Early this year, the Singapore Ministry of Health announced that the country’s public healthcare sector will undergo major restructuring. The six current regional health systems will be regrouped into three integrated clusters (West – National University Health System; Central – National Healthcare Group; and East – Singapore Health Services), while a new polyclinic will be established in western Singapore.

The aim of such reorganization, according to Health Minister Gan Kim Yong, is to “better optimize resources and capabilities, and provide more comprehensive and patient-centred care to meet Singaporeans’ evolving needs.”

In the recently concluded Singapore Health and Biomedical Congress (SHBC) 2017 held at the Singapore Expo, Chief Medical Officer and Global Director of Healthcare Transformation at IBM Healthcare and Life Sciences, Dr Paul Grundy, expounded on the elements needed to achieve  effective patient-centred care.

Putting patients first

Speaking before the 3,500 SHBC delegates present during the congress’ opening ceremony, Grundy stressed on some of the pain points uncovered in the old system which he referred to as the ‘Master Builder Model’ (See Figure 1). According to him, this model –  one in which the doctor is the centre of the delivery system – has already failed healthcare professionals in delivering quality care for the patients.

Figure 1: Master Builder Model
Source: Foundation for Healthcare Transformation the Patient-Centered Medical Home by Dr Paul Grundy
Figure 1: Master Builder Model Source: Foundation for Healthcare Transformation the Patient-Centered Medical Home by Dr Paul Grundy


“We’re moving past the information age, and moving into the age of intelligence,” Grundy said.

“All of us, physicians, are somewhere between a hundred and a thousand years behind our reading—we cannot keep up. We do not have the ability to stay on top of [the Master Builder System]. The dilemma of the burning platform, the dilemma of information overload is really forcing us to think about a new way of looking at how we are going to do healthcare,” he explained.

Grundy then introduced a new model—one that puts the patient in the centre of the system (See Figure 2). The new model, Grundy noted, helps aid the human dilemma that the Master Builder Model failed to address.

“The data is no longer stored in the doctors’ heads, it is shared by a team of people who have access to the information,” explained Grundy.

While the Master Builder Model’s focus is on the patient visits, the patient-centred model places more importance on the patient’s overall health. Additionally, while the Master Builder Model focuses more on providing routine care to high-risk patients, the newer model identifies and manages high-risk patients, which in turn helps in promoting the patient’s health.

Figure 2: Patient-Centred Model
Source: Foundation for Healthcare Transformation the Patient-Centered Medical Home by Dr Paul Grundy
Figure 2: Patient-Centred Model Source: Foundation for Healthcare Transformation the Patient-Centered Medical Home by Dr Paul Grundy


Building patient trust

What is the foundation of the healthcare delivery system that works? According to Grundy, it is patient trust.

“Patient trust must be at the core of any system that you have for delivery — if you do not build it, your system will fail,” said Grundy.

He enumerated the key principles of ‘Medical Home’ that help build patient trust:
  • Personal healer – making sure that the patient has an ongoing personal relationship with the physician
  • Whole person orientation – the physician is in charge of providing the patient’s healthcare needs as well as arranging care with other qualified healthcare professionals
  • Coordinated and integrated care – across all elements of complex healthcare community
  • Safety and quality – patient care decision-making must be guided by evidence-based medicine
  • Enhanced access to care – enabling open scheduling, providing new communication paths and afterhours care
  • Payment is appropriate – added value provided to patients who have a patient-centred medical home


Value-based care components

Reminding the audience on the importance of population involvement in order for a system to work, Grundy remarked: “When you begin to build a delivery system that works, you will need input from your citizens.”

“You’re going to have to understand your population, down to an individual case — everyone has to have a plan. These elements are those built on a data foundation of trust.”

He also shared several pointers to aid healthcare professionals in delivering value-based care to patients. These include risk analytics or the management of contracts, and quality and cost reporting; practice analytics or the cost of care analysis, physician efficiency profiling, and drug profiles; case management or the patient risk stratification, medication, and referral management, as well as population management or the visit, RX and lab compliance, and readmissions.

All in all, Grundy emphasized on banking on the data that healthcare professionals can access and study.

“Data is going to do for our mind what X-ray and images have done for our vision. It used to be like shadows we look at, now it’s like an anatomy that we’re looking at. I am optimistic of what data can do to improve practice outcomes and enhance patient care,” he concluded. MIMS

Sources:
https://www.moh.gov.sg/content/moh_web/home/pressRoom/pressRoomItemRelease/2017/reorganisation-of-healthcare-system-into-three-integrated-cluste.html
http://www.nhsconfed.org/~/media/Confederation/Files/Events/ACE15/0900%20Dr%20Paul%20Grundy.pdf