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Perspectives on Fixing a Disjointed Health Care System
In this issue, we are taking a hard look at our health care system today, and there should be no disagreement that it is fragmented. Continuity of care is minimal, and even when there are processes in place to support such continuity, the information is either uninterpretable, useless, or arrives too late to inform immediate treatment decisions.
In one of our From the Field feature articles (page 48), Pecora et al share information from a meeting of health care professionals in Aspen, Colorado in early 2023. Representing various stakeholder perspectives, including legal/regulatory experts, government and commercial payers, technology vendors, and physicians, participants shared their thoughts on how to improve health care to deliver consistent high-quality care and outcomes, reduce unnecessary costs, and make care more affordable and accessible. While their conclusions and solutions may seem obvious, the value of this piece is in keeping these issues at the forefront of discussions in value-based care. They conclude that “self-imposed problems have tied the health care industry into knots with no clear path to untie them” and recommend that “tearing down the barriers and replacing them with innovative and effective alternatives is needed and can be achieved if we continue to talk to and not past each other…”
Coming at this disjointedness from the employer perspective, our Transformative Employer Trends column (page 62) discusses persistent stakeholder disconnect, middleman distractions, and misalignment with siloed disengagement. These problems leave employers and other commercial plans or administrators seeking solutions as they face emerging risks. The authors contend that efforts to support plan members and deliver clinically appropriate, cost-effective therapies with ever-improving outcomes are increasingly falling short, with numerous public lawsuits and research exposing the issues in pharmacy benefit offerings, pricing, or claims. Especially as it pertains to costly precision therapies, traditional and contemporary health care management strategies have not solved for the inequities that are rapidly emerging around precision cell and gene therapies for patients, providers, and plan sponsors. Continuing the traditional path of siloed vendors, management, and cost is no longer a sustainable option.
As we all strive to fix the health care system, we at the Journal still believe that clinical pathways have an important role in controlling cost and optimizing outcomes. However, their utility has evolved, with pathways moving from a necessary tool to reduce treatment variation and cost to becoming one of many ways to manage the entire patient journey, the total cost of care, and outcomes. With this evolution in mind, I am pleased to announce that the Journal of Clinical Pathways is retiring our old tag line, “The Foundation of Value-Based Care” in favor of a new tag line, “Advancing Value-Based Care.” This helps reflect the continuing need to balance cost and clinical perspectives in health care without losing sight of the end goal, which is delivering the best patient care.
The Journal of Clinical Pathways is always open to receiving your submissions highlighting your work and research in the space throughout the year. Manuscripts can be submitted at www.editorialmanager.com/jclinpath.
