sport than a solo endeavor. For the population with the most complex health, an empowered and engaged patient will proactively reach out for the right care at the right time with the help of a knowledgeable and trusted partner—imagine an angel. At the same time, the care team will have enough knowledge to reach in with proactive actions to prevent small problems from becoming bigger ones. This give and take will look like a family, where everyone is involved in getting the job done, thus keeping the patient at his or her highest potential of health and independence. Jessica Maurer made the point during the conference that it is “everyone’s” responsibility to provide care for this population. And, as Commissioner Toumpas said, we need to put the “health” back in healthcare and stop relying on the current “sick-care” model.
Read the summary for highlights from the roundtable.