Zeke Emanuel Speaks About Transformation in Healthcare

On October 15, 2016, the Solomon Center for Health Law and Policy hosted Professor Zeke Emanuel for a talk on transformation in the healthcare system. He provided a preview of his forthcoming book on providers that have transformed how they care for patients—and offered some political and policy insights into the options that might be pursued by those who want to repeal the Affordable Care Act. Professor Emanuel is optimistic that many of the transformations he writes about have been so successful in reducing costs and improving outcomes that they could survive and spread even if the next Congress makes major changes to the ACA.

Professor Emanuel’s book is based on extensive qualitative research with a variety of providers of many types. These providers have the data to prove that they have successfully improved patients’ health while reducing costs. He found that some of the biggest impacts come from paying attention to seemingly small moments of interaction. Changes in scheduling practices get patients in to doctors sooner, preventing the escalation of minor problems, strengthening provider-patient relationships, and decreasing time wasted by missed appointments. Truly effective care management is essential but does not need to be high tech or even overly medical. One key, says Emanuel, is hiring genuinely empathetic people, situating them directly in a provider’s office, and empowering them to connect regularly with the patients who are struggling.

A number of providers have discovered the power of transforming rooming. According to Emanuel, the process of walking patients into the examination room has traditionally been given little thought. Transformative practices have reconfigured the work of the medical assistants who do this job. Now, medical assistants don’t just walk the patient to the room, take the patient’s blood pressure, and leave. Instead, they schedule any outstanding preventive services, such as a mammogram or cholesterol testing. They find out why a patient has come in and pull up any relevant past test results or history in the electronic health records (EHR). And they complete all preliminary information on the current visit in the EHR. When the doctor then walks into the room, she can focus entirely on the patient’s current needs, with minimal time spent staring at the screen. Emanuel reported that, as a result, patient satisfaction goes up, employee satisfaction for both the doctor and the medical assistant goes up, preventive service gaps are closed, and overall patient health improves.

Professor Emanuel also called out the importance of increasing our focus on behavioral health. According to Emanuel, mental health has become the third most expensive healthcare issue in the United States. Patients with behavioral and physical health co-morbidities cost hundreds of dollars a month more than patients with the same physical conditions. One transformative solution is the co-location of behavioral health providers in primary care clinics and offices. Professor Emanuel described a practice in Hawaii where such a co-location, even on a part-time basis, has substantially improved outcomes for patients whose initial screening suggests mental health issues.

Ultimately, Professor Emanuel concluded that the inescapable need to slow the growth of medical costs is creating a sufficient crisis for many healthcare providers to incentivize leaders to step up and transform their practices. Moreover, Emanuel says, there seems to be substantial bipartisan support for payment reform efforts in Congress. The Medicare Access and CHIP Reauthorization Act (MACRA), which ties a portion of Medicare payments to quality metrics or programs, was passed by a Republican Congress last year.