Improving Collaboration and Breaking Down Silos Between Acute and Post-Acute Providers
Darren Swenson, MD, is an accomplished physician executive, healthcare entrepreneur and clinical educator who specializes in post-acute care delivery, value-based care programs and graduate medical education program development. As president of TeamHealth’s Post-Acute Care division, Dr. Swenson is responsible for developing, implementing, and advancing TeamHealth’s strategy to invest and expand the post-acute care service line while identifying and enhancing health outcomes through continuous innovation.
During this conversation with Modern Healthcare Custom Media, Dr. Swenson shares the ways in which optimizing alignment between acute and post-acute care providers can lead to improved outcomes for patients and clinicians.
What are the unique challenges facing both hospital and post-acute care providers right now?
DS: There are many challenges across the healthcare ecosystem facing acute and post-acute providers. I’d categorize these into three areas: One being mental health, two being communication and transition of patient care, and three, managing the patient experience. When we think about mental health, we have an increasing number of patients with mental health comorbidities who are in need of post-acute care. But (post-acute care) has limitations regarding staffing ratios, regulatory challenges and the reimbursement framework which doesn’t support comprehensive patient care for behavioral health today. Regarding communication and transitions of care, while the acute care providers have moved to EHRs, in the post-acute environment, the providers are still in the early stages of EHR adoption. So, when we think about the transition of care and communication between acute and post-acute, we are not on a level playing field, and sometimes the patient is stuck in the middle. Lastly, when we think about managing the patient experience, which is a fundamental priority of the healthcare delivery system, the compression of the length of stay in the acute care environment leaves less time and opportunity to transition the plan of care to the postacute team. As one of the largest integrated physician practices in the nation, what solutions does TeamHealth offer to solve these challenges?
DS: TeamHealth Post-Acute Care provides not only primary care but comprehensive onsite behavioral health. And in rural areas, we are providing telehealth behavioral healthcare. Additionally, our post-acute providers use a single EHR system, so we achieve an interdisciplinary approach that is comprehensive and consistent. TeamHealth is truly focused on providing a continuum of care solution. We provide a 360-degree, door-to-door connection of care to our patients. Regarding patient experience in post-acute care, it is about being available to the patient and family. This is our primary focus and central to what we provide. Our physicians and advanced practice clinicians are in the post-acute care facility five to six days a week, and our visibility and availability to patients are fundamental.
What do you see as key future trends facing post-acute facilities in the next year and beyond? And how can improved alignment with partners across the acute care spectrum help address those challenges?
DS: In the next several years, we will see that the greatest challenge we face is staffing. Most clinicians don’t go to school to be a post-acute care provider. At TeamHealth, we are embracing new graduates who are trying to figure out where they fit into the healthcare ecosystem. We are educating them and providing resources to make them proficient in post-acute care. We have to attract clinicians who are going to be passionate about the post-acute care environment even with limited resources and staffing challenges. In terms of improved alignment with acute care, communication makes it a more comfortable environment. When we are aligned with our acute care colleagues around a common goal to provide outstanding patient care, we complement each other rather than compete with each other.
What are some of the successes you have seen in markets where TeamHealth has both a strong acute care and postacute presence?
DS: In markets where we are providing ER services, hospital medicine and post-acute care, there is a true seamless transition from one site of care to the next. We see a hand off between emergency medicine to the hospitalist, which means we are lowering ER wait times and we are ensuring the plan of care is evolving efficiently. When we take the hand off in post-acute, we are ensuring that there is open communication, and there is an understanding about what the patient needs. Ultimately the patient doesn’t want to be moved from location to location if it can be avoided. This is where TeamHealth really excels: in our ability to provide door-to-door care among teams that are aligned and working together. This Executive Insight was produced and brought to you by: To learn more visit: www.teamhealth.com/post-acute
“How you measure—what you measure— can be extremely different. I can’t underscore how differently it permeates all aspects of how work gets done.” Rita Khan, chief digital officer at Mayo Clinic
CLINICAL MENTORSHIP
Having a mentor on the clinical care side helped smooth Rita Khan’s 2020 transition into the role of Mayo Clinic’s first chief digital officer.
Khan wasn’t entirely new to healthcare; she had spent the previous three years as an executive vice president of consumer digital at UnitedHealthcare. Before that, she held vice president titles at Digital River, an e-commerce and payments software company, and worked for nearly 10 years at Best Buy.
But Khan’s position at the Rochester, Minnesota-based health system was her first at a care delivery organization. Her partnership with Dr. Bradley Leibovich, a urologist and medical director of the Mayo Clinic Center for Digital Health, gave her a clearer idea of how digital technology fit into clinical workflows and affected patient care.
Khan implemented a similar program for others joining the digital team. All employees at the director-level and above in the digital health center are matched with a “culture mentor,” such as a physician, nurse or other staffer relevant to their work.
The partnership, Khan said, “grounds us in how we’re supposed to do digital solutions, which is understanding user needs”—in other words, the needs of patients or clinicians.
Khan noted that she needed to adjust her thinking to focus on how digital tools can improve health outcomes or patient satisfaction. At a health system, care ultimately underpins discussions about strategy and goals.
She was able to bring ways of measuring digital initiatives from retail, such as assessing “user effort,” meaning how much effort it takes a user to complete a task. In healthcare, that could involve changes to how patients enter a telehealth visit or making it easier to schedule appointments.
Identifying the return on such investments, though, takes patience. In retail, a company might change their website or app and see immediate results. When deploying a digital tool at a hospital, the team may need to measure success by tracking patients’ health outcomes over time—sometimes years, depending on the
health condition that’s being targeted.
“How you measure—what you measure—can be extremely different,” Khan said. “I can’t underscore how differently it permeates all aspects of how work gets done.”
LISTEN FIRST, ACT LATER
New executives of large, multistate health systems can get a broad idea of how tech is used throughout the organization by touring facilities and speaking with employees from different sites.
When Prat Vemana joined Oakland, California-based Kaiser Permanente as its first chief digital officer in 2019, his boss, then-chief information officer Dick Daniels, gave him a directive: For his first 90 days, just take time to learn the organization and don’t make any decisions.
Vemana spent those 90 days traveling to Kaiser’s sites in various regions and meeting with clinicians and other staff. One day, he shadowed a case nurse to understand the workflow. On another, he visited a pharmacy fulfillment center to learn how it used robotics and automation. He visited call centers that field questions on clinical care, insurance and other support.
The 90-day period grounded him in what day-to-day operations looked like across the organization and helped him understand healthcare’s complexity from the onset, he said.
Vemana had joined Kaiser after holding multiple leadership roles at retail giants, most recently as chief product and experience officer at Home Depot. His background in consumerfocused digital experience was one of the reasons Kaiser executives cited for hiring him when the organization announced his appointment.
“I came into it knowing that I have so much to learn,” Vemana said. “And at the same time, I bring so much with me as well.”
Providence’s Moore said he’d recommend a “listening tour” approach to others making the move into healthcare.
To get insight into the state of the health system, he spent his first six months visiting its hospitals and clinics— asking administrators, clinicians and other staff where they thought IT could improve to inform his first steps.
“I even did a mock ‘robotic surgery’” to try out the equipment, he said.
The tour was a productive way to see how care delivery works firsthand and build relationships with others in the organization, so Moore would know whom to call in the future with questions. It also helped him to contextualize issues he encountered in his role, such as how long it took for new Providence employees to get access to the right equipment and IT systems.
Speaking with employees helped Moore understand that the problem couldn’t entirely be chalked up to inefficiency: Health systems must ensure that only the appropriate people have access to certain systems and data, which slows onboarding. Moore ultimately streamlined the process by creating a mobile app that walks employees through steps like setting up a password and getting the equipment they need for their job.
“That’s why you’re brought in from another industry—to have a diverse perspective,” Moore said.
“I came into it knowing that I have so much to learn. And at the same time, I bring so much with me as well.” Prat Vemana, chief digital officer at Kaiser permanente