Live from HXD: From One-to-One to Many-to-Many

From One-to-One to Many-to-Many, by Danielle Hicks

Value based care means caring about outcomes. How can we move from a one-to-one ecosystem to an ecosystem with tools that can do many things?

Traditional, encounter-based model of care

This model is a bit limited. Patient goes to a provider. The Medical assistant shows the patient to the exam room, the provider answers the patient’s questions, then charts the encounter. But providers aren’t the only people who can care for patients.

Other people who care for patients:

  • Clinical support staff
  • Chief medical officer
  • Practice manager
  • Care manager
  • Quality manager
  • Patient outreach
  • IT staff

They all participate in caring for a patient. Some of them chase data around patients’ charts, or the document everything, or handle billing. And they may give vaccines, or referrals, etc.

Their complaints are a symptom of a flat, encounter-based, single-patient-focused care model. We don’t want the one-to-one model to go away, but we also need a model that describes the varied relationships between healthcare professionals and patients.

Inverted care pyramid: value based care

Value based care can be viewed through an inverted care pyramid to look at the jobs to be done. The upper layers don’t have a lot of depth; the lower layers can’t scale.

  • Strategic population-based work. For example, a quality manager and care manager identifying patients due for a visit.
  • Care management. For example, care manager reminding patients about a nutrition clinic via text messaging campaign.
  • One-to-one. For example, someone on the support staff queues up A1C orders.
  • Patient action. For example, a patient’s care giver helps prep their medications for the week.

People occupy multiple layers. So a patient may be addressed at all layers, and also a certain HCP may send text campaigns as well as work one-on-one with a patient.

This tool helps to consider non-clinical team members and other personas who are participants in the patient’s experience.

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