Time to reimagine healthcare?
Intervention early on could prevent many a hospital visit according to Gemma Self of Reimagine Health.
The NHS is an incredible institution – amazingly, it treats a million people every 36 hours. We’ve all got stories of how it’s cared for loved ones and the concept of free healthcare for all is the envy of the world over. However, in its current incarnation it exists to fix problems, rather than preventing them. What about healthcare that provides services based upon the outcomes that matter to people?
That’s what Gemma Self is aiming to do with Reimagine Health, a healthcare consultancy startup based upon principles of Value Based Health. Having worked in the NHS for eight years, Self recognises that it is an amazing organisation with huge roles and responsibilities and an overstretched budget, but also that working on such a monolithic scale can limit agile change. The last ten years have seen the NHS focusing on a system that counts things; bed numbers, waiting times, processes, staff numbers and money. This was necessary to drive down waiting lists and costs, but means that organisations compete on money and processes.
"What is missing is whether we are making a difference for patients’ wellbeing," says Self. "Healthcare needs to be delivered in a way which resonates with today’s society and who we are now. Health is wellness, not absence of illness. It is about looking at the whole person rather than a part of a body or a condition."
Value Based Healthcare doesn’t ignore money and process, but combines it with the impact on people. Value is defined as an equation which brings together the measurable impact upon a patient, divided by the cost of delivery. Currently we pay for the treatment of things which could have been avoided. For example, rather than training, education, community support or early intervention when people are experiencing less severe symptoms, it often ends up that treatment only happens when illness occurs.
"The NHS payment structure currently funds hospitals every time someone is admitted," says Self. "We don’t have a payment structure that allows specialists to do the right thing for that person’s wellbeing. Imagine if we gave the specialists within a hospital a pot of money to help prevent falls and rewarded them for evidencing a reduction of falls in the population of older people that they serve."
Health is wellness, not absence of illness
No one wants to go to hospital, and many visits to hospital could be prevented with the right intervention early on. If healthcare is responsible for trying to improve the population’s wellbeing rather than solely treating ill health, then a system that wants to achieve that could reward institutions that prevent people having to be admitted into hospital, rather than remunerated every time they do.
This is one of the principles of Value Based Healthcare – upfront funding for a package of care that prevents admission and helps citizens to live healthier lives. It will also ultimately lead to cost reductions and a healthier population.
What Reimagine Health is trying to do is embed this change in mindset. Increasingly organisations recognise that this is the ideal, but it's hard to achieve from the current state. People, culture and systems can get very quickly into routines, and Self aims to help guide those people to the answers that might work. Changes have to happen at every level to deliver system-wide health improvements. Reimagine Health’s mission is to develop innovative approaches working to deliver a health service that an ever changing society needs. Self says that "I went into healthcare management and leadership because I wanted to make things better."
Reimagining how healthcare can be delivered is just the first step. Delivering it is the hard bit. Self was selected to study Value Based Healthcare with experts at Harvard Business School, is working on a consultancy project with KPMG and has set up pilot contracts in London boroughs. "Partnership and collaboration is at the heart of what I want to do," Self says. "I am not going to change the system by myself – but by spreading the learning, setting up test beds, and providing my advice and experience and working with expects we can start the ball rolling for a whole system change and radically improve health in ways that matter to those being treated."
Photo credit: Alejandro De La Cruz