Unlocking the Opportunities

for Health Care Delivery

Transformation
Unlocking the Opportunities for Health Care Delivery Transformation 1

E very health care organization’s goal is to transform care delivery to achieve

better outcomes and lower costs. Can this transformation be arrived at
through continuous improvement, or does real change demand disruption?

“I feel our current system of health care is so fundamentally flawed and rife with
anachronistic processes and perverse disincentives that the only likely way we’ll achieve
true transformation is through disruption,” says Richard Zane, MD, Chief Innovation
Officer at UCHealth System and Chair of the Department of Emergency Medicine at
the University of Colorado School of Medicine.

Zane is one of eight NEJM Catalyst Insights Council members – a qualified group of
U.S. health care leaders and clinicians at organizations directly involved in health care
“I FEEL OUR CURRENT SYSTEM OF HEALTH CARE IS SO
delivery – who candidly shared their experiences and insights for this ebook. This past
year, NEJM Catalyst Insights Council survey results illuminated the opportunities and FUNDAMENTALLY FLAWED AND RIFE WITH ANACHRONISTIC
barriers that exist in health care delivery transformation, as you will see in the data
shared throughout the ebook. You’ll also get an inside look at how our eight leaders PROCESSES AND PERVERSE DISINCENTIVES THAT THE ONLY

are helping their organizations hurdle the hard stuff, so they – along with their
LIKELY WAY WE’LL ACHIEVE TRUE TRANSFORMATION IS
patients – can enjoy the benefits that transformation promises.
THROUGH DISRUPTION.”

RICHARD ZANE, MD

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Unlocking the Opportunities for Health Care Delivery Transformation 2

Demanding Deep Change

Many health care leaders join Zane in calling for is coming, and who view fundamental change as
bold changes in health care, saying the industry an opportunity to lead instead of a big threat.”
is too mired in traditional thinking and heavy- These are health systems with “not much to
handed government regulation. “The waste in lose,” like Intermountain Healthcare or University
health care is shocking. The redundancy in health of Colorado Health, which he describes as
RICHARD ZANE, MD care is shocking. And the profits in health care “forward-thinking and willing to embrace and
Chief Innovation Officer at are huge,” he says. “There just can’t be any more define disruption” and “without much
UCHealth System and Chair of tolerance for the high cost and truly mediocre competition.”
the Department of Emergency outcomes.”
Medicine at the University of As an example, he says health care can be
Colorado School of Medicine, Taking a slow-but-steady approach to
“Amazon Primed” by offering a few free
Aurora transformation won’t move the needle, in his
primary care visits via a virtual home
opinion. “Medical homes, new payment models,
health system with an annual membership.
“MEDICAL HOMES, NEW scribes, practice redesign, and things like that are
slow and iterative. There is nothing disruptive
PAYMENT MODELS, SCRIBES, Such out-of-the-box thinking is difficult for
about them,” Zane says. Gaining “wholesale
entrenched health systems because many are
PRACTICE REDESIGN, AND change” is going to take either an outsider like
“totally hooked” on fee-for-service medicine. “It’s
THINGS LIKE THAT ARE SLOW Amazon, Google, “three guys in a garage in Palo
the entire system, which includes the providers.
Alto,” or a partnership like CVS and Aetna.
AND ITERATIVE. THERE IS If the general principle of a new idea means
Disruption could also come from “a health care
agreeing to take a pay cut, everyone is less
NOTHING DISRUPTIVE system or two not so completely addicted to
willing to do that.”
fee-for-service care that they can’t know change
ABOUT THEM.”

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 Unlocking the Opportunities for Health Care Delivery Transformation 3

A third of our Insights Council respondents to

our survey on payer-provider integration indicate
that the top barrier to organizations
implementing value-based payments is that one
“ What
What is the
value-based
toptop
is the
value-basedpayment
barrier
barrier
payment at atyour
to implementing
to implementing
yourorganization?
organization?
”
of the involved parties does not have strong
incentive to proceed.

JOANNE ROBERTS Then who will drive disruptive

Senior Vice President and Chief transformation in health care? “Patients
Value Officer at Providence and payers will grow intolerant” of the
St. Joseph Health, Renton, WA

“UNTIL WE SHOW
state of care and push harder to get away
from fee-for-service and other constricting
parameters, says Zane.
32%
CONSUMERS WHAT
Joanne Roberts, Senior Vice President and Chief
EXCELLENCE LOOKS LIKE,
Value Officer at Providence St. Joseph Health,
THEY WON’T KNOW. ONCE headquartered in Renton, Washington, agrees that
THEY SEE IT, I BELIEVE THEY real change in health care will require more
aggressive moves than the shift to value-based
WILL GO FOR IT.” One of the involved parties does not
care has required thus far. “I just think the system is One of the involved parties does not
have strong incentive to proceed
still so unwieldy and difficult to use. Patients aren’t
shopping around, they are just filling themselves
have strong incentive to proceed
with dread about having to go through the health
care system. Until we show consumers what
excellence looks like, they won’t know. Once they
see it, I believe they will go for it,” she says.

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 Unlocking the Opportunities for Health Care Delivery Transformation 4

Data for Disruption

IN THE PAST, DATA WOULD BE Offering transparency into quality, patient regional, local, unit, or provider-based, is presented in a
satisfaction scores, and other measures has the non-blinded fashion so that the organization can be
USED TO REPRIMAND LOW-
potential to overturn health care delivery because constantly learning. In the past, data would be used to
PERFORMING HOSPITALS, BUT patients will demand value, or so the hypothesis reprimand low-performing hospitals, but then leaders
THEN LEADERS “FLIPPED THE goes. In practice, transparency has yet to drive “flipped the culture,” she says, and now, low-performing
wholesale change. The top two barriers to successful hospitals are paired with higher-performing hospitals
CULTURE,” AND NOW, LOW- implementation of transparency in organizations, to increase learning.
PERFORMING HOSPITALS according to our survey on the topic, are data

ARE PAIRED WITH HIGHER-

limitations (collecting, risk-adjusting, disseminating) What are the top two barriers to successful
(chosen by 54% of respondents) and lack of buy-in
implementation of transparency in organizations?
PERFORMING HOSPITALS TO among providers on transparency’s importance
INCREASE LEARNING. (48%). Roberts also finds that patients don’t yet
Data limitations

54%
seem to want detailed information on quality and
JOANNE ROBERTS (collecting, risk-adjusting,
cost, even though they are on the whole paying a
disseminating)
larger share of health care bills.

Providence St. Joseph Health is tackling these

barriers by focusing on transparency inside
the system, which leaders hope will translate
into excellence that consumers can see.

Lack of buy-in
For instance, the health system collects data, under
the rubric called “Value-Oriented Architecture,”
which reveals variation of quality against costs at
48% amongproviders
on transparency’s
importance
a granular level and shares it across “all strategic
domains,” Roberts says. All data, whether system,

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Unlocking the Opportunities for Health Care Delivery Transformation 5

Effecting behavior change through analytics is not an realize he was towering over the patient in an
easy task, according to Frederick Southwick, MD, intimidating manner. Since then, he has made a
Professor of Medicine at the University of Florida conscious effort to be eye level with patients. The
College of Medicine in Gainesville. Analytics are usually experience led him to believe that all medical staff,
neither granular enough nor turned around fast including seasoned physicians, could use a coach to
enough to resonate with physicians. “Feedback is very review and then help improve their performance.
helpful, but I think a lot of it needs to be more Although he has received pushback from some staff,
qualitative and less quantitative,” he says. Traditional Southwick is intent on making coaching commonplace
FREDERICK SOUTHWICK, MD scoring systems like Press Ganey take weeks to make within the organization.
Professor of Medicine at the their way back to medical staff. “How can you change
University of Florida College of your behavior if you don’t remember what happened?”
Medicine, Gainesville
Delays in feedback also have an impact on patients
because when feedback is requested at the time of
ANALYTICS ARE USUALLY
their stay, “it is diametrically opposed to the feedback
NEITHER GRANULAR ENOUGH survey results.”
NOR TURNED AROUND FAST
ENOUGH TO RESONATE WITH To ensure that patient feedback is taken
seriously, the medical staff Southwick leads
PHYSICIANS. does end-of-round check-ins where everyone
on the care team reviews what they observed.

All members are free to speak up and Southwick

himself is open to criticism. Four years ago, a medical
student noticed that a patient seemed uncomfortable
as Southwick did his consultation. Southwick didn’t

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 Unlocking the Opportunities for Health Care Delivery Transformation 6

BEATA SKUDLARSKA, MD Transforming data collection and analytics usage is As an example, when he assumed the administrative
Executive Medical Director for going to take a complete redesign of feedback duties of the diabetes center, he integrated a
Palliative, Geriatric and Hospice solicitation, according to Beata Skudlarska, MD, psychologist into his subspecialty endocrinology practice
Care at Atrium Health, Charlotte Executive Medical Director for Palliative, Geriatric and to overcome behavioral health barriers to successful
Hospice Care at Atrium Health in Charlotte, North diabetes management. “For years, people would come in
“WE HAVE TO STOP ASKING Carolina. Data collection today tends to be disease- to the practice with poorly controlled diabetes that
specific, focusing on a population’s hemoglobin A1c seemed to result from mental health problems, like
HOW WE’RE DOING AND ASK
numbers or vaccination rates, for example, but she depression and stress. It was embarrassing for me to
HOW PATIENTS ARE DOING?” contends that’s not what patients are after. “Patients report back to their primary care physicians that our skills
want to know about their functional status, but we as endocrinologists were inadequate to improve their
don’t yet have a good grasp of that,” she says. patients’ blood glucoses. We started the conversation
about integrating behavioral health services multiple
Until feedback scoring systems such as Press times but had no measurements to quantify the
Ganey and Leapfrog become patient-centric contribution of behavioral health disorders to diabetes
instead of taking the point of view of the control and to justify the integration,” he says.
health system, hospital, and provider, invoking
change will be difficult, she says. “We have to In partnership with the MaineHealth Clinical
stop asking how we’re doing and ask how Integration Program, his practice contracted
patients are doing?” with Maine Behavioral Health to bring on the
part-time expertise of a psychologist who can
“Data and analytics is where I would actually like to bill for consultations separately. Since then,
see more resources, and where I find frustration,” Brodsky has noticed a positive effect,
says Irwin Brodsky, MD, MPH, Medical Director for anecdotally, although he’d like to have
Diabetes at Maine Medical Center in Portland. He analytics to back up that assessment.
credits his health system, MaineHealth, for being
“forward-thinking,” but would like to see greater Even though MaineHealth is an accountable care
investment in data and analytics to fully assess the organization and receives merit-based incentive
value of certain clinical programs. payments, “our minds are still in fee-for-service because
that’s how we get paid,” Brodsky says. “We’re trying to
innovate but it’s difficult to switch over.”
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Unlocking the Opportunities for Health Care Delivery Transformation 7

The Need for Integrated Care

“
Integrated care will definitely require transformation at some health What do you consider the top two most
systems. Integration of mental and behavioral health services has
What do you consider the top two
pressing
most pressingbarriers related
barriers to to
related delivery
deliveryof
posed a significant challenge to primary care. Roberts says she’s
looked at many integration models and has yet to see one that works ofmental
mental and
and behavioral healthservices
behavioral health services

CHRISTOPHER DALE, MD, MPH

Chief Quality Officer at Swedish
health system in Seattle
ideally. In part, the difficulty stems from the broad nature of different
conditions, which can include depression and suicide diagnosis and
treatment, addiction and substance abuse therapy, behavior change
ininyour
your community?
community?
”
management, and more. “We all know it’s important, but I think we
need to define what we mean by mental and behavioral health and a
INTEGRATION OF MENTAL standard range of services a clinic should have,” she says. Providence
AND BEHAVIORAL HEALTH St. Joseph Health is trying to discern those standards through
its partnership with the Well-Being Trust and the Institute for
CARE IS NEEDED “FROM
Healthcare Improvement.
A SOCIETAL PERSPECTIVE,
Christopher Dale, MD, MPH, Chief Quality Officer at
BUT IT’S EXPENSIVE.
Swedish health system in Seattle, which is part of
Providence St. Joseph Health, says that integration of
34% 33%
mental and behavioral health care is needed “from a
societal perspective, but it’s expensive.” Nonetheless,
Swedish has started blending these services into its
primary care practices.

Our survey on mental and behavioral health integration finds that the
most pressing barriers to integrating these services into care delivery
are absent or inadequate insurance coverage (34%), fragmentation of AbsentAbsentor
orinadequate
inadequate Fragmentation
Fragmentation
care (33%), and lack of access to specialty care (32%). coverage
insurance coverage of care
of care

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Unlocking the Opportunities for Health Care Delivery Transformation 8

FOR INTEGRATED CARE TO BE David Grace, MD, Chief of Internal Medicine at turnover, rapid access, and long-term panels all at once,
Atrius Health’s PMG Physician Associates in will refer patients to other independent practices in the
SUCCESSFUL, THE INDUSTRY
Plymouth, Massachusetts, says his practice is community, but, according to Grace, they don’t get the
NEEDS TO MOVE TO MORE fortunate to have good access for urgent same kind of quality and access. “We need urgent and
VALUE-BASED CARE, GRACE psychiatric needs, but follow-up care for long- long-term care going forward,” he says.
term psychiatric needs is still lacking.
SAYS. “RIGHT NOW, IT’S A The Swedish health services experience is similar.
Urgent consultations are handled by a hospital-
VERY SCHIZOPHRENIC
based outpatient psychiatry practice, which “has “We pick up initial intake, triage, a few visits,”
ENVIRONMENT. made itself very accessible for primary care Dale says, “but then how to navigate to longer-term
health,” he says. “Where it breaks down is when behavioral health, the handoff, the scope of services,
DAVID GRACE, MD
the patient needs chronic care.” Oftentimes, the requires more thoughtfulness.”
psychiatric practice, which can’t deliver rapid

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 Unlocking the Opportunities for Health Care Delivery Transformation 9

Grace believes the industry-wide move away from He would like physicians to be rewarded instead on
primary care toward specialty medicine over the quality, outcomes, and keeping medical expenses
years has created fragmentation and contributed to under control.
the increase in the cost of care. “We’ve tried as an
industry to develop a team approach, but we’ve One disruptive approach to improving health
actually become more siloed in care delivery with care would be to redesign care delivery
specialists upon specialists,” he says. so that patients can receive care without
actually entering a health system’s facility,
Roberts agrees. “It’s redesigning primary care to be a according to Dale.
primary care rather than a referral service. We want
DAVID GRACE, MD
people to not have to use hospitals. We haven’t been “We haven’t offered people the dominant solution
Chief of Internal Medicine at
completely explicit in that message and we need to yet – the better thing for less cost,” he says.
Atrius Health’s PMG Physician
be,” she says. “Consumers and health systems want the best
Associates, Plymouth, MA
overall health with the least amount of burden.”
“WE’VE TRIED AS AN Grace would like to see a restructuring within
primary care as well, where the physician
INDUSTRY TO DEVELOP A
leads the team at the top of his/her licensure.
TEAM APPROACH, BUT WE’VE “Doctors should see the complicated patients,
and a physician’s assistant or nurse
ACTUALLY BECOME MORE
practitioner can see the not-so-complicated
SILOED IN CARE DELIVERY patients,” he says.
WITH SPECIALISTS UPON
For integrated care to be successful, the industry
SPECIALISTS.”
needs to move to more value-based care, Grace says.
“Right now, it’s a very schizophrenic environment. We
have a capitated system where revenue is prepaid and
based on quality measures; and a system based on
productivity, so we get paid for patients we see.”

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Unlocking the Opportunities for Health Care Delivery Transformation 10

The Role of Technology in Transformation

“EMPOWERED CONSUMERS Digital innovation is an essential part of improving

ARE GOING TO BE BETTER health care. Technology can support increased patient
engagement without intense provider participation.
FOR COST OF CARE AND As an example, Dale points to the Circle mobile app,
ENGAGEMENT.” which was developed by the digital innovation team
at Providence St. Joseph Health and was acquired by
JOANNE ROBERTS
Wildflower Health in June 2018. The app, aimed at
delivering care to mothers more effectively, enables
patients to access content, tools, and trackers about
the mother’s and baby’s health, and is integrated into
the health system’s EMR.

“The Circle app was really driven by consumers and

dispatched direct to consumers,” Roberts says. “I “The hospital model is not sustainable.
would love to see more apps like that dedicated to Many clinic visits will become obsolete. Not
patients with chronic diseases such as diabetes, everything [that happens in health care] is
heart failure, and COPD.” going to go through the system. There won’t
“Or Google. Think of everyone on their [cell phones], be health care systems or care delivery
or any mobile device, becoming a medical device systems anymore – only health systems,”
along with all the data that comes off of them she says. And in those systems, “empowered
informing next steps and care,” Zane says. consumers are going to be better for cost
of care and engagement.”
To boost the profile of health technology, Roberts says
the industry must move away from the traditional
mindset of patients physically engaging with
hospitals and care delivery systems and accept
a more virtual posture.

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Unlocking the Opportunities for Health Care Delivery Transformation 11

“A LOT OF THESE PARTS OF What are the top three barriers to applying design thinking to health care problems?
KU ynamreG anihC adanaC a aeroK htuoS Australia ailartsuA South Korea a Canada China Germany aUK Australia South Korea Canada China Germany UK

MEDICINE CAN BE DONE

WITHOUT HUMAN
INTERACTION,” WHICH
WOULD FREE UP RESOURCES

52% 47% 32%

FOR MEDICAL PERSONNEL
WHO CAN WORK TO THE
TOP OF THEIR LICENSURE. limited buy-in from limited understanding insufficient training in
decision-makers of design thinking design thinking
BEATA SKUDLARSKA, MD

More robust technology will help eliminate the middle steps (according to 95% of respondents) but faces obstacles in
that can make health care seem complex, Skudlarska says. respondents’ organizations due to limited buy-in from
decision-makers (52%), limited understanding of design
Much like the travel industry enables consumers to (47%), and insufficient training in design (32%).
directly book their travel, she expects to see more
Digital innovation is just one driver of change at
health systems encouraging patients to schedule
Providence St. Joseph Health. “We plan to go from a
appointments and procedures through a portal or
hospital-based system of 51 hospitals to hospitals being
mobile app, reducing the need for dedicated schedulers.
just one-sixth of our business units by 2022,” Roberts says.

“A lot of these parts of medicine can be done without Community partnerships, digital access,
human interaction,” she says, which would free up behavioral health prevention (including behavior
resources for medical personnel who can work to the change management), and wellness will be at
top of their licensure. the forefront of the redesigned system.
Over the next few years, Roberts says Providence St. Joseph “Our new intention is what happens outside of the
Health expects to concentrate more on digital innovation hospitals,” she says. “The idea is to find the resources
and new models of care, all driven by design thinking with before or at the emergency room door and put a whole
heavy input from patients. Design thinking, as our survey lot of energy there.”
on this topic shows, has great applicability to health care
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Unlocking the Opportunities for Health Care Delivery Transformation 12

“TECHNOLOGY IS LITERALLY UCHealth has put a stake in the ground in technology

and virtual health with its Virtual Health Center and
BECOMING PART OF THE
Virtual ICU, which care for patients throughout the
PATIENT’S CARE TEAM. entire continuum of critical illness (inpatient, urgent
and emergent care, and skilled nursing and home care),
TECHNOLOGY CAN HELP YOU
Zane says.
DELIVER BETTER CARE FROM
Inpatients, including ICU patients across the system,
ONE END OF THE SPECTRUM are centrally monitored by experienced critical care
TO THE OTHER.” nurses and intensivists who watch cameras as well as
vital sign readings for indicators of decline. If they
RICHARD ZANE, MD
detect anything, they notify local nurses, and when
appropriate, the Virtual ICU physician can intervene.

“Technology is literally becoming part of the

patient’s care team,” Zane says. “Technology can
help you deliver better care from one end of the
spectrum to the other.” UCHealth also plans to
equip patients headed home from the hospital
with remote monitoring tools to monitor vital
signs, movement, and symptoms so that typical
reasons for readmission within the first few
days, such as medication compliance, wound
care, and heart issues, can be closely managed
and patients can safely stay home.

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Unlocking the Opportunities for Health Care Delivery Transformation 13

Community-Driven Change

“
Jonnathan Busko, MD, MPH, FACEP, Emergency What are the top two biggest barriers to
Department Medical Director at St. Joseph Hospital in What are the top two biggest barriers to
providing excellent care in rural settings?

JONNATHAN BUSKO, MD,

Bangor, Maine, would like to disrupt business-as-usual in
the emergency department but finds it difficult under the
current reimbursement model. “Most of the things that
would be disruptive within the emergency department
”
providing excellent care in rural settings?

MPH, FACEP are anathema to success in fee-for-service,” he says.

Emergency Department Medical
Director at St. Joseph Hospital in
Bangor, ME
As a result, he’s working to make an impact
through partnerships with the rural communities
that the local hospitals and health systems
49%
RURAL COMMUNITIES ARE serve. These communities in crisis, hit hard by
Distance/travel
“THE TRUE DISRUPTORS. THEY opioid addiction, loss of health care services, Distance/travel
time to facilities
providers, and traditional jobs, as well as aging time to facilities
ARE THROWING AWAY ALL THE
infrastructure, are “the true disruptors,” he says.
OLD MODELS. INSTEAD OF
“They are throwing away all the old models. Instead of
SAYING, ‘WHAT DO WE HAVE Recruitment/
saying, ‘What do we have and how do we apply it?’ they Recruitment/
AND HOW DO WE APPLY IT?’ are saying, ‘What services do we need and how do we
retention
retention of
get there?’” Busko says. ofphysicians
physicians
THEY ARE SAYING, ‘WHAT
SERVICES DO WE NEED AND Care providers must acknowledge the critical

HOW DO WE GET THERE?’”

differences between urban/suburban and rural care.
Respondents to our survey on rural health say the two
biggest barriers to providing excellent care in rural
49%
settings are distance/travel time to facilities (49%) and
recruitment/retention of physicians (49%).

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 Unlocking the Opportunities for Health Care Delivery Transformation 14

“IF PAYERS ARE SPECIFYING Busko finds that many people living in rural areas Payers have to unshackle providers and health
will travel to a larger town for primary care visits, care systems so they can innovate, Busko says.
BOTH OUTCOMES AND
often scheduling multiple appointments and Recently, he was exposed to a bat and needed a
PROCESS – OR OTHERWISE other errands at once, but are looking for access series of rabies vaccines. While the vaccinations
THEY WON’T PAY FOR IT – to urgent and emergency care in their own cost only $700, the insurer required the shots to
communities. These patients are pushing back on be administered in an urgent care or emergency
THEN THERE REALLY CAN’T health systems to invest more heavily in the department, increasing the total cost to more
BE INNOVATION.” types of services they need, he says. than $5,000. “I could have had a home health
nurse come to my house for $150 and give me the
JONNATHAN BUSKO, MD, MPH, FACEP
shots,” he says. “If payers are specifying both
For instance, one rural community in
outcomes and process – or otherwise they won’t
northern Maine is evaluating the disruptive
pay for it – then there really can’t be innovation.”
move of having specially trained Community
Care Paramedic Practitioners perform some
aspects of urgent care under the remote
oversight of a physician, including wound
management and administering certain
medications beyond routine Emergency
Medical Services care.

This dramatic change would require intense

physician oversight, telemedicine infrastructure,
and payer buy-in. “Will payers reimburse the
physician who oversees these providers? Will they
pay Community Care Paramedic Practitioners to
provide urgent care?” For the program to succeed,
these questions have to be answered, he says.

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Unlocking the Opportunities for Health Care Delivery Transformation 15

Tackling the Social Determinants of Health

The local community also is instrumental in What are the top three biggest challenges

“
promoting behavior change and understanding
in scaling social network tools for health
social determinants of health, Brodsky says. What are the top three biggest challenges
cin
are delivery?
scaling social network tools for health
IRWIN BRODSKY, MD, MPH
MaineHealth’s evidence-based program
Let’s Go! was created to battle and
care delivery?
”
@
Medical Director for Diabetes at prevent childhood obesity.
Maine Medical Center, Portland, ME

“THE LOCAL COMMUNITY

In partnership with government, schools, health
care practices, and community organizations, @ @
IS INSTRUMENTAL IN MaineHealth branded the “5-2-1-0” message:
PROMOTING BEHAVIOR CHANGE five or more servings of fruits and vegetables,
two hours or less of recreational screen time,
AND UNDERSTANDING SOCIAL
one hour or more of physical activity, and zero
DETERMINANTS OF HEALTH.” sugary drinks.

Brodsky says Let’s Go! is a way to tap into a

child’s social network, including parents and
teachers, to apply healthy habits and “create an
environment for success.” He understands that
47% 59% 66%
providers are a big part of the equation, which Patient Provider Time
Patient Provider Time
the NEJM Catalyst Insights Council also agrees adoption
adoption adoption
adoption investment
investment
with, indicating that time investment by the byby health
health
health care team (66%) and provider adoption care team
care team
(59%) are the top two barriers to social networks
being used to incent better health, according to
our survey on the topic.
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Unlocking the Opportunities for Health Care Delivery Transformation 16

UNDERSTANDING THE Obesity in particular requires innovative ways to

engage patients of all ages. Our survey on the She expects emerging technology, including mobile
BARRIERS AND OPPORTUNITIES apps, to facilitate even more support for patients and
topic finds that lack of patient perception of obesity
WITHIN YOUR OWN as a problem/health issues (39%) and difficulty their social networks through forums and chat groups.

ORGANIZATION WILL HELP sustaining weight loss (39%) are the two biggest
barriers to getting patients into treatment. And although she finds health care to be far behind in patient-
DETERMINE WHAT STEPS ARE facing technology, she optimistically says, “the sky’s the limit”
Skudlarska, who treats patients diagnosed with
POSSIBLE NOW AND DOWN in putting devices and apps to good use going forward.
dementia or impaired memory loss, is hoping for
THE ROAD. innovation in social networks. For her part, she Understanding the barriers and opportunities within your
leads group visits where patients, families, and own organization will help determine what steps are
RICHARD ZANE, MD other caregivers engage in collective discussions possible now and down the road. “Unequivocally, we will
and share resources such as patient care. end up with a fundamentally transformed health care
system,” Zane says. “The time frame could be six months
or 60 months, but it’s going to happen.”

What are the top two biggest barriers in engaging patients in treatment for obesity?

39% 39%
Lack of patient perception of obesity Difficulty sustaining weight loss
as a problem/health issues
catalyst.nejm.org
We’d like to acknowledge the members of the NEJM Catalyst Insights Council. It is through
their voice and commitment to the transformation of health care delivery that we are able
to provide actionable data that convene a collaborative dialogue about moving the
industry forward in a positive direction. Insights Council members participate in monthly
surveys and the results are published as NEJM Catalyst Insights Reports, including
summary findings, expert analysis, and commentary from NEJM Catalyst leaders.

To join your peers in the conversation, visit join.catalyst.nejm.org/insights-council.

About NEJM Catalyst

NEJM Catalyst brings health care executives, clinical leaders, and clinicians together to share
innovative ideas and practical applications for enhancing the value of health care delivery.
From a network of top thought leaders, experts, and advisors, our digital publication,
quarterly events, and qualified Insights Council provide real-life examples and actionable
solutions to help organizations address urgent challenges affecting health care.

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