By BETSY TAYLOR
Dr. Rhonda Medows, Providence St. Joseph Health's executive vice president of population health spoke with Catholic Health World about how the system is transforming to improve care quality and outcomes while managing costs for defined groups of people. She detailed how the system has revamped its approach to pinpoint the needs of specific populations and how to best address those needs.
Medows is a family medicine physician with extensive experience in state oversight of Medicaid and State Children's Health Insurance Programs. She also is a CHA board member. Medows was an executive vice president and chief medical officer of UnitedHealth Group before joining Providence St. Joseph Health in 2015. She oversees value-based care — care delivery models that align financial incentives to reward improved outcomes and lower spending. She also oversees payer strategy and contracting, population health informatics, physician services, care management, a health plan and a medical group for the system. She said the system spent 2015 and 2016 restructuring and aligning these areas to support its entire enterprise.
What are a few key areas where Providence St. Joseph Health has successfully advanced its population health strategy?
There are five things we did in 2017 to move us along in population health management as well as in value-based care. Number one has been developing our model of care, and making sure it is implemented throughout our enterprise. That has meant improving ambulatory clinical quality in a measurable way as well as introducing resource management, utilization management, for everything.
Number two is introducing payment models to tie in how we provide care to value-based care payment models — both population-based as well as bundles. (A bundled payment is a set reimbursement for an entire episode of care.) We have about 1.3 million people in various value-based care partnership programs and agreements, and that includes Medicare, Medicaid, commercial and direct-to-employer. That's important because it helps us get closer to the population health outcomes we want. For value-based contracts, the system primarily contracts at the regional level, but does have some multistate value-based contracts with national payers that include common quality, patient experience, utilization measures and/or cost-sharing agreements.
The third focus area was the development of an enterprise care management service that includes new care managers who focus on the most medically complex people and the people who need the most additional support services, like social services and community resources. It began in Oregon; we then rolled that out in Washington and we'll be moving it into the other states.
Number four is something I'm really proud of. We developed Community Pathways to Health. That's our analytics and predictive analytics tool that incorporates clinical data with social determinants of health information. The data is used to identify and risk-stratify our patients who need more support for care management.
It is already in use and helping to identify people who need care management, for example, the more medically complex patients in Medicaid.
And number five is that we, finally hallelujah, have developed an ambulatory cost accounting system that will help us and our efforts to understand our total cost of care … and therefore, do a better job of managing it appropriately.
What's been achieved so far?
We're already seeing some early positive indicators, but this is multiple years of an endeavor. For it to be successful, we have to be consistent and persistent.
For clinical quality, we have core ambulatory quality measures that our physician leaders, including group practice leaders, agreed on. All of our physician providers use them whether they're employed or affiliated with the system. Providers receive electronic dashboards, and they can see where they are in their performance. They have the same core quality measures. Those measures are common to Medicaid, Medicare and commercial populations. We also use them in value-based care arrangements. We have the same core measures and the same methodology in every market, and that's critical. Otherwise, you have no idea how to compare.
We have a few learning measures that are basically in the pipeline, such as one on patients and advanced care directives.
For 2017, we're really proud that providers hit and exceeded their ambulatory quality improvement goals for the eight measures that everybody agreed would be common. And they cover everything from prevention to chronic disease management to, this year, behavioral health, pediatrics and more.
We're seeing some early successes in some of our contracts with major payers that have value-based care terms, meaning we've hit quality measures, we've hit consumer experience measures, and we've achieved some shared savings through appropriate resource management.
We've also built an accountable care organization to care for our own employees using our own providers to achieve a $70 million saving last year. And that's significant because it shows our providers are walking the talk on doing things that we believe improve employee population health.
How are you including actionable information about social determinants of health — the conditions in which people grow, live and work and which can affect their health — in this work?
We're taking the social determinant information that we have, and we're acquiring more of it, and including that in the new Community Pathways to Health analytics tool.
We use data from the community health needs assessments, so we can map out needs by zip code. In the patient intake form, there are questions related to social determinants of health as well. Physicians and clinical care teams are encouraged to ask questions about resource needs.
That information is then put into the electronic health record as a care management note with the information about where a patient is at risk, whether it's education level, whether it's income level, whether it's access to behavioral health, any of those things can impact the actual outcome of care. The physician or care team or nurse practitioner will have access to what we already identified about that patient and what their needs are.
The enterprise care management team works with the practice-based care coordinators who are literally embedded in the practices. We have home health services partners, some within our own enterprise and some of them are external, that do home visits. There are community service partners that we already have formal arrangements with. So, there's our network.
What's being done to address the needs, particularly of the poor and vulnerable patients?
In 2018 each of our communities is going to choose one of the top community health needs that's been identified by the community health needs assessment. Then, they're going to select a social determinant or two to focus on.
They're going to select a community partner or two to work with. And they need a five-year outcome goal that they are going to reach. They'll design an intervention and report monthly on their process, program and the outcomes. They'll also have a third-party effectiveness evaluation of the intervention. The idea is to have a more focused and targeted approach to making an impact.
Is the momentum in population health slowing as politicians argue over the future of the Affordable Care Act and direction of health care policy?
I don't think the momentum in population health is slowing at all. I think, if anything, the changes and the uncertainty about the entitlement programs, Medicaid and Medicare, as well as the individual markets actually make population health even more urgently needed. …We don't need to have the government tell us to do it. We already know that it's the right thing to do.
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