THE ROLE OF PATIENT VALUE AND PATIENT-CENTRED
CARE IN HEALTH SYSTEMSWhat every health system should understand is that the evolution will not end with the creation of
integrated care and multi-disciplinary teams of clinicians wherever appropriate.
William McColl is vice-president for policy and advocacy at AIDS United, an American patient
advocacy group. He explains that the experience of the Ryan White programme in the US, which
provides comprehensive care for people living with HIV who lack insurance, made clear that, even if
efforts are focused on one condition, other issues quickly become apparent.
“Food and nutrition, for example, are for many people a fundamental part of treatment but are
not considered a medical intervention. It’s true for people living with HIV but also true for others.
Somebody with kidney disease not getting the food they require will have poorer health outcomes.”
The implication of a focus on the patient has also helped Humana—a large US insurer with over 20m
members that also runs clinics serving 260,000 people—to learn that valuable interventions to improve
health go far beyond those traditionally found in medicine (see Box).
When health systems focus on preferred
outcomes for individuals, rather than the
volume of medical activity, the range of relevant
interventions grows rather than contracts. A
recent survey of both private and public US
health providers found that 81% are in some
way integrating into their activities matters
related to the social determinants of health.^38Roy Beveridge, chief medical officer of
Humana, explains that this is not simply a nice-
to-have. “We have to take care of the patient
holistically,” he says, “because, if we don’t, we
are not going to fix the disease. Perhaps the
patient is unable to fully participate in their
care because they couldn’t get to see you, or
their blood sugar levels may not be doing well
because they eat canned, sugary food since
that’s all they can afford. We need to think
about the patient more broadly.”Humana demonstrates the range that such
activities can take.Dr Beveridge says that the company identified
barriers to care through discussions with
thousands of its members to find out their
preferences and needs. This research showed
that “transportation for people with low
salaries is a huge issue. It is not that they are
not coming back to doctor because they don’t
want to. They can’t afford to take a cab.” In
response, the company ’s Florida operations
have integrated into every Medicare insurance
policy free or assisted transportation to its
clinics. The uptake has been substantial.Dr Beveridge reports that “the last time I was
in Miami, Humana seemed to be the biggest
bus service in Florida. It was probably not, but
a lot of people were using it.” The integrationBox: Humana: Looking at the wider boundaries of patient-centred care
- Change Healthcare, The 8th Annual
Industry Pulse Report, 2018.