Community-based care can be viewed as healthcare systems’ way of becoming more patient-centric, by shifting care where possible, closer to the people who need it. Moving the right care to the right setting, at the right time enables providers to intervene sooner when better outcomes are possible. This approach also allows for care to be delivered in a more cost-effective way (without expensive hospital infrastructure and overhead), and in a more readily accessible and convenient manner for patients.
The results of the 2021 Healthcare CEO Future Pulse illustrate that the shift into community-based prevention appears to be catching on – by being integrated into corporate strategies (35 percent), or by being put onto organizational agendas (46 percent); however, substantial implementation of this is still limited (9 percent). Despite respondents representing hospitals, health systems, and integrated provider networks, implementation progress is not vastly different – at 7 percent, 11 percent, and 9 percent, respectively. Despite this being potentially perceived as an existential threat to hospitals, they are not averse to this thinking, with only 12 percent identifying this as something they are not addressing at all; this is consistent with the suggestion that hospitals are open to focusing their efforts on higher value care.
The shift to community-based care not only refers to infrastructure, but in enlisting the community to support the burden of an aging and growing population with increasing multi-morbidities. Nearly two-thirds (65 percent) of CEOs expect communities to substantially contribute to collective and individual health. Many (70 percent) expect hospitals themselves to evolve into ‘healthcare hubs’ where more complex care is delivered, while the ‘spokes’ of primary care are embedded in the community through multispecialty clinics, primary care physicians, and digitally enabled monitoring.
This aligns with what Sarah Downey, president and CEO of Michael Garron Hospital, a community teaching facility in Toronto, Canada wants for her organization:
“Our vision is to create health and build community. We understand that it’s not simply by treating acute conditions that we’ll improve the health of the people we serve. It’s through a broader view of health and partnerships that we’ll help transform lives and empower the people in our neighborhoods.”
President and CEO Michael Garron Hospital
The survey data suggest that Downey is progressive compared to other respondents. While many executives (63 percent) said it’s important to shift delivery of care out of hospitals and care facilities and into the community, fewer than one fifth overall (18 percent) are investing time and resources in this area. Even greater disparities play out when looking at shifting from cures to prevention, and from in-person to digital care. Herein lies the gulf between dreams and reality, healthcare leaders know what they need to change; but transformation will not happen without substantial investment of staff time and resources.
There’s recognition that systems often take the shape of how they are paid. To get from dreams to reality is not only an issue for provider organizations realigning their investment plans. Reimbursement systems should be aligned to stimulate necessary transformation. Figuring out the financial rewards will be difficult, says Rob Webster, CBE, chief executive of South West Yorkshire Partnership Foundation Trust and lead chief executive for the West Yorkshire and Harrogate Integrated Care System in the United Kingdom, thanks in great part to long-held standard practices in his country. “We have a tariff-based system that incentivizes acute care but we are required to manage multi-morbidity and prevention in the community,” he says. “Is it a surprise that we’ve got more hospital consults and money spent in hospitals?”
Before business models, financial incentives and even data structures can be aligned, healthcare leaders must fundamentally believe in the importance of, and value found in, community care. At the highest levels, an active decision must be made to engage with one’s community if one expects to serve it. “You need to decide that working together is better than working apart,” Downey says, “And that we’ll figure it out together.”
Community-based care is a model of creating more sustainable systems that can manage costs, enable access, and improve patient outcomes by intervening sooner and closer to patients.
Health leaders should strive to be agile and flexible in their thinking by forgoing lower-complexity, lower-value care, and focusing their efforts and expertise on more complex care that can yield better reimbursements and allow their practitioners to deliver greater value. In doing so, they’re making an investment that aligns in a value-based agenda.
Health systems should consider how adapting incentive structures that incorporate a broader ecosystem of partners (beyond traditional care providers) can support delivery of outcomes
How to take action
If care is truly a ‘team sport’, health leaders should expand who’s on their team, and how they ‘win’ together around patient outcomes through integrated care strategies. This requires a shared vision and goals for the future, technological integration, governance frameworks, shared incentives, and handoffs between care providers, and for communities, and patients to get involved in care delivery. By focusing on improved patient outcomes and experiences as common causes, health leaders can mobilize the right players, create accountability frameworks and recognize the appropriate roles for each player. By laying these foundations, payers and commissioners can align reimbursement to incentivize value.