Last week I had a phone call from the wife of a dear friend whom I met many years ago in a work-study summer program. She was updating me on her husband’s encounter with a well-regarded Rochester, N.Y., health system and, to no one’s surprise, it was a fragmented, frustrating episode that initially harmed more than helped him. Only by taking matters into their own hands and seeking help from the palliative care team, who listened and changed medication combinations, was a potentially lethal experience avoided.
Over the past weeks, our Island has seen the unfortunate demise of our local Vineyard Nursing Association, and subsequent transfer of responsibility for Medicare and related home health patient services to an experienced and larger Cape-based home nursing association and health system.
How are these two events connected? In short, the two experiences illustrate a major challenge in health care: how to achieve efficiency and scale while also ensuring quality and continuity.
The experience of my friend in Rochester is something many of us have encountered even when health care is provided by experienced and clearly well-intentioned organizations. In many cases the health care is piecemeal, disconnected and often risky because one party does not know what another party has done or is doing.
The situation with the Island’s VNA reflects the loss of a specific opportunity to have the locus of responsibility for our care locally coordinated and not dispersed among different specialized organizations.
Our Island is blessed with committed and skilled health professionals. We have all the components needed to achieve an integrated and accountable health care experience for residents. These include a community hospital backed up by a Boston teaching hospital; primary care, dental and many specialty physicians; rehab and long-term nursing home care; mental health emergency triage, outpatient care, addiction outpatient, day treatment and sober living resources; a community health center; enrollment navigators; prevention specialists focusing on family violence and youth risk behaviors; holistic health approaches; and, no doubt, more resources that I have unintentionally omitted from this list.
What almost all of these health services have in common is that by themselves they are of a size and scale that leave them potentially vulnerable to the same fate as our local VNA. The drivers of today’s health care are integrated care systems that are patient-focused, cost-effective and based on proven standards. One response to these drivers is what happened to our VNA. The service gets absorbed into a larger specialty organization that does the same work, but control shifts. An alternate response might be for Island-operated health resources to initiate a process of formal collaboration that provides the holistic patient experience, size, scale and efficiency demanded by the times.
Formal collaboration can take many forms, and does not require a monolithic entity on the Island. Collaboration begins with small steps including sharing space and administrative functions, and coordinating infrastructure supports, from electronic patient records to patient care.
Insurance plans are looking for these integrated care entities, and patients are looking for continuity of care that minimizes risk of error. And health providers are looking for opportunities to focus on care, not the administrative gobbledygook that consumes almost 20 per cent of every health dollar spent.
Time is running out. The cost and efficiency drivers are strong. We need leadership from Island health organizations and interested parties from our governments and civic organizations to consider how an integrated care experience can be achieved for Island residents, on-Island, and by Island-accountable providers. Ignoring this option represents an invitation to repeat the Vineyard Nursing Association experience. Or in the words of W. Edwards Deming: “It is not necessary to change. Survival is not mandatory.”
Victor Capoccia is a Vineyard Haven resident, health policy researcher and consultant. He is president of Martha’s Vineyard Community Services.