We are trans­form­ing our or­ga­ni­za­tion’s vi­sion of our own health­care sys­tem from ‘sick care’ to ‘health care.’

Modern Healthcare - - OPINIONS COMMENTARY -

with a ded­i­cated group of pri­mary-care providers that com­mit­ted to pro­vid­ing our as­so­ciates with care co­or­di­na­tion, man­ag­ing out­comes and us­ing our well­ness pro­gram ser­vices. These physi­cians have ei­ther reached Level 3 ac­cred­i­ta­tion for a pa­tient-cen­tered med­i­cal home from the Na­tional Com­mit­tee on Qual­ity As­sur­ance or will ac­quire this level in the com­ing year.

The pri­mary-care providers are tar­get­ing ar­eas that Pen­rose-st. Fran­cis, as an em­ployer, iden­ti­fied as needs of our pop­u­la­tion, in­clud­ing pe­di­atric asthma, car­dio­vas­cu­lar dis­ease, di­a­betes and pre­ven­tive screen­ings. The pri­mary-care providers will re­port pa­tient-cen­tered med­i­cal home met­rics, as de­fined by the NCQA, to us over the next cou­ple of years.

Pen­rose-st. Fran­cis pays these pri­mary-care providers a per-mem­ber, per-month fee, funded in part by elim­i­nat­ing some of the care- and dis­ease-man­age­ment func­tions we for­merly paid our third-party ad­min­is­tra­tor to per­form. We re­al­ized the mar­ket re­jec­tion of the gate­keeper pri­mary-care provider re­fer­ral model—and the sub­se­quent move to an open-ac­cess pre­ferred provider or­ga­ni­za­tion—had the un­in­tended con­se­quence of dis­rupt­ing pri­mary-care re­la­tion­ships, leav­ing our as­so­ciates to nav­i­gate their way through the com­plex health­care sys­tem. While mean­ing well, the med­i­cal man­age­ment pro­grams that grew up to fill this void con­flicted with, rather than com­ple­mented, the ef­forts of the physi­cians who were re­spon­si­ble for ac­tu­ally caring for their pa­tients. We felt it was im­por­tant to pay our pri­mary-care providers for co­or­di­nat­ing care, which low­ers over­all costs and im­proves qual­ity of care. Dur­ing the next year, we hope to in­tro­duce pay-for-per­for­mance or shared-sav­ings mod­els.

While our as­so­ciates had a choice in se­lect­ing their pri­mary-care providers, we built fi­nan­cial in­cen­tives in the plan de­sign for choos­ing a part­ner pri­mary-care provider that had achieved pa­tient-cen­tered med­i­cal home ac­cred­i­ta­tion. About 50% of our as­so­ciates have cho­sen to ob­tain their care from one of these physi­cians. As a re­sult of the pa­tient’s abil­ity to choose to par­tic­i­pate, there has been lit­tle dis­rup­tion to our as­so­ciates, which has helped with the over­all as­so­ci­ate sat­is­fac­tion with our pi­lot.

We have be­gun to see some pos­i­tive changes al­ready. Our em­ploy­ees are be­com­ing (mea­sur­ably) health­ier as proven by our an­nual health fair bio­met­ric screen­ing re­sults. Our ab­sen­teeism has de­creased and sev­eral area em­ploy­ers are of­fer­ing our well­ness pro­grams to their em­ploy­ees. And, not un­ex­pect­edly, our area em­ploy­ers and health plans are be­gin­ning to em­brace the pa­tient-cen­tered med­i­cal home con­cept, and have be­gun dis­cus­sions of their own with these pri­mary-care providers.

Most im­por­tant, we be­lieve we are on our way to a demon­stra­ble, sus­tain­able cul­ture of health. We are trans­form­ing our own or­ga­ni­za­tion’s vi­sion of our health­care sys­tem from one of “sick care” to “health care” and we’ve aligned our ben­e­fits pack­age with that vi­sion. And it’s a highly ef­fi­cient way to cre­ate the in­fra­struc­ture for pop­u­la­tion health man­age­ment.

Our ex­pe­ri­ence served as a pi­lot pro­gram for Cen­tura Health—our par­ent com­pany and the largest hospi­tal and health­care net­work in Colorado—and it is now be­ing adopted sys­temwide af­fect­ing nearly 14,500 as­so­ciates at 13 hos­pi­tals.

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