Dr. Anthony J. Billittier

DSRIP Efforts Should Be Grounded in Research that has Already Revealed Best Practices

FROM THE CHIEF MEDICAL OFFICER

By Anthony J. Billittier IV, MD, FACEP

Much attention will continue to focus on reformation of the U.S. health care system. Continuously soaring health care expenditures are not sustainable, especially when multiple outcome measures reveal a product less effective in many ways to other developed nations that spend significantly less per capita.

So what can we do differently that will help us achieve the triple aim?

While there is no single magical solution, risk stratification and care management of high risk patients; a shift from payment for quantity to payment for quality; and widespread implementation of evidenced-based medicine are arguably among the best strategies for bending the cost curve, improving health care delivery and increasing wellness.

Evidenced-based medicine or EBM is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients.

EBM integrates clinical experience and patient values with the best available research information. * (It should be acknowledged though that clinical research is ever evolving, and EBM will always be a moving target.)

Further, solid science often is lacking for management guidance of many conditions. However, when research has uncovered best practices, we must ensure that every patient receives care based upon EBM. EBM should be agnostic to payer, provider, location, health system, etc.

The Delivery System Reform Incentive Payment (DSRIP) Program is supposed to employ evidenced-based initiatives.

In other words, DSRIP efforts should not be research in discovery of best practices. Rather, DSRIP efforts should be grounded in research that has already revealed best practices.

In fact, the flagship DSRIP project to create an integrated delivery system (2ai) includes the phrase “focused on Evidence-Based Medicine….”

On a more micro level, a handful of specific deliverables for individual Millennium projects clearly focus on EBM. For example, Millennium’s Cardiovascular Health– Implementation of Million Hearts Campaign (3bi) project requires that “the practices will adopt and follow standardized treatment protocols for hypertension and elevated cholesterol.”

To clearly and definitively articulate standardized treatment protocols for our partners, Millennium’s Physician Steering Committee has created best practice workgroups in cardiovascular disease, smoking, maternal child health and behavioral health.

These groups include Millennium network partner clinicians and other topical experts who have been charged with oversight of the adoption/adaptation, updating, dissemination, monitoring, etc. of best practices. Much work has already been done by these dedicated individuals, and some best practices will soon be circulated to our partners. However, much work needs to be done. In fact, their work will never be done because EBM will always be a moving target.

*Evidence Based Medicine – New Approaches and Challenges. Izet Masic, Milan Miokovic, and Belma Muhamedagic. Acta Inform Med. 2008; 16(4): 219–225. Published online 2008 Dec. doi: 10.5455/aim.2008.16.219-225. PMCID: PMC3789163

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