What Technology Will Need To Accomplish In The Future For Clinically Integrated Networks & New Models Of Reimbursement

By Michael Hunt, Chief Executive Officer and President, St. Vincent’s Health Partners

Michael Hunt, CEO and President, St. Vincent’s Health Partners
Michael Hunt, CEO and President, St. Vincent’s Health Partners
Technology is the “go-to” methodology in today’s new models of healthcare delivery. I submit that people and process are the foundation to any organizations’ ability to manage populations, succeed at new models of reimbursement, and engage and convince providers (physicians, hospitals, networks) to tackle the hard work of transformation to collectively exceed expectation of the stakeholders of the new models of reimbursement.
Organizations have invested precious resources in EMRs. Meaningful Use added additional incentive for healthcare organizations to move electronically ultimately to prevent penalties. Additionally, EMRs offer organizations the opportunity to compete for the potential new revenue streams and provide new capabilities to manage the ever-increasing negative pressure on fees. And yet…the issue still needing to be asked and solved is current day infrastructure capable to successful participation in the new models of reimbursement. The simple answer is no! EMRs are facing increasing challenged to exceed provider, governmental, and consumer demands. As much as EMRs are working to be the sole solution to population episodic health, the diversity and disparity of data to manage all transitions of care remains elusive and problematic for EMR vendors to develop their platforms allowing a translational ability to create longitudinal patient records encapsulating all aspects of care simultaneously managing to payer contracts with confidence to move to models of reimbursement accepting increasing levels of risk.
Technology empowers healthcare providers to do outstanding feats of episodic care. The ability to use “intelligence” to save lives in so many ways is catapulting informatics scope of work that teams of informaticists can spend whole careers focused on a single transition in care. Today, taking risk requires organized delivery systems to manage patients exceeding the Quadruple Aim, and absorb diverse disparate data from every transition of care timely, repetitively, and continuously impactful to manage populations at large while serving unique “at-risk” patients acutely. The literature has well documented diverse operating models uniquely serving cohorts of populations, but not solving the need for scalability to the whole population economically.
Ultimately, population health technology vendors will need to establish capabilities that extend beyond episodic care, capture and facilitate successful management of populations exceeding contractual payer requirements, and allow an organizations to understand the impact of healthcare delivery economically to provide guided insightful impact to manage acute challenges to cost respecting the partnership between payer and provider to manage the “risk” of serving the population and achieve cost-effective, high quality, continuous care! BPCI exemplifies the need for actionable data to compete for gainshare.
Bundle Payment Care Improvement exemplifies the need to serve patients entering acutely into the healthcare delivery system for an initiating event and follow them through every transition of care with high quality cost-effective services that meets target pricing. Organizations across the U.S. are demonstrating a wide-range of capabilities while discretely identifying the plethora of operational opportunities within and external to healthcare organizations ability to influence. Thereby establishing the conundrum moving to full risk regarding cost of care while insuring quality at every patient care encounter over a full population.
The solution…an organized delivery system that has the ability to allow each transition of care to independently serve their patients with the best quality of care economically, while focusing on the “whole” population and effectively influence each transition uniquely and timely. That organized delivery system must effectively partner with each transition of care’s leadership and provide insightful ability to transform and collectively collaborate to drive down the excessive cost of care and enhance quality.
St. Vincent’s Health Partners, Inc., the first URAC accredited clinically integrated network in the United States is moving towards execution of the organized delivery system that has fundamentally transformed the experience of healthcare providers from every transition of care that collaborates and is developing people and processes to resolve the barriers to transition and hand-off. Recently, the members of the network (hospital, five skilled nursing facilities, four home health agencies, two hospices, and more than 400 providers [physicians and mid-levels]} celebrated the current success of collaboration of our journey so far. SVHP doesn’t own these fine organizations, instead we work together while preserving the independence each organization. During our Summit, we showcased a patient and his daughter who was served by our integrated network. The patient’s initiating event was highly complicated requiring significant surgical and post-procedure expertise. This gentleman was invited to share his experience as a consumer of our collective services. The power of healing demonstrated by the network serving this patient through each transition of care is what we strive to offer every patient every day. The gentleman’s complex life-saving care required expertise in each transition of care. Because our system was able to track centrally and insure handoffs, the confidence of our members is exploding. The excitement shared by each member’s leadership was inspirational.
These transformed collaborative leaders are vindicating how people and process changes have allowed them to manage populations while serving unique patients. These leaders’ palpable excitement articulating the difference of the processes within our network and when working outside of our network is convincingly supportive of the network. In turn, they have challenged SVHP to up their game, and develop new and more effective analysis and reporting allowing the clinically integrated network to further enjoy these new models of reimbursement, prevent the downward pressure on fees and cost, and continue to preserve the diversity of organizations under our network umbrella. SVHP’s current model is centralized population oversight while allowing each network member to perform at their best and compete effectively in the marketplace. SVHP will need to continue to develop technological support allowing insight into the population while facilitating the longitudinal record of the individual patient. Currently, SVHP has three technologies are uniquely deployed, but requires staff skill to connect them successfully. SVHP’s journey is automate more aggressively and develop additional skills within predictive modeling to timely and insightfully influence each participating member to continue their institution transformation!