Mapping the pathway

(This is the eighth in a 10-part blog series on industry trends that are shaping the future of healthcare. To see a report on all ten trends click here)

Despite the very thorough and regulated processes used to dictate care pathways in our healthcare system, there exists a troubling gap in the process, where patients can easily fall through the cracks. In the hospital, staff are focused on using evidence-based checklists, treatment guidelines and care pathways to enhance efficiency during the inpatient stay and improved outcomes at time of discharge. Concurrently, physician practices are focused on coordinating and streamlining care across the outpatient setting. This “protocolization” of care is a positive development being spurred by health system payment reform that is increasingly geared to reward provider cost-effectiveness and penalize untoward outcomes such as non-reimbursable “never events”.

It is the space between these two systems where the gap emerges.

The time between a patient’s discharge and their enrollment into community care can be a treacherous minefield of deleterious clinical events that can have profound quality of life and economic consequences. This gap in care coordination leaves the patient (and caregiver) in a world of disconnected health information and uncertain health events.

 Until this gap is closed – possibly through integrated healthcare delivery networks that combine primary, secondary and tertiary care under one framework – the system is putting patients, providers, payers, policy-makers and life science companies at risk.

How should biopharma respond?

In the near-term, life science companies can proactively engage with patients during the time between hospital discharge and patient enrollment into community care – a critical phase in their treatment journey – and help them navigate this unchartered territory. Similar to the robust reimbursement support and patient assistance programs that have been rolled out over the last decade, new programs are warranted that reaffirm discharge planning, provide continual information feeds on expected risks and benefits during this post-discharge period, and bridge the patient’s treatment plan to the next checkpoint in the community setting. In addition to patient engagement, life science firms can connect hospitals and physician practices with patient monitoring information in order for providers to optimize and customize treatment plans.

Payers, providers and patients all stand to benefit from a reduction in untoward events, such as hospital readmission or delayed community care engagement, precipitated by noncompliance with discharge planning. Closing this gap in care will open opportunities for the life science sector to improve health system value and population outcomes, as the requirement for demonstrating product value continues to build.