Team Care for the 21st Century

Newtown, CT - October 2, 2015

350 million people, 350 million networks - On Wednesday September 30th, at a NEJM-sponsored event in Washington DC, Dr. Bas Bloem, a neurologist from the Netherlands, explained how he had launched an innovative solution for the care of patients with Parkinson's disease, ParkinsonNet. The concept is pretty simple. Every patient gets his/her own network. In the US we call these "pods", and Sarah Singer, who was co-presenting with Bas, calls them teams. The personal network surrounding the patient in ParkinsonNet includes a physical therapist, a neurologist, nurse, home health care specialist and others. Each team is calibrated to meet the specific needs of the patients. For example, patients without caregivers will get more home health and other support to reduce the prospect of isolation and depression. Dr. Bloem is now experimenting with COPDNet and his research suggests that these personal networks can be extended for all different types of conditions. The glue that keeps the teams together, much like teams in other companies in other industries, is on-going and active communications and sharing of data. The fuel that powers them is a bundled payment. They exemplify our oft-quoted theorem that form follows function and function follows incentives.

What this means to you - During the Q&A portion of his talk, Bas was asked how many networks he thought would be needed to produce the type of care delivered by ParkinsonNet to all the Dutch. His answer was simple and to the point. There are 50 million people in the Netherlands which would require 50 million networks. I could tell that the US audience during the event, which was mostly made up of clinician leaders and policy makers, couldn't process Dr. Bloem's answer, and yet it's not that difficult to understand if you take the patient's perspective. In a truly patient-centered health care system, it's not the plan predetermining the network, or some health system stuffing a patient into its network. Rather, patients assemble a team based on their specific needs. For some, that "network" will be a retail clinic, a pharmacy, and perhaps a nurse practitioner. For others it could be a far broader team that includes clinicians from different specialties and a PCP. Much like in ParkinsonNet, the glue to make this all work would be the free-flow of information, and we proposed solutions to that issue in a recently released RWJF report. The fuel would be a blend of episode-based payments adjusted for the severity of the patient and other payment modalities. Some will say that consumers can't possibly put these personalized networks together, and yet consumers assemble networks of professionals constantly for all types of services and coordinate all that activity at home and at work. There are many apps that make those tasks easy and those apps could be adapted to health care. Information on cost and quality is becoming freely available and more widely deployed. The only ingredient that seems to be missing is the imagination to get it done. Bas Bloem has provided us with the seed of the model that could complete the image of a truly patient-centered health care model. Not the one that physicians or health systems talk about, which is really a provider-centric model that tries to cater to patients, but one in which the patient is really in charge. It's a terrifying thought for many, but an exhilarating one for us.