Prakash Jayakumar, M.B.B.S., MRCS, FSEM, DPhil,
Prakash was a fellow in orthopaedic surgery and honorary researcher at the University of Oxford where he was awarded his Doctor of Philosophy in health outcome measurement after injury. This followed scholarships at the Harvard T.H. Chan School of Public Health and Harvard Medical School performing studies involving patient reported outcomes. Jayakumar is a principal investigator in a 5-year global patient outcomes project, funded by the AO Foundation in Switzerland. He has a special interest in human-centered design and been a clinical advisor for design teams in the medical device industry and organizations such as NASA. He has also explored design-led approaches to enhance population health through A.I and data visualization in a Masters in Research in Health Care Design developed by Prof Lord Ara Darzi at the Royal College of Art / Imperial College London. Jayakumar consults for the University of Oxford and medical device companies on value based health care and digital health. He completed his medical degree at Kings College London, holds a 1st class honors bachelor’s degree from University College London, and is a member of the Royal College of Surgeons of England.
During his Harkness fellowship, Prakash was based at the University of Texas at Austin, Dell Medical School, where his topic focused on Transforming Musculoskeletal Health Care through Condition-focused Integrated Care. Based on the substantial burden placed on US and UK health care by high prevalence, high cost chronic musculoskeletal conditions such as degenerative joint disease (DJD) of the hip and knee, escalating joint replacement surgeries and low value interventions, and questions around appropriateness and variation in outcomes, there is a critical need for better value care i.e. outcomes benefiting patients relative to cost, for this preference-sensitive condition. Efforts to date have mostly focused on the procedural episode to achieve this critical need through alternative payment models, however, improvement in quality metrics and reductions in spending have been relatively modest. Few focus on a 360o whole person, team-based, condition-focused, integrated approach i.e. one incorporating alternative management strategies such as behavioral health, social support, nutritional guidance, substance abuse prevention, and advanced shared decision-making around surgery. The purpose of this project was to explore the experiences of learning health systems in delivering integrated care for DJD and to assess the value i.e. outcomes and costs of a comprehensive condition-focused, integrated practice unit.
Prakash’s work demonstrates emergent themes related to the delivery of integrated care within systems (e.g. culture change, vision for longitudinal condition management), the team approach (e.g. development of novel roles and responsibilities), and organization of care (e.g. co-located facilities, enabling technologies). It also demonstrates substantial benefit in health-related, clinical and process outcomes for patients (including vulnerable, underserved populations) experiencing non-surgical strategies, along with large scale differences in costs of non-surgical care cycles.
The work highlights opportunities to develop advanced care delivery models for DJD in the US and UK, supporting the development of alternative payment models for longitudinal condition-focused care and shifting the focus upstream along the care pathway. In the UK, resource pressures continue to impact such preference-sensitive conditions, highlighting the need for alternative approaches to commissioning services. Opportunities exist in leveraging existing assets in the NHS (e.g. integrated primary care services, triage hubs, GPs with specialist interests, specialist physiotherapists). Further, new models may reduce burden on community resources and limit costly outsourcing.
Prakash is continuing in Austin as appointed faculty to advance this work and generate further evidence for an integrated, condition-focused approach to providing the right care at the right time for musculoskeletal patients, driving the transition toward orthopaedic population health.