Analyzing Healthcare through Embedded Criticality with Sachin Jain

Introduction 

Poor social conditions have always been a big hindrance toward healthcare accessibility. We witnessed this, like never before, during the recent pandemic. Healthcare for the homeless has always been one of the biggest challenges faced by the healthcare industry. As a large part of the U.S. population, physicians, healthcare reformers and government officials have battled endlessly with efficient ways to provide care to homeless patients. A scalable model, that’s easy to replicate, and guaranteed to succeed has been a long-standing need. Will the application of innovative solutions and a fresh mind-set bring in the much-desired solution? Let’s find out.   

Challenges with Current Healthcare Systems  

The current Medicare fee-for-service or Medicare Advantage model has a host of challenges: 

• Non-coverage of dental care and ophthalmological care 
• Episodes of denied care 
• High wait-times and care delays 
• Provider access issues 
• Low Accountability 

Adopting Principles of Managed Care 

The first approach should be towards preventive outpatient services, as opposed to expensive, reduced value-added inpatient services. When this approach is applied to the homeless population, it addresses the main cost concern. The intelligent allocation of healthcare resources and technologies toward managing the homeless population has been a tested success strategy. Building intensive primary care or behavioral health care opportunities can reduce the likelihood of homeless patients requiring acute care settings, which in turn can lower the total cost of care.  

Managed care should be designed with a goal of applying the utmost effort toward keeping the homeless population out of hospital management. Stabilizing or managing care is a successful strategy that avoids high costs from ICU stays and other intensive units. An efficient strategy toward this end has been the regular visits of healthcare workers to homeless shelters to provide flu and COVID shots. It naturally mitigates the challenges of accessibility and costs.  

A Fresh Viewing Lens  

The healthcare industry needs to start viewing the homeless population health from a fresh perspective. The traditional approach is one where it is assumed that homelessness has been brought on due to a housing supply issue. However, closer analysis suggests that homelessness is often caused due to the attached healthcare component. One where care costs were so high that it eventually led to homelessness. This fresh healthcare view-point functions with an equal balance between care and connection. It can start with efforts as basic as feeding the homeless population. The real critical component here is a check on the authenticity level of healthcare organizations and their desire to provide care in its true form.  

The healthcare industry needs to view patient care management with a higher level of accountability. ‘Care’ is the critical word. Higher the accountability and transparency, easier it’s to mitigate traditional challenges on a deeper level. It will also allow for easier structural changes.  

Healthcare First Model  

The general perspective has always been to build a housing first model. The new reality demands building a healthcare first model, with a singular quality metric attached to it. It would be prudent to approach the care-giving approach with the goal of ensuring that the patient is housed by the end of the care-giving service. This makes healthcare the entry point toward housing.   

The crucial path towards building a functional model is to understand the user’s needs, to adopt a patient priority perspective. The patient’s needs should be at the forefront of the structuring of the program. The best way to identify these needs is through actual involvement on the front lines. This is bound to create a clear understanding of the needs of the population and will result in a more scalable solution. Another advantage of hands-on involvement is the ability to accurately identify the defects of that particular care system. It provides a case-by-case witnessing of, for example, the inability of a patient to access medical transportation, or a rebate, or prior authorization. Solutions are much easier to design when the healthcare problems are more thoroughly understood. The goal is not to build a solution, but to cure the problem.   

Reality-Oriented Models    

Many models sound functional theoretically. However, the reality of it is very different. Let’s consider the home-based care model. When this idea was suggested, healthcare organizations seemed to be lapping it up as a much-needed solution to most caregiving requirements. The reality may be quite different. A dialysis patient, receiving care at home, can create more difficulties than ease. Without a sole focus on the technology or solution in question, healthcare workers need to consider the difficulties involved with providing this care at home. The physical difficulties associated with this kind of caregiving, within the home environment, make it an impractical solution. A good model doesn’t always work, but patients are forced to adopt it due to the reimbursements involved.  

Reality-oriented healthcare models are good but also work well. They address the sorting problem, wherein the right people are assigned to the right job. The idea of shifting care duties toward people who are neither trained nor physically able is a big hindrance to the home-based care model. The costs may have been reduced, but so has the care outcome. It’s almost as bad as appointing fresh medicine graduates to the sickest patients. Even when supervised, this is a risky approach. High need patients need high-quality care and that’s a basic healthcare reality that cannot be ignored.   

Conclusion 

As we move along the evolved culture of patient-centric care in the healthcare sector, the patient has never been as empowered as now. As essential as the process of providing care is the value being seen in a well-informed patient that accepts and works toward their own welfare and quality of life. When patients are misinformed or lack information, their choices and decisions can go against physician advice and cause a deterioration in health. Healthcare for the homeless requires a basic approach that holds the patient as the priority. Explore more interesting topics and listen to insightful podcasts related to healthcare only on CareTalk.  

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