Dr Dennis Scanlon on barriers to learning health care systems


Fee-for-service models and outdated infrastructure are among the biggest obstacles to learning about health care systems, said Dennis P. Scanlon, PhD, professor of health policy and administration at the Pennsylvania State University and editor of The American Journal of Responsible Care® (AJAC).


What are the main obstacles preventing a health system from becoming a learning system?

I think there are a number of systemic and fundamental barriers. I would say one of them is our payment model — the way we pay for health care, the traditional fee-for-service model. We’ve changed many variations of this, whether it’s partial capitation, accountable care organizations, episode-based care, or bundled care. But, as I look at how things have been over the last 2 decades and even the last decade since the Affordable Care Act was passed, although we’ve made progress on that, we’re still largely a discounted health service. care system. There is therefore no doubt that payment and reimbursement are a clear and fundamental obstacle.

Beyond that…we’re stuck in our history, in many ways, to do the same thing as we always have. What do I mean by that? If you look at traditional clinical training – whether in academic medical schools, even nursing schools, pharmacy schools, etc. – we have not really evolved in terms of training future clinicians to operate in a world strongly oriented towards digital technology. , where patients, clients and consumers want to be treated as clients and consumers. They want digital technology; they want easier communication. We also have organizations that have been structured organizationally—in terms of governance, in terms of operating structure—very inefficiently. They don’t think about their cost of production because they never really had to. They don’t think about production functions. They don’t think about how to substitute or change to produce better care more efficiently.

So I think there are a lot of systemic barriers. I think data, access to data, transparency and information to guide decision-making: this is lacking in health care. Really, at the end of the day, I’d probably say it’s a confluence of historical payment models largely driven by fee-for-service, lack of transparency still, and not a good flow of information, some of which, quite frankly, is to the benefit of people who make money from this lack of transparency. Then I would just say legacy infrastructure that is really not up to date with how the rest of the world or other businesses operate.


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