It is clear to me that the healthcare system is undergoing defragmentation. The defragmentation process is rapidly accelerating because of the unhinged rising cost of healthcare, the leaps in artificial intelligence (AI), and the increasing number of people experiencing pain and suffering caused by the pandemic. The healthcare system simply has to become more efficient and cost-effective and generate better clinical outcomes. It needs to be "defragged."
Defragmentation is the process of reorganizing data stored on the hard drive so that related pieces of data are put back together and lined up in a continuous fashion. The process picks up all the pieces of data spread across a hard drive and puts them back together again. As a result, efficiency and output significantly increase.
Disk fragmentation occurs when a file is broken into pieces to fit on the disk. Because files are constantly being written, deleted, and resized, fragmentation is a natural occurrence. When a file is spread out over several locations, it takes longer to read and write.
Many users blame computer performance problems on their operating system or simply think their computer is "old" when disk fragmentation is the real culprit.
A fragmented healthcare system
Marc Cooper, DDS, MSD.The healthcare system is deeply fragmented because it is broken into small or separate parts. Separations exist between providers, payors, patients, vendors, and suppliers. All the pieces are seemingly floating around and carelessly connected.
In the current healthcare system, dentists are viewed as peripheral, nonessential players in the system. They're outliers, but this will dramatically change as defragmentation occurs.
In the world of computers, defragmentation physically organizes the contents of the mass storage device into the smallest number of contiguous regions. The same will be true for healthcare. The elements that constitute healthcare will be physically organized into smaller contiguous regions.
When a system is fragmented, it requires more work to deliver value and better outcomes. Furthermore, the ability of the system to adapt to environmental changes is diminished. The greater the fragmentation, the more vulnerable the system. In healthcare, this vulnerability was readily exposed by COVID-19.
Three major elements contribute to this problem of fragmentation in the healthcare system.
1. Silo mentality
Dentistry concentrates its power in vertical units. These silos are reinforced by functionally oriented metrics that have no discernable connection to the performance of other areas in the healthcare system. Without whole system metrics and management systems, silos obscure essential connections and fragmentation increases. A simple example is gingival inflammation and bleeding that relates to the markers in type 2 diabetics.
2. Physical fragmentation
This is the unavoidable result of the actual separation of functions. One consequence of separation is the time it takes a transaction to move from one group to the next. In healthcare, more serious is the degradation of information associated with transactions as they travel between different providers and other entities. Such delays result in time in which no value is being added. Finally, there is also the possibility that the transaction will simply be screwed up.
This could help explain a Johns Hopkins study that showed more than 250,000 people in the U.S. die from medical errors every year. Other reports claim the numbers could be as high as 440,000. Before COVID-19, medical errors were the third-leading cause of death after heart disease and cancer. Defragmentation would save lives.
It's obvious that defragmentation is going to occur -- and with it will come change. There is expanding access to evidence-based knowledge, which will directly impact diagnosing, treatment planning, determining quality assurance, and allowing provider rating systems, along with which procedures are most strongly recommended on a per-case basis.
Of course, there will also be mandates, which means letting patients, providers, and payors know that certain treatments are not warranted because of existing chronic conditions. If these conditions improve, then the patient would be eligible for that crown or that bridge, for example. As the system becomes defragmented, everything in the clinical dental arena will be more clearly defined.
Defragmentation will absolutely demonstrate the efficiency and value of delivering a number of primary care functions during a dental visit. The patient is already in the chair. They say time is money, but today, time is cost. Getting things done at the same time only makes sense.
3. Cultural fragmentation
This type of fragmentation is less obvious than physical fragmentation but is often far more deleterious. Cultural fragmentation comes from a lack of alignment on priorities and is aggravated by internally, functionally focused metrics. Items that are a high priority in one healthcare entity are shuffled to the bottom of the pile in another organization. Does a physician have any clue what to do with gingival inflammation ratings and bleeding scores? Barriers are not crossed. As the degree of misalignment increases, so, too, does the "leakage" of value and money, along with a decrease in performance.
Then there are the ego and identity issues of the various stakeholders. The ego naturally generates a pecking order, the identity a hierarchy of arrogance. These ego and identity-driven cultural divisions will be the hardest barriers to overcome.
Conclusion
System fragmentation occurs when critical processes aren't managed as an integrated system. Workflows become a complex series of handoffs between organizations, providers, functions, accountabilities, and information systems. Each handoff represents an opportunity to introduce error, delay, and cost.
Processes in a fragmented system are like a convoluted system of poorly joined plumbing, with pipes that leak time, money, and, in healthcare, optimum patient care. Not getting a flu shot at a hygiene appointment makes no sense. And while we're at it, the computer monitor shows the patient needs a blood draw for his or her yearly blood panel. If done in the dental office, this simple procedure will save $400 to $700 and two hours of time for the patient. A physician's interaction, if required, can be done on their respective screens.
Therefore, defragging healthcare will be value-driven and cost-driven. As defragmentation occurs, the traditional walls between the many disparate entities in the healthcare industry will be demolished. The system must work together, not as a bunch of dissimilar parts.
Counterpoint
I've spoken to my contacts in the insurance industry, both medical and dental. They say it will never happen: "We've been talking about this for years. Dental insurance is not even in same universe as medical insurance. Capitation doesn't work in dentistry. The IT platforms are alien to each other. Costs too much money to make any changes. There is no leadership to make it happen. Everybody is 'kind of' happy where they are."
I've been around long enough to know that when the costs painfully outweigh the benefits, change happens. Defragmentation will happen, it is happening, and it will change a lot of things, including who dentists are and what they do.
Marc Cooper, DDS, MSD, is the president of MBC Consultants. Dr. Cooper has worked throughout the healthcare industry during his career, with the majority of his clients being in the dental industry. His current focus is coaching leaders, dentists, and senior executives on how to effectively navigate their organizations and lead their respective teams during this period of tremendous uncertainty. Connect with him on LinkedIn.
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