Dr. Richard Freeman, vice dean of Clinical Affairs at the Dell Medical School at The University of Texas at Austin, was recruited to the school's inaugural faculty to help design and implement new models of care. Freeman's initial focus is improving specialty care through a model known as integrated practice units, or IPUs.
In his experience as a transplant surgeon, Freeman typically practiced medicine as part of a team consisting of a pharmacist, a behavioral health specialist, a nurse coordinator, and other caregivers from different medical and surgical disciplines. This integrated team coordinated efforts to provide the necessary care for a patient. This framework is similar to how care will be delivered in the IPUs the Dell Medical School is launching in November 2017 to deliver value-based care to the community.
Integrated Practice Units and Value Based Care
When care is reorganized through IPUs, the individual members of a multidisciplinary co-located team can step in where they're most needed and treat specific conditions and needs of a patient in a more efficient and successful way.
"The idea of an IPU is to say, 'ok, someone with a specific condition or disease doesn't necessarily need to see the doctor for all of the things that could help improve their health,'" said Freeman. "In fact, there are members of a team that are specifically trained to deliver parts of that care that are better equipped than the physician. For example, the pharmacist when a complicated drug regimen is necessary for a patient's care."
Today most health care is paid for through a fee-for-service model. In this model, doctors are paid to do procedures and see patients in clinics.
In fee-for-service models, a provider may not bill for a pharmacist to manage medication, drug interactions, and patient compliance.
"Value-based care is aligning the payment structure with what outcomes patients and the community want to improve health," Freeman explains. "It's changing the payment system to be directly aligned with improving the health of the population."
To deliver value-based care and achieve the best results for a patient and ultimately the community, a wide range of professionals have to combine and focus their efforts.
In an IPU, the team of physical therapists, doctors, pharmacists, and others are paid to provide physical therapy, manage medications, and treat related conditions. Many patients can be kept out of the hospital and avoid surgery, something patients and providers both want.
Technology, Design, and the Patient Experience
IPUs are also being designed to improve the patient experience. Studies show patient experience influences how well a patient complies with treatment and perceives the effect of a medical intervention.
"You can take [IPU model] way out to one end of the spectrum and say, 'Well that's what Starbucks does.' They're not developing health care services but they very carefully craft their experience so you comply with them, meaning you'll go back to them as a customer," Freeman said.
To get the best patient interaction with an IPU, these experiences have to be designed so patients are more likely to return and engage with the different components. It requires designing every step to ensure a patient isn't lost before, during, or after their first visit.
In the not so distant future, Freeman said, technology will go so far as to replace in-person follow-up appointments with secure video conferencing, allow patients to give video tours of their homes so an IPU can identify health risks (i.e. throw rugs in the homes of the elderly who are prone to falling), and even relay vitals to a doctor through wearable devices.
"In a very low-cost way, we can gather some of these really important determinants of what your health is and then we can synthesize that into a larger data system and begin to understand," Freeman said. "It all goes back to value-based care."
With the help of design and technology, the patient experience will improve, the system will save money, and most importantly, the health of the community will improve.
The Future of Travis County
With IPUs reorganizing care around the patient and incentivizing healthier outcomes and better patient experiences, the future of Travis County health care is looking bright. Design and technology will lend a helping hand gathering patient information, relaying this information across the system efficiently, and develop measurement for population risks.
Through value-based care and IPUs, the focus will become getting the best results for the patient, as well as creating the best results for our community.