As the move toward value-based care continues—and likely accelerates post-COVID-19—healthcare leaders need a strong infrastructure for clinical integration. That means ensuring they have the resources and alignment necessary to meet the rising demands of consumers, payers, and employers.
Change is hard, but irrelevancy is worse
“Change is hard, but irrelevancy is even worse,” said Charles Dennis, MD, executive vice president and system chief medical officer at Carle Foundation Hospital in Urbana, Ill., during Session 2 of Guidehouse’s 2020 Clinical Integration Summit.
As consumer price sensitivity rises and financial pressures for businesses increase, efforts to reduce healthcare costs will intensify. Providers prepared to move forward with value-based partnerships—even amid the pandemic—will be better positioned to leverage previously unseen challenges such as COVID-19 to transform care and reduce costs, Dr. Dennis said.
During the Clinical Integration Summit, Dr. Dennis and Don Brunn, MHSA, FACHE, senior vice president of network development at Emory Healthcare in Atlanta, shared the secret sauce in their care transformation successes with four lessons learned.
1. Describe the “why”
In 2017, Carle Foundation Hospital’s board and leaders led an organizational recommitment to hold each other accountable to be a top-decile performer. The hospital renewed its focus on offering high-value care, including in quality, safety, access, service, and cost. Carle worked with Guidehouse to mobilize a transformation journey with the prioritized initiatives of improving hospital length of stay, preventing readmissions, formalizing a post-acute network strategy, and participating in the Bundled Payments for Care Improvement Advanced program.
To activate physicians and staff, Carle found it imperative to describe the “why.” That means providing tangible examples of successful approaches to value transformation.
“For instance, increasing quality of care and patient safety while reducing costs clearly drives value,” said Dr. Dennis. “Programs where the cost is greater than the quality of care derived from them do not provide value. Neither do services that substantially increase quality, yet access to these services is limited.”
At Carle, knowing the “why” behind value transformation strengthens collaboration across the continuum of care, engages teams in new models for care such as bundled payments, and encourages team members to hold each other accountable for continuous improvements using data to measure impact. It was a shared purpose that kept team members intensely focused on their value journey.
And the results prove it. Carle has nearly eliminated excess hospital days, reduced readmission rates by 11%, and continues to lower acute care average length of stay and increase access so that it can serve more patients.
2. Use existing relationships to solve health challenges
“We show up in a spirit of partnership in collaboration with our payers and with our affiliate partners,” said Emory Healthcare’s Brunn. “We’re committed to seeing quality outcomes that improve health and bend cost trends.”
In 2009, Emory developed a model for clinical integration and invited the four major payers in its market to participate—a markedly different approach than that of its competitors. “We had the good fortune to anticipate the coming wave of population health management ACOs and so forth in our market,” Brunn said.
Launched in 2011, the model initially only covered the 28-county Atlanta metro area. Each year, Emory reduced medical costs by 3%-15% year over year, “[A]nd we’re using all the tools in the population health management and [clinically integrated network] toolbox that many of the rest of you have available,” Brunn told attendees during the Clinical Integration Summit.
Because of these successes, Emory has not had to engage in risk-based contracts with penalties or clawbacks. “Payers often see the value of including Emory in their narrow network product plans in non-Atlanta markets, and our reputation for expert clinical management of patients who need the most complex and quaternary care is valued across the region,” said Brunn.
3. Find out-of-the-box opportunities to collaborate
At the start of the pandemic, Carle partnered with the University of Illinois at Urbana-Champaign’s Grainger College of Engineering and Carle Illinois College of Medicine to create a ventilator prototype in just 14 days.
The prototype demonstrated performance that was equivalent to that of commercial ventilators at a time when commercial ventilators were in short supply. “Belkin Electronics picked it up and is now manufacturing it for less than $100,” Dr. Dennis said. “The University of Illinois also helped us with our PPE needs through their fabric engineering department.”
At the start of COVID-19, Carle also looked for ways to leverage relationships in its newly developed post-acute network to streamline discharge planning for COVID-19 patients. The hospital launched a “Carle at Home” initiative to provide in-home care for patients with moderately low to moderate cases of COVID-19, limiting the time spent in inpatient environments while freeing up in-hospital resources for the most severely ill patients.
Leaders also directed nursing resources to skilled nursing facilities so these facilities would be able to reopen unused beds and move high-risk patients out of the inpatient hospital environment. “COVID-19 has allowed us to seize many of these opportunities,” Dr. Dennis said, while the hospital’s culture of care transformation “enabled us to see where opportunities existed.”
4. Give all leaders a stake in the network’s success
“All of us on the management team share one set of annual and strategic goals. We also are graded against the same performance measures each year, and our setups are truly aligned,” Brunn said.
“In my opinion our organizational structure and philosophy was intentionally designed this way to align the hearts and minds of our leadership team and, by extension, the hearts and minds of our physician colleagues, our hospital teams, and our system teams. Together, we see the same sunrise, and we watch the same sunset at night.”
The time for clinical integration is now
The movement to value will continue to drive organizations to develop and discover ways to improve care, enhance the patient experience, and lower the cost of care. Although the pandemic has confronted leaders with many challenges, it has also been a call to action to embrace evolving opportunities to engage with their clinically integrated network and build capabilities to accelerate the value transformation journey.
Taking cues from leaders whose organizations have experienced clinical integration success could help health systems design their own successful models.