Delivering High-Quality Medical Care at the Cross Roads of Patient, Physician, and 3rd Party Payer

Dr. Adam Tabriz

Quality For Patient Experience, Efficiency of Physician Time, and the Cost Set by the Insurance Industry
Medical CrossroadPhoto byAuthor using Wonder

The overwhelming complexity has riddled today's medical practice. Countries worldwide, particularly those developed, have been using various levers to contain the increasing healthcare costs. They still do so via indiscriminate reform policies, regulations, and mandates.

Healthcare regulators enforce their levers through surveys, certifications, and manipulating reimbursements and penalties. Nonetheless, such arm-twisting undertakings have led to unintended consequences; thus, we witness complexities in patient care and the healthcare system.

Indeed, due to indiscriminate policy shifts, today's patient care is a complex project. That is precisely why healthcare project management has become one of our epoch's most conspicuous business skills for decades.

Having a robust project management tool in place is essential today. That is if healthcare leaders intend to control costs, maintain quality patient care, and meet their expectations.

The project management approach, be it Agile, Lean, or Spiral methodology, is merely about systematic planning, organizing, and executing tasks while efficiently utilizing resources and achieving objectives, that is, patient health.

The complexity of the healthcare system inevitably translates into a convoluted physician practice system and the complexity of the clinic workflow process.

Some predict the future of complexity leading to:

  1. The science behind the complex care model will eventually grow.
  2. Healthcare and medical practice operations will someday embrace the nuance of what operational standard is suitable to whom and in which scenario.
  3. Eventually, every medical practice will embrace social determinants of health to create a collaborative space between clinicians and social services.
  4. Complex care programs will emerge, thus disrupting the care pipeline. Unless clinicians diligently identify patient risk factors from early life, the consequences will be the cumulative downstream workload. That is where more and more patients will flow into complex care pathways, further complicating physician practices.
  5. Healthcare organizations will get sleeker about pinpointing patient risks.
  6. Technology will push for new methods of care delivery.
  7. Primary care will be exhaustive and more complicated.
  8. Third-party payers will reimburse for complex care differently.
  9. Accountability for equity will evolve into a new standard.
  10. Public health will become another investment opportunity.

The Radical Healthcare Complexity Shift and a Vaccum Drawing in More Challenges

Within the ever-complex realm of medical care delivered to patients and the existence of an increasing number of variable balancing costs, the quality of service to patients in a reasonable timeframe is beyond walking in the woods.

For instance, in our contemporary era, it is simply insufficient to cure a patient at the clinicians' terms. Patients expect more convenience and less discomfort at an affordable cost, a plan of action that makes sense to them.
Healthcare CrossroadsPhoto byAuthor using Wonder

The tools and requirements for meeting patient expectations are becoming more creative than ever. Those options include online appointment scheduling, patient engagement portals, curbside and virtual waiting rooms, check-in kiosks, real-time patient experience survey means, price transparency tools, and much more.

One significant challenge that needs close lookout with the introduction of the tools above; is designing measurement tools for patient expectations. That challenge is also applicable to physician practices, as, if handled with such measures, physicians can provide and monitor patient-centered care with custom-tailored outputs to patient expectations.

The tools and prerequisites for medical practice efficiency often overlap with patient expectations, like the patient engagement portal. However, the complexity of the medical practice environment today is why many practice management solutions have emerged.

Amidst all the interconnectedness and complexity of medical practice workflow, one should pay attention to the significance of the conflict between insurance policy with patient expectations and physician workload.

The quality of care seen through the 3rd party payer lens may differ from what transpires between the physician and the patient. And since with regards to services rendered to patients for which insurance companies are the sole payers, one can hardly evade the conflict of meeting quality based on patient expectations and balancing cost within the limits of time allocated for the care of that patient by the payer.

Sustaining the three components of the patient care project ideally translates into respecting patients' values and expectations. It must accommodate coordination, collaboration, and integration of multidisciplinary care, reinforce education, and maximize comfort and emotional support.

The patient care project also implicates family and friend involvement, establishing and maintaining access, transition, and continuity of care at all times.

All said and done, delivering high-quality medical care may be about balancing cost, time, and quality of patient care.

However, today, when it comes to patient care, the project management triangle is at a crossroads of meeting the efficiency of physician time while insurance companies predetermine the cost and quality specified by the corporate strategy.

Therefore, it should come across as utter hypocrite to talk about patient expectation, physician satisfaction, and practice efficiency when neither have control over the project in which they are the innate members. So, which quality, what cost, and efficiency at whose expense?


  1. I envision The Future Of Complex Care | Health Affairs. "Envisioning The Future Of Complex Care | Health Affairs Forefront," February 19, 2021.
  2. Executive and Continuing Professional Education. "A Primer on Project Management for Health Care," December 17, 2015.
  3. Lipsitz, Lewis A. "Understanding Health Care as a Complex System: The Foundation for Unintended Consequences." PubMed Central (PMC). Accessed November 14, 2022.
  4. NewsBreak Original. "Spiral Project Management Methodology in Healthcare | Dr. Adam Tabriz | NewsBreak Original." Accessed November 14, 2022.
  5. NewsBreak Original. "Agile Project Management and Its Application in Medical Practice | Dr. Adam Tabriz | NewsBreak Original." Accessed November 14, 2022.
  6. NewsBreak Original. "The Waterfall Project Management Methodology | Dr. Adam Tabriz | NewsBreak Original." Accessed November 14, 2022.

Illumination Publication initially publicized this article on Medium!

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