Rethinking Patient Compliance in Chronic Disease Management

Medicine is complex. It’s getting more complex. We double what we know in medicine every 73 days. There’s 800,000 journal articles published every year. It is impossible for any human to keep up. It’s just impossible. There’s a lot of talk about amazing technology to help humans manage the 26,000 variables in heart failure treatment or what have you. And, yeah, I’m a huge fan of technology doing what technology is good at doing. But here’s a point to ponder: Just like meds don’t work if the patient doesn’t take them, technology kinda doesn’t work unless it’s part of a bigger framework. Who in the practice uses it or deploys it? Who checks the dashboard and follows up with patients and how do they follow up with patients?

This is all process. Of course, there’s good processes and not-so-good processes. But a value of process as a construct is you can incrementally improve a process. You can’t incrementally improve everybody doing different things at different times. Nobody seems to talk about this in the “cool” circles, but any quality expert will tell you that complexity can only be mastered with process.

Said another way (and this is inarguable), if anyone is trying to improve the quality of care delivered in any provider organization or any organization really—regardless of whether that organization is a solo practitioner or employs thousands of clinicians—the only way to improve the quality of care across time and the entire patient population is to standardize care at some level (ie, you have to have processes or care plans or pathways or whatever you want to call them). If you don’t, the quality of care will always regress to the mean. The average of care will always be the top of the bell curve. You’ll always hover around 65% of whatever measure.

Why will you never be better than average if everybody is doing whatever they decide to do solely based on their own individual experience at that moment in time? Because you’ll always have your great doctors (the 95 percenters) and your not-so-great doctors (the 45 percenters). So, if you want to level up, you have to deploy care standards that push up the poor performers. But those great performers? Consider this: Probably those great performers have a process. Otherwise, they wouldn’t be consistently great, whether they realize it or not. Furthermore, great consistent performance generally happens with a team-based approach. That’s more and more indisputable. And the second you have a team, you need a playbook—otherwise known as a book of processes. This is one of those boring aspects of delivering great care that gets lost in the hype of cool technology. Everybody’s an individual, but every individual is a human—and there are some basic truths and precepts and research for what good care includes and constitutes at different points in care journeys and for differing diagnoses.

In this health care podcast, I’m talking with Bob Matthews, president and CEO of MediSync. He’s also VP for quality and care redesign for PriMed Physicians. Our conversation spirals in a few different directions, but the central theme is this: How and why does a provider organization level up care? And speaking of leveling up care, we talk about the business reasons to do so right now for organizations who base their decision making on their financials, which many in the health care space do. And once a provider organization has decided that they’re going to produce better outcomes across their whole patient population, what are the major constructs necessary to pull it off? Process is a long tentpole in that big tent. So is culture. So is technology. So are the right incentives in quality measures. An upcoming Relentless Health Value episode with Grace Terrell, MD, also digs into this topic, so stay tuned.

Bob Matthews is president and CEO of MediSync. Bob has led multiple medical groups over 20 years. He is Black Belt trained in the Six Sigma quality methods. The MediSync team creates sophisticated processes and AI technologies to enable physicians to achieve best-in-the-nation clinical outcomes, especially in chronic disease management.

04:47 How do you address concerns about chronic care costs? 06:15 What are the disjunctures in the health system? 07:01 “Very few organizations today know how to do a great job in managing [chronic care].” 09:58 “Some medical group organizations … put the pressure on, but they don’t offer much help.” 10:09 “There’s something inherently difficult about the work, or we wouldn’t have this problem.” 10:44 What is the increasing pressure on practices to manage chronic conditions? 11:51 “We just simply cannot afford to get the outcomes we need with the system we have.” 13:37 “The pressure to improve outcomes is just really now starting to heat up.” 14:00 What things need to be focused on to improve outcomes? 17:32 “The only thing you get rewarded for is speed.” 19:20 “Just because you start the journey doesn’t mean that you’re going to succeed.” 23:18 “Complexity can only be mastered with process.” 25:38 “We do need to work on ways to help patients want to take their own medicines.” 29:21 Who is MediSync?

Bob Matthews of @MediSyncHealth talks #medtech on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

How do you address concerns about chronic care costs? Bob Matthews of @MediSyncHealth talks #medtech on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

“Very few organizations today know how to do a great job in managing [chronic care].” Bob Matthews of @MediSyncHealth talks #medtech on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

“Some medical group organizations … put the pressure on, but they don’t offer much help.” Bob Matthews of @MediSyncHealth talks #medtech on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

What is the increasing pressure on practices to manage chronic conditions? Bob Matthews of @MediSyncHealth talks #medtech on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

“We just simply cannot afford to get the outcomes we need with the system we have.” Bob Matthews of @MediSyncHealth talks #medtech on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

What things need to be focused on to improve outcomes? Bob Matthews of @MediSyncHealth talks #medtech on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

“Complexity can only be mastered with process.” Bob Matthews of @MediSyncHealth talks #medtech on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech