In­te­grat­ing spe­cialty care

Pan­elists dis­cuss pop­u­la­tion health, IT data risks and chal­lenges, cut­ting costs

Modern Healthcare - - EDITORIAL WEBINAR -

Edi­tor’s note: As health sys­tems con­tinue to di­ver­sify across the con­tin­uum of care, health­care lead­ers will need to iden­tify which ser­vices to of­fer and where to of­fer them. A re­cent Mod­ern Health­care edi­to­rial we­bi­nar, “The Fu­ture of Spe­cialty Ser­vice Lines in a Di­ver­si­fied Sys­tem,” fo­cused on that im­por­tant trend and ad­dressed a num­ber of key ques­tions, in­clud­ing: Should hos­pi­tals be bring­ing more ser­vices in-house? Where do spe­cialty hos­pi­tals fit into the pic­ture? Which strat­egy holds out the great­est prom­ise of en­hanc­ing both the top and bot­tom lines? The we­bi­nar was hosted by Mod­ern Health­care re­porter Beth Kutscher, and the pan­elists in­cluded Aaron Bu­jnowski, se­nior vice pres­i­dent of strat­egy and plan­ning, Texas Health Re­sources; Robert Huck­man, pro­fes­sor of busi­ness ad­min­is­tra­tion and fac­ulty co-chair of the Har­vard Busi­ness School Health­care Ini­tia­tive; and Alan Sat­tler, pres­i­dent, ProMed­ica Acute Care Di­vi­sion. What fol­lows is an edited ex­cerpt of the Q&A ses­sion of the we­bi­nar. Beth Kutscher:

Fifty per­cent of hos­pi­tal ad­mis­sions are now com­ing in through the emer­gency depart­ment. How will emer­gency medicine be af­fected by the in­te­gra­tion of spe­cial­ties? Robert Huck­man:

I think that the key here is go­ing to be try­ing to spend some time look­ing at the pat­terns of the emer­gency cases that come in. A lot of or­ga­ni­za­tions are try­ing to be­gin to wres­tle with this is­sue. We may very well have pat­terns and flows within the emer­gency depart­ment that be­gin to look in many ways like many forms of spe­cial­ized care paths—and I don’t want to use the term pro­to­col be­cause I know that of­ten comes with judg­ments around it—but none­the­less, look­ing for a sort of pat­tern recog­ni­tion in the types of cases that do come through ERs and be­gin­ning to think about, can we come up with mech­a­nisms for us­ing cer­tain trig­gers and cer­tain cases to set off a cer­tain flow of ac­tiv­i­ties? And I think a lot of that would mimic a lot of the ben­e­fits of spe­cial­iza­tion that are seen in other ar­eas of the hos­pi­tal, and cer­tainly would help with ob­vi­ously the mas­sive co­or­di­na­tion is­sues that are re­quired for a large num­ber of emer­gency pa­tients.

The other piece that will help us is, hope­fully, stronger in­te­gra­tion of tech­nol­ogy. So, we are see­ing al­ready that emer­gency ra­di­ol­ogy is quite firmly housed in emer­gency de­part­ments now, not so much in ra­di­ol­ogy. In many ways, you’ll be­gin to see some of th­ese spe­cial­ties define them­selves in a slightly dif­fer­ent way be­cause of the na­ture of what’s com­ing into our hos­pi­tals and where it’s com­ing in.


Mr. Sat­tler, how does ProMed­ica in­te­grate post-acute into the acute-care hos­pi­tal and physi­cian re­la­tion­ship in­cen­tives for man­ag­ing tran­si­tions? Alan Sat­tler:

Quite frankly, in the posta­cute area we are look­ing at any met­rics that we can link to that ser­vice line, and most of the fo­cus, at least ini­tially in the first year or so, has been around the acute-care ex­pe­ri­ence. But the nice part about the ser­vice line struc­tures that we have set up is ev­ery year we look at new met­rics, and we de­ter­mine if those met­rics need to be changed, in part­ner­ship with our physi­cians. And as we es­tab­lish im­proved per­for­mance, we are able to look at new met­rics and es­tab­lish those. So, I think we’ll branch out and we’ll look at a deeper op­por­tu­nity to ex­pand clin­i­cal ex­cel­lence and prob­a­bly pick up post acute as well as other ar­eas as we con­tinue to make sure that we have the very best clin­i­cal ex­cel­lence in our acute care ar­eas.

To date, we prob­a­bly haven’t done it a tremen­dous amount there, but the struc­ture and the model is flex­i­ble enough and nim­ble enough that ev­ery year we change those met­rics. And we’ll ex­pand that and de­velop it. And, of course, it’s ever chang­ing, right?

The met­rics will change just as the de­mands and the re­quire­ments within the health­care seg­ment change. So that’s the beauty of the flex­i­bil­ity of be­ing able to look at those each year and set those met­rics for the com­ing year.


Mr. Bu­jnowski, do you see any re­luc­tance in pa­tients in trav­el­ing to spe­cialty care cen­ters? Aaron Bu­jnowski:

We’ve ac­tu­ally taken a look at pa­tients and pa­tient travel times. I think it de­pends on the con­di­tion. We

haven’t seen a huge aver­sion to peo­ple driv­ing for their spe­cialty care, es­pe­cially when the com­pe­tency of the physi­cian and the staff at the lo­ca­tion is deemed to be great.

In the Dal­las metro­plex, when we do the analy­ses, we see peo­ple driv­ing from one side of the metro­plex to the other for care; al­though, prin­ci­pally, they will seek care some­what in a ge­o­graph­i­cally close area to where they live or work, and cer­tainly we try to ac­com­mo­date that. But for spe­cialty ser­vice lines, es­pe­cially at the higher-acu­ity lev­els, the travel doesn’t seem to be a sig­nif­i­cant is­sue or bar­rier to them re­ceiv­ing care.

Kutscher: What in­for­ma­tion tech­nol­ogy plat­forms ex­ist to col­lect, an­a­lyze and man­age pop­u­la­tion health, and how is it in­te­grated into care man­age­ment? Sat­tler:

I don’t know if we have an over­rid­ing plat­form to­day that I could an­swer that ques­tion with. We use McKes­son’s in our clin­i­cal ap­pli­ca­tions, but we are look­ing at, how do we do that in an IT so­lu­tion for pop­u­la­tion health? And I’m not sure we have the an­swer to that to­day, but clearly it’s go­ing to be im­por­tant as we go for­ward.


At Texas Health, pop­u­la­tion health is one of our pri­mary strate­gies look­ing for­ward. At our 14 wholly owned hos­pi­tals, we have Epic de­ployed. We’ve ac­tu­ally tried to ad­vance our IT. Re­cently, we were named one of the most wired sys­tems na­tion­ally, and for many years, we pushed for­ward our IT in­fra­struc­ture. And so within all our hos­pi­tals, we have very good flow of in­for­ma­tion within the wholly owned hos­pi­tals. We are cur­rently build­ing an HIE to con­nect all of our physi­cians’ clin­ics to our hos­pi­tals, and that will even­tu­ally ex­tend out into the com­mu­nity as well. And so we’re try­ing to ad­vance our IT in­fra­struc­ture as quickly as pos­si­ble.

The three of us were speak­ing be­fore the call that be­ing able to use data to truly look at risk, and risk-strat­ify pa­tients, is go­ing to be a key to ac­count­abil­ity, and if you take away the O in an ACO and just say ac­count­able care, to be ac­count­able for those pa­tients and un­der­stand where the risk fac­tors are and be­ing able to ad­dress those risk fac­tors ap­pro­pri­ately, that health­care in­for­ma­tion is go­ing to be crit­i­cal to all of that. And at Texas Health, we’re

“The met­rics will change just as the de­mands and the re­quire­ments within the health­care seg­ment change.”

try­ing to push that for­ward as quickly and ag­gres­sively as we can.

Sat­tler: I would echo that. Holis­ti­cally, I think Rob talked about the holis­tic ap­proach. Does that get lost in spe­cial­iza­tion? And so we use McKes­son on the acute-care hos­pi­tal side clin­i­cally, and then we use Allscripts in the physi­cian group prac­tice. But we know, ul­ti­mately, we need to have a sys­tem so­lu­tion that brings both the am­bu­la­tory-out­pa­tient physi­cian and acute-care fa­cil­i­ties to­gether from an IT stand­point, and we are ag­gres­sively on that same path.

Huck­man: I think as both Alan and Aaron have sug­gested, the chal­lenge of just try­ing to co­or­di­nate all of the ac­tiv­i­ties that oc­cur from when the pa­tient en­ters the acute-care or even the pri­mary-care de­liv­ery sys­tem through when they get their acute treat­ment re­solved is enough of an in­for­ma­tion tech­nol­ogy prob­lem to try to man­age; but I think as Aaron hinted at, so much of the IT is­sue is go­ing to also be draw­ing data at a much ear­lier point in the process, that is from the con­sumer and where con­sumer health is prior to ac­tu­ally in­ter­act­ing with the sys­tem. And I think this is the thing that makes the in­te­gra­tion chal­lenge even larger than the sig­nif­i­cant is­sue it’s kind of been his­tor­i­cally.

Sat­tler: I think the won­der­ful op­por­tu­nity there is the con­sumer. ... Un­der health­care re­form, I think the con­sumer as­pects of this are go­ing to push our in­dus­try ag­gres­sively in that con­sumerism-type ap­proach in ways that maybe we can’t even think of to­day, but I think in the end, it’s go­ing to all be good. And if we just keep our eye on the things that mat­ter, which is what mat­ters to pa­tients and to fam­i­lies in the broader con­text, then I think the in­dus­try as a whole is go­ing to get bet­ter,

Alan Sat­tler Pres­i­dent, ProMed­ica Acute Care Di­vi­sion

and we’re go­ing to do bet­ter be­cause of it.

Bu­jnowski: And I think maybe one ad­di­tion to, per­haps the holy grail of it all, is to make sure that the right in­for­ma­tion is ac­tu­ally in the hands of the pa­tient, be­cause, ul­ti­mately, each one of us in­di­vid­u­ally is re­spon­si­ble for our own health.

And to the ex­tent we can as health­care providers en­able the con­sumer to un­der­stand the con­trib­u­tors to his or her own health, and we as providers can help fa­cil­i­tate in­ter­ven­tions that help them mit­i­gate those risks even be­fore they ex­press, that’s where the true dif­fer­en­tia­tor is in terms of a de­mand side kind of shift in cost as we pre­vent ill­ness even be­fore they walk into a hos­pi­tal.

Kutscher: Mr. Bu­jnowski, have you thought about your in­sur­ance part­ner­ships and the im­pact they have on this process and hav­ing a holis­tic ap­proach to ser­vice-line de­liv­ery? Bu­jnowski:

The pay­ers are cer­tainly go­ing to be the near-term and the long-term key play­ers in the spe­cialty ser­vice lines. We work very closely with the in­sur­ance com­pa­nies and the pay­ers to de­velop ar­range­ments that would be ben­e­fi­cial, es­pe­cially when we look at some of the value-based pay­ments and the way we’re ar­rang­ing those. Texas Health re­cently signed on the prin­ci­pally pri­mary-care side, an ACO ar­range­ment with Aetna to look at ways that we can en­gage with in­di­vid­u­als ear­lier in the pop­u­la­tion health realm. Look­ing at spe­cialty ser­vice lines, op­por­tu­ni­ties for bun­dled pay­ments or tar­geted carve- outs I think will con­tinue to be there and will be en­hanced by the per­for­mance of the ser­vice line to the ex­tent that ser­vice line is ca­pa­ble of pro­vid­ing top­tier out­comes and top- tier cost per­for­mance. The op­por­tu­ni­ties for bun­dled pay­ments to de­liver that value to those who are at risk, whether it be an em­ployer or a plan, will be there even more ag­gres­sively in the fu­ture.

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