Communication, Coordination and Mass Adoption of Value-Based Care Can Cure Healthcare Quickly: Belle’s Q&A with Cheri Lattimer

Cheri Lattimer is an RN by training and has worked at all levels of care. She is a valued member of Belle’s strategic advisory board. Cheri has held various leadership positions including Administrator for the Case Management Society of America and Executive Director for the Transition of Care Coalition. Cheri also maintains active roles on several national boards and committees including URAC, Roundtable on Critical Care Policy, CMS Caregiver Workgroup, ACHIEVE, and American Nurses Association. We recently sat down with Cheri to explore a range of healthcare topics.

When you look at the year ahead, what is one of the biggest priorities you want to see addressed?

One of the top concerns for the year ahead is addressing misuse of opioids. How do we use pharmacists, case managers and community health workers to improve transitions of care from in-patient facilities to rehab to home? How do we keep patients and their caregivers more informed and connected to the care team? This is top of mind for me.

There has been a lot of discussion in the industry about the importance of assessing and addressing social determinants of health. How do you think we’re performing in this area?

Social determinants of health (SDoH) have a significant impact on overall health and specifically on readmissions. You can have the best plan in place, but if an individual is struggling with unmet SDoH needs, that plan can be easily derailed. Over the last half decade, we have seen a great deal of progress in the completion of SDoH assessments, but once you identify gaps and barriers, what do you do with that information? We don’t always see a consistent response across the care continuum. Even if we have a solid initial response to these needs, how well are we making sure we pass this information along during the next transition of care? And then there is the occurrence of checkbox medicine, where providers ask the right SDoH questions, document responses and move on because they have fulfilled their responsibility. The bottom line is that there is still a lot of work for us to do in this area.

What’s your take on the growing trend of moving healthcare into the home?

I care most about improving coordination of care and ultimately making a positive impact on clinical outcomes and patient satisfaction. The number one way to accomplish that is by understanding an individual’s home environment and gaining consistent access to the home in order to build continuous patient relationships. This allows you to provide education, support and referrals while working closely with the individual, their care team and their caregivers. We know from data, that patients will often say yes to their doctor, but follow through is difficult once they leave the office. So, intervening consistently with them between visits is really important. Being in the home allows us to accomplish this.

If you had a magic wand and could change one thing about our healthcare system, what would it be?

The biggest issue with our healthcare system currently is communication. If I had a magic wand and could immediately fix one thing, it would be putting every organization on the same technology system so everyone could communicate with one another. It doesn’t matter how well we each do things within our silo, if we can’t effectively follow the patient throughout the care journey.

How do you feel about the influx of technology in healthcare, and where we are headed?

I am excited with where technology is headed. Take utilization management as an example. In fields such as cardiology or orthopedics, if you leverage AI, you can process an initial decision on next steps within 120 seconds. That is amazing. Additionally, there are technologies aimed at supporting patients with dementia and Alzheimer’s that allow these individuals to live safely at home instead of a facility. There is also technology that allows residents to simulate surgeries and learn virtually versus practicing on live human beings.

Even more practically, we should continue to be smart with how we use technology to prevent unnecessary in-person visits. I’ll give you a personal example. My daughter-in-law took one of her three children in to the doctor for pink eye. The doctor wrote a prescription. A few days later, one of her other children caught pink eye. The doctor required her to bring the child into the office to get a prescription, instead of handling it virtually.  This type of scenario has to change. Technology can help us change it. But also, we have to move away from fee-for-service, because that was the ultimate motivation for the unnecessary visit.

You’ve mentioned improving communication across the healthcare system, and also moving away from fee-for-service so we can do the right things for patients. What will it take for us to see progress on these fronts?

We are applying a lot of band aids right now, so I’m skeptical we will see dramatic improvement in the short term. That being said, if we treated these issues like we did the transition of billing forms back in the day, we could solve for them. It didn’t take long to move to a new way of billing when payment depended on it. We could move with the same speed in terms of improving the ability to communicate across platforms. The same goes for value-based care. When Medicare or commercial plans decide they will only pay for value-based care, we will see mass adoption of value-based care. It’s much more appropriate. It’s the right thing to do. But I am not sure what the path forward is unless we legislate this as the payment structure.

It seems there is more we can do for chronically ill individuals in this country. This also seems to be a priority for CMS. What are your thoughts?

CMS obviously cares about providing more support to individuals with complex conditions. That is why they created chronic condition management codes and community health integration codes. They have made it clear this is a priority, and yet a lot of these codes are underutilized for a variety of reasons. I do want to see more utilization because these are meaningful activities that make a real difference.

One of the challenges is that we simply don’t have enough clinicians to take care of everyone. That means it is necessary to look beyond traditional clinical roles. You see an expanding use of community health workers (CHWs) in both Medicare Advantage and Medicaid populations. In the last four years alone, we have seen a dramatic uptick in CHWs being deployed, and that is a good thing.

When it comes to the shortage of medical professionals, what should be done to reverse that trend?

There are lots of things we have to address. We don’t have enough instructors, for one. Even when we see an influx of candidates for medical positions, we struggle to staff enough educators to train them. No one wants to teach for the same reason no one wants to serve as a primary care physician. There is more money and opportunity elsewhere. Also, we have to reduce the cost of education and the burden of financial debt on those who choose to pursue a degree in the medical field. Once we graduate professionals into the healthcare system, we have to ensure they are fulfilled and able to engage in the work they set out to do in the first place. We have to deliver on the promise of purpose if we want to see people stick with this. And a final thought, we have to reduce the cost of malpractice insurance and protect clinicians from some of the frivolous and inappropriate lawsuits that are coming their way.

The US healthcare system is constantly under fire for being the most expensive among developed nations, while not ranking highly in terms of quality. Is this criticism warranted?

Do we have issues to address? Yes, we do.  And despite the challenges we are facing, I still believe we have one of the best healthcare systems in the world. We are allowed as healthcare professionals to work toward solutions and collaborate on how we can make things better. We can work together. We have common goals at the end of the day. I personally wouldn’t want to receive my healthcare anywhere else.

Stay tuned for additional Q&A articles featuring industry experts. Want to hear more from Dr. Wilson? Have an expert you’d like to recommend we interview? Contact us here to continue the dialogue.