Strate­gic provider part­ner­ships de­liver best value in pur­suit of pop­u­la­tion health

Modern Healthcare - - COMMENT - By Tom Jack­iewicz In­ter­ested in sub­mit­ting a Guest Expert op-ed? modernhealth­ View guide­lines at Send drafts to As­sis­tant Man­ag­ing Edi­tor David May dmay@modernhealth­ at

The pre­vail­ing model for academic med­i­cal cen­ters is to own and ex­pand a pri­mary-care net­work. There is, how­ever, an­other model—one fo­cused on ge­og­ra­phy and com­mu­nity need.

We be­lieve the fu­ture of academic medicine lies in strate­gic part­ner­ships, where univer­sity med­i­cal cen­ters af­fil­i­ate with pri­mary-care physi­cians and lo­cal spe­cialty groups, com­ple­ment­ing these re­la­tion­ships with ter­tiary and qua­ter­nary ex­per­tise drawn from the academic in­sti­tu­tion.

In our view, this ap­proach is both vi­sion­ary and prag­matic. Los An­ge­les may be a unique mar­ket, but there are lessons that can be ap­plied in other com­mu­ni­ties. And if we take a step back, we can see where this dis­cus­sion fits.

Value-based health­care is premised on the value equa­tion: qual­ity and ser­vice/cost. The goal is to pro­vide high qual­ity and ef­fi­cient care for each pa­tient. Pop­u­la­tion health pro­grams take a broader view by ex­plor­ing and un­der­stand­ing dis­crete pa­tient pop­u­la­tions, and pro­vid­ing the ed­u­ca­tional tools and pa­tient care to pre­vent dis­ease, pro­mote bet­ter health and pro­long life. As an ex­am­ple, at Keck Medicine of USC, we have a stroke aware­ness pro­gram that uses de­tailed lo­cal de­mo­graphic in­for­ma­tion to iden­tify at-risk neigh­bor­hoods and ed­u­cate res­i­dents about the dan­gers of smok­ing or be­ing over­weight, and so on.

Pur­su­ing pop­u­la­tion health man­age­ment is typ­i­cally idio­syn­cratic; in­sti­tu­tions are de­vel­op­ing their own ap­proaches and lack a real tem­plate. Many or­ga­ni­za­tions say they have a strat­egy and have as­sumed in­creased risk, de­ploy­ing pro­grams aimed at de­fined pop­u­la­tions. But we know from re­cent sur­veys that too many health­care executives, while promis­ing to pur­sue pop­u­la­tion health ini­tia­tives, haven’t ac­tu­ally started the process.

To achieve the ob­jec­tives of pop­u­la­tion health, value-based care needs to be in­ter­wo­ven with pop­u­la­tion health pro­grams. It’s es­sen­tial to fo­cus on the pop­u­la­tion while si­mul­ta­ne­ously de­liv­er­ing value-based care to in­di­vid­ual pa­tients (i.e., de­liver care in­di­vid­u­ally and fo­cus on a pop­u­la­tion’s needs). Hos­pi­tals and health­care providers are adopt­ing value-based op­er­a­tional mod­els. While some choose to own their pri­mary-care net­works, our in­sti­tu­tion chose to af­fil­i­ate with strate­gi­cally sit­u­ated pri­mary-care and lo­cal spe­cialty groups to broaden our foot­print. The strat­egy is to work with com­mu­nity providers to im­prove care lo­cally while of­fer­ing the com­plex care an academic med­i­cal cen­ter can de­liver.

Our pop­u­la­tion health man­age­ment strat­egy runs counter to what most academic med­i­cal cen­ters are do­ing— that is, to try to man­age care through own­ing pri­mary-care and spe­cialty physi­cian groups—which ig­nores com­mu­nity physi­cians and their long­stand­ing re­fer­ral re­la­tion­ships. Los An­ge­les’ broad ge­og­ra­phy and our deep ex­per­tise in treat­ing crit­i­cally ill pa­tients prompted us to go in an­other di­rec­tion. Be­cause qual­ity pri­mary care is be­ing pro­vided lo­cally, we have de­parted strate­gi­cally from the con­ven­tional model. Bet­ter to part­ner with pri­mary-care doc­tors and com­ple­ment lo­cal med­i­cal spe­cialty groups—and thereby en­able our or­ga­ni­za­tional strengths to shine through.

To that end, we set up unique part­ner­ships to sup­port the area’s di­verse health­care com­mu­ni­ties while bring­ing the most com­plex cases back to our hos­pi­tals. We want to of­fer a high level of ex­per­tise while bring­ing care closer to pa­tients on the as­sump­tion that if our sur­geons can do cases in hos­pi­tals in the com­mu­nity, that’s what makes the most sense for the pa­tient.

In prac­tice, this means that for our mul­ti­ple part­ners dis­persed across South­ern Cal­i­for­nia, spe­cialty care is now avail­able. At Tor­rance Memo­rial Hospi­tal, for ex­am­ple, our in­sti­tu­tion has ef­fec­tively be­come the fa­cil­ity’s car­diac surgery pro­gram. Ditto for other spe­cialty pro­grams around the re­gion. As these part­ner­ships demon­strate, our pop­u­la­tion health goal is to add our ex­per­tise to the value equa­tion.

As we grow our pop­u­la­tion health man­age­ment strat­egy, we plan to take on risk for a spe­cific por­tion of the pa­tient pop­u­la­tion. That will mean tak­ing cap­i­ta­tion for high-end care and then fo­cus­ing on re­duc­ing our costs, im­prov­ing our qual­ity, and mak­ing sure that we’re ac­ces­si­ble for peo­ple when they need us.

We be­lieve that’s a for­mula for both good busi­ness and ex­cep­tion­ally good med­i­cal care.

Tom Jack­iewicz is CEO of Keck Medicine of USC in Los An­ge­les.

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