Hi this is James Fricton again and this is the third part of the module on transforming the healthcare system. And the, this lecture is about what are the steps that we can take to really make changes in our healthcare system? It's, I do not believe we cannot overcome the barriers that we talked about. And address the problems. And, and there are some simple steps that we can take to make those changes. But we need to get to the root of the problem. We have to really change all the way from our model of care to our paradigms that we, we have with regard to our care, to what are the care strategies that we use? As well as, how do we deliver those strategies? And so every aspect of the system needs to change or tweaked a little bit. We don't want to throw out the good stuff that we have. But we really want to be able to, make substantial changes on how we understand health and illness and how that plays a role in healthcare. So these are slides that I presented in module 19. Also that we've talked about, a broader model of care. And so I'm going to reiterate some of this just to emphasize how important it is to make these kind of changes. So we need to learn a new, broader model of care and this whole course is about a human systems approach. And so we need to basically ring out the old and ring in the new. With a new approach where we not only identify the diseases, the conditions, that are causing the pain or other symptoms. But also those contributing factors, those risk factors and protective factors that play a role either in increasing or delay in recovery, increase in illness. Or in protecting us from an illness. We need to be holistic, we need to establish these long term relationships with our patients. Need to be more processed versus procedure oriented and finally we really need to look at broad based outcomes not just symptom reduction. And pathology reduction but also how does it impact our life and our function and quality of life. So once we understand that a new model of care and we begin to think about illness and patients and health and wellness we then need to shift our paradigms. That's the language that we use when we talk to patients. Or patients in what we understand how the, how illness and health and wellness work. So here's some of the paradigms and we've discussed this throughout the entire course. But let me just summarize again. We have to assume that everybody's multidimensional. That we all have these seven realms and we have risk factors and protective factors. And we have to address, address and identify all of those factors. And by, and that helps us understand the whole person. And then we need to focus on self responsibility, patients need to know that they are responsible for their health. That we can certainly provide treatments that will help have an impact on reducing illness and improving health, but really most of the, the impact that a person has on their health and illness is based on the patient. And thus, as a result they need to engage in self-care. We, as health professionals, need to provide the training and education of patients, as well as part of our routine care. 80% of a patient's success is based on what they do, 20% is based on the evidence based treatments. We need to provide that 80%. And then we need to create these long-term sustainable changes, when patients realize that change is not a quick fix, but it takes six months to a year, really restore health from a illness, because, lifestyle changes, relationship changes changes in the pathophysiology of a condition, just take time. And with, and with regard to the care strategies, we really need to focus on these multi-level care strategies. I know it gets more complicated when we do that, and it's hard to ju, just change our workflow. We have to work as a team. But it's not impossible. In fact, it's a, can be a very, pleasurable experience in the care. So, we want to continue to provide our medical or dental interventions but we really need to focus on these three things first. We need to teach patients about daily personal wellness, prevention of chronic pain and other illnesses. We need to do early detection and not just detection of the condition. But also early detection are variations in risk factors and protective factors. We need to, again, enhance protective factors, reduce risk factors. But also provide the medical intervention. And this is the proportions that we need to focus. Most of it should be on this and then we need to provide this in the cases that are really needed. Then these care strategies need to be integrated into a process, a care process, and to really make this effective. And I know I talked about this in the last lecture, the last module but, we need to be strong partners and realistic expectations with regard to patients. We need to be empowering and motivating a patient. We really need to explain the fact that they have most of the impact on their illness. We need to help them gather social support. We need to provide that support for patients, but they also need to get the support from the people around them so that everybody is really focused on how to have a good life, how to have, be healthy and happy. And that, that everybody has that same goal of being content. But in every case it does go up and down. We need to measure these multidimensional outcomes that I mentioned before. And of course in the, in the end these changes will really result in a transforming of person's life. One of illness, or chronic illness, to one of really health and wellness. This is what we really want to achieve for our patients. So transformative care I believe, is a solution to our healthcare problem. And it's a simple solution. It's simply integrating robust self management training in with evidence-based treatments. We, right now, do a great job with evidence-based treatments, in our clinics, and all over the, the surgeries, the medications, the therapies that we provide can be very helpful. But, at the same time, we don't do a very good job in self-management training, so. The four Ts of transformative care. Test to identify not only the diagnosis but the risk and protective factors through these personal assessments. We need to train patients in reducing these risk factors and enhancing protective factors. We need to treat with evidence based treatments, medications, rehab, surgery if indicated. And it takes a team to do that. Whether it's a physical therapist, a health educator, a clinical psychologist a health coach integrated in with our medical or dental treatment. I think is really important. But transformative care is always going to have to occur with in a health care delivery system. So, we need to focus on a new model for providing care, particularly outpatient care. And that's the three I's of changing our care delivery. We need to be interdisciplinary, integrative, and individualized. Interdisciplinary means that we have to work on a team as I just mentioned. And we need to integrate somebody who's going to train the patient. A health coach, therapist, psychologist, to train the patient on what they need to do as well as integrate with physicians, dentists, and other health professionals to provide that evidence-based care. Integrative really means that we need to integrate different models, care models as well as treatment strategies together within a program. We understand that for instance, certain treatments all work in different, with different mechanisms. And by adding those treatments together they are Ssynergistic. In other words they can all have a bigger impact on reducing the illness, but then when you add that on top of what the patient can do. Whether it's working on posture, reducing strain, reducing stress and sleeping better, eating well, losing weight, whatever those lifestyle factors are. By integrating those changes with the treatment you're going to have a much better success. And it needs to be individualized. Every patient that comes to my clinic is completely different in terms of the risk factors and protective factors. I do an assessment and develop and individual treatment plan based on their characteristics. And, we follow them over time based on their needs, their goals. What do they want to change? And we understand that not everybody's going to be able to change everything right away. It's a process that you go through and that's what's important about the relationships. But, with any care delivery system, it's really the economics, as I talked about with regard to the barriers. The economics need to change. There's no question about that. Our health care system's very expensive, 5% of the gross national product. And we need to focus on how do we achieve better health with less spending? And here are a couple of characteristics that are recommended. One is, of course, transparency. Patients need to know how much it's going to cost for me to get care for this condition. Bundling of fees is one way to really do that, and to open the book on fees. Well, you say, well, I don't know what my fees are going to be. Well, predict it. When you integrate a care model like transformative care, you will see the patient for six months and you can predict the total services that are involved in that and bundle it together. Health plans should be open to the possibility of doing this. We need to reward consumers, whether it's reducing health plan fees or deductibles for positive behaviors, being involved working with the health coach, improving lifestyle factors. We also need to reward healthcare providers. In other words, we need, healthcare professionals, need to be reimbursed for this risk assessment, and the time and self-management training. And there are codes that can do that now, and I'm happy to share that on a handout as a part of this course. And so, we also, need to be paid for outcomes. If we're successful in achieving, a transformation, a reduction in pain, so that the patient has now, for the rest of their life, control over their pain conditions. That saves an enormous amount of cost. And so by doing that we need to really make sure that we collect this type of data as part of routine care. And then share in the profits, so that, that accountable care organization concept is something that's useful not only for hospitals but perhaps for all health professionals and as I mentioned, also covering bundled care. So, with this approach, I believe that you will overcome both financial barriers, work flow barriers. Training barriers are going to be a little more difficult but we need to bring this knowledge into academic health centers. And finally consumer barriers. And healthcare will be transformed. This will be a triple win which is pretty unique. By making it successful for health plans and industry. By providers, clinics, and hospitals, so that they don't go bankrupt, so they're able to pay their bills, and, of course, the most important thing is the patient, gains by improving their condition and control, long term, as a result of self-management. So thank you for your attention. [SOUND]
