‘We have to stop the tide of com­mu­nity hos­pi­tals be­ing closed’

Modern Healthcare - - Q & A -

Dr. Howard Grant has been pres­i­dent and CEO of the not-for-profit La­hey Health Sys­tem in Burling­ton, Mass., since 2010.

In 2012, La­hey Clinic Foun­da­tion and North­east Health Sys­tem formed La­hey Health, serv­ing east­ern Mas­sachusetts and south­ern New Hamp­shire. Grant pre­vi­ously served as ex­ec­u­tive vice pres­i­dent and chief med­i­cal of­fi­cer at Geisinger Health Sys­tem and served as CMO at Tem­ple Univer­sity Health Sys­tem. Mod­ern Health­care re­porter An­dis Robeznieks re­cently spoke with Grant about ris­ing health­care costs in Mas­sachusetts, his op­po­si­tion to the con­tin­ued ex­pan­sion of Part­ners Health­Care and his sys­tem’s ac­count­able care ef­forts. This is an edited tran­script.

Mod­ern Health­care: How has the na­tional Oba­macare ex­pe­ri­ence com­pared with Mas­sachusetts’ Rom­n­ey­care ex­pe­ri­ence?

Howard Grant:

We are for­tu­nate to have about 98% of the res­i­dents of the com­mon­wealth in­sured. The most strik­ing dif­fer­ence is that health­care costs have con­tin­ued to es­ca­late in Mas­sachusetts, where the av­er­age cost of care is 40% higher than the na­tional av­er­age. We’ve got a dis­pro­por­tion­ate amount of care be­ing de­liv­ered in higher-cost aca­demic hos­pi­tal set­tings. Now that state law has capped the growth of to­tal med­i­cal ex­penses, it’s in­cum­bent on every­body in the com­mon­wealth to fig­ure out how to lower the cost of care. We think we’ve got a real good recipe for do­ing that at La­hey.

MH: What is your recipe?

Grant:

When La­hey Clinic came to­gether with North­east Health Sys­tem, we made a com­mit­ment to do ev­ery­thing we could to keep pa­tients in the com­mu­nity hos­pi­tal set­ting when­ever pos­si­ble and only have pa­tients come to the high­er­cost set­ting, La­hey Hos­pi­tal and Med­i­cal Cen­ter, when ab­so­lutely nec­es­sary. Our sys­tem, which added Winch­ester Hos­pi­tal sev­eral months ago, is al­ready see­ing a sig­nif­i­cant in­crease in the amount of care de­liv­ered in the com­mu­nity set­ting, and only pa­tients that ab­so­lutely need to be in the ter­tiary set­ting are com­ing to Burling­ton for that care. It’s re­sulted in su­perb qual­ity at lower cost.

MH: You re­cently helped put to­gether a coali­tion to protest the ex­pan­sion of Part­ners Health­Care. What has that coali­tion done and why?

Grant:

When the orig­i­nal pro­posed set­tle­ment was an­nounced be­tween At­tor­ney Gen­eral Martha Coak­ley and Part­ners, most providers in the com­mon­wealth were stunned by the pro­posed scope of Part­ners’ growth. We spent the next month talk­ing with health plans, con­sumer groups, re­li­gious groups and em­ployer groups, try­ing to un­der­stand the set­tle­ment. It be­came clear the set­tle­ment would re­sult in the cost of care con­tin­u­ing to go up at an ac­cel­er­ated rate and that the growth of Part­ners would be even more pro­nounced. So the coali­tion of providers came to­gether and tried to ed­u­cate the pub­lic about it. A judge re­cently de­cided to put off any fi­nal res­o­lu­tion pend­ing an op­por­tu­nity to fur­ther in­ves­ti­gate the many com­ments from var­i­ous groups. She noted that this was not just the coali­tion that might have a com­pet­i­tive con­cern, but also other dis­in­ter­ested par­ties that were con­cerned about the im­pli­ca­tions for costs. The next stage of the process was put off un­til Nov. 10, after the elec­tion.

MH: What chal­lenges and suc­cesses has La­hey’s ac­count­able care or­ga­ni­za­tion ex­pe­ri­enced?

Grant:

Pop­u­la­tion health is where most health­care providers need to move as quickly as pos­si­ble. The great chal­lenge all or­ga­ni­za­tions face is mov­ing to risk in ac­count­able care while still par­tic­i­pat­ing in the care of many pa­tients in the old fee-for-ser­vice struc­ture. And it’s a big chal­lenge com­ing up with the re­sources nec­es­sary to build the in­fra­struc­ture for man­ag­ing a pop­u­la­tion of pa­tients bet­ter.

We’re in­vest­ing prob­a­bly $200 mil­lion in the in­stal­la­tion of an Epic Sys­tems elec­tronic health record. We’ve had some suc­cess in our risk con­tracts, though we did not have as much suc­cess as we would have liked in one com­po­nent of the or­ga­ni­za­tion in the first wave of the Medi­care Shared Sav­ings ACO. Our ini­tial pre­dic­tions for 2014 sug­gest much bet­ter per­for­mance.

“Pri­or­ity No. 1 in ev­ery as­pect of what we do is keep­ing our pa­tients safe.’’

MH: How does La­hey’s col­lab­o­ra­tion with the CVS Minute Clinic re­tail clin­ics fit into the ACO plan?

Grant:

We’re pleased that CVS also is in the process of in­stalling an Epic EHR sys­tem so we’ll have easy com­mu­ni­ca­tion be­tween the CVS sites and La­hey’s pri­mary-care physi­cians.

MH: How do you in­te­grate hos­pi­tals un­der your gov­er­nance model?

Grant:

We made a com­mit­ment at La­hey to share in equal gov­er­nance with the board mem­bers of the legacy North­east Health Sys­tem. We wanted to cre­ate a new vi­sion for the sys­tem and not have it be a com­pet­i­tive pos­ture be­tween the mem­bers of the new board. As other or­ga­ni­za­tions join us, we’ve made a sim­i­lar com­mit­ment that they, too, will be able to par­tic­i­pate equally in gov­er­nance. This gov­er­nance model is not typ­i­cal when larger or­ga­ni­za­tions merge with smaller or­ga­ni­za­tions. It has served us well to keep our fo­cus on the com­mu­ni­ties that we serve.

MH: What have you done to ad­vance pa­tient safety at La­hey?

Grant:

Pri­or­ity No. 1 in ev­ery as­pect of what we do is keep­ing our pa­tients safe. In our or­ga­ni­za­tion, we at­tempt to start ev­ery meet­ing with the dis­cus­sion of pa­tient safety and qual­ity. It doesn’t mat­ter if it’s a clin­i­cal con­ver­sa­tion or a fi­nan­cial con­ver­sa­tion or a man­ager’s meet­ing on any sub­ject. We try to talk about safety first. We try to build an ur­gency for ev­ery man­ager and ev­ery front­line staff that gives them the con­fi­dence that if they’ve got a con­cern about a pa­tient’s safety, every­body’s got both the abil­ity and the re­spon­si­bil­ity to raise a ques­tion. We have com­mit­ted as an or­ga­ni­za­tion to pur­sue top 10% per­for­mance in ev­ery ob­jec­tive qual­ity metric in those ar­eas where we haven’t yet achieved that.

As CEO, it’s my re­spon­si­bil­ity to make sure that safety and qual­ity are top of mind for ev­ery leader in the or­ga­ni­za­tion, for the goals we es­tab­lish, and for in­cen­tive com­pen­sa­tion. Qual­ity and safety al­ways rep­re­sent over 50% of the goals and in­cen­tives.

MH: What is the fu­ture of com­mu­nity hos­pi­tals?

Grant:

Within La­hey Health, we’ve been able to demon­strate that we can de­liver much more care in our com­mu­nity hos­pi­tals. As a re­sult, Bev­erly and Ad­di­son Gil­bert hos­pi­tals are busier than they’ve been in decades as a re­sult of keep­ing pa­tients close to home and serv­ing them at con­sid­er­ably lower cost and with greater con­ve­nience with­out com­pro­mis­ing qual­ity.

Over half of the hos­pi­tals in Mas­sachusetts have closed in the last 20 years. In ev­ery com­mu­nity where a hos­pi­tal has closed, it has been the source of rea­son­ably priced health­care, emer­gency ser­vices and jobs. We have to stop the tide of com­mu­nity hos­pi­tals be­ing closed as more and more care is be­ing de­liv­ered in a higher-cost set­ting. As a sys­tem, La­hey Health is com­pletely com­mit­ted to mak­ing sure that doesn’t con­tinue.

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