Steve Jobs and coordinated care
Jobs transformed multiple industries including personal computing with the Apple II, animated movies with Pixar, the music industry with the iPod, mobile phones with the iPhone and publishing and tablet computers with the iPad. In 2010, Forbes estimated his net worth at $6 billion and ranked him as the seventeenth most powerful person in the world, several positions ahead of Nicolas Sarkozy, President of France.
Jobs benefited from receiving cutting edge healthcare technology including a liver transplant. He was one of the first people in the world to have all of the genes of his cancer tumor as well as of his normal DNA sequenced. It was a process that cost more than $100,000.
On the other hand, his billions could not buy care coordination. Walter Isaacson, Steve Jobs’ official biographer, describes how the wife of the seventeenth most powerful person in the world needed to assume responsibility for coordinating his care:
…Jobs allowed his wife to convene a meeting of his doctors. He realized he was facing the type of problem that he never permitted at Apple. His treatment was fragmented rather than integrated. Each of his myriad maladies were being treated by different specialists- oncologists, pain specialists, nutritionists, hepatologists and hematologists- but they were not being coordinated in a cohesive approach… “One of the big issues in the health care industry is the lack of caseworkers or advocates that are the quarterback of each team,” Powell [Job’s wife] said. This was particularly true at Stanford, where nobody seemed in charge of figuring out how nutrition was related to pain care and to oncology. So Powell asked the various Stanford specialists to come to their house for a meeting… They agreed on a new program regimen for dealing with the pain and coordinating the other treatments.
Jobs, with all of his wealth, could not purchase coordinated care, a nonexistent service at Stanford. Our volume–based payment system pays for doing volumes of “stuff” to patients but fails to reimburse for coordinating “the stuff.” Instead, Jobs’ wife assumed the role of coordinator by inviting all of his physicians to their home to create a treatment care plan. One can imagine an invitation from the seventeenth most powerful person in the world is not to be ignored. Patients and families with less power (i.e. the rest of us) remain ineffectual in requesting to convene clinicians.
Coordinating care represents an intersection of clinical quality with the patient/family experience. Coordination enhances the experience of care and supports clinical quality by preventing duplication, errors of omission (“I thought specialist x was handling that”) and errors of commission (adverse interactions between different treatments).
Park Nicollet’s strong primary care base working with excellent specialists naturally coordinates care, but remains unsystematic. The Park Nicollet Care Model/Aligned payment must assure we systematically coordinate care with patients and families. Coordination improves quality, enhances the patient/family experience and reduces costs.
Have you benefited from effective care coordination or been frustrated by a lack of coordination? Please feel free to comment. We encourage a free exchange of ideas but, as always, we reserve the right to remove comments that make personal criticisms or attacks on individuals or specific businesses.