Bringing care back to the patient
Under value-based care, it’s important that patients are proactive in seeking care. When patients participate and are engaged in their care, outcomes are more likely to be positive. This has become an opportunity for providers to experiment with new ways to bridge patients to care, as retail-style competitors disrupt the market in the name of convenience.
Leaders at the roundtable discussed how they’re expanding access through concierge medicine, home health and virtual care.
At Geisinger in Dansville, Pa., the philosophy historically has been “build it and they will come,” said Jaewon Ryu, MD, JD, the organizations’ CEO and president. “If I look at our aging demographic and challenges such as disease burden and affordability, I think our next chapter at Geisinger will be more building it and taking it closer to the people.”
As an organization that includes hospitals, clinics, health plans and a medical school, Geisinger understands that better outcomes are enabled when healthcare is made easier. That’s universally true, but especially so with the government programs, a major priority for Geisinger.
With that in mind, the health system launched Geisinger 65 Forward Health Centers this past summer, designed to provide what Ryu calls “Primary Care 3.0,” specifically for older adults. These concierge-style centers feature multidisciplinary teams and more time for doctor-patient interaction.
In an effort to better serve some of the system’s sickest patients, Geisinger@Home began offering advanced in-home care. Clinicians are providing advanced care, such as IV infusions and ongoing care management. Among participants, there has been a decrease in utilization, with greater than 40% reductions in ED visits and inpatient admissions. For certain elective procedures, Geisinger is also offering home delivery of supply kits that engage patients in taking important steps for their recovery and reduce complications following surgery.
A “fresh food pharmacy” serving over 8,000 doctor-prescribed meals a week has also helped improve outcomes among foodinsecure patients, according to Jun Amora, the system’s vice president for enterprise supply chain services. Patients in the program are more likely to seek primary care and had an average reduction in Hemoglobin A1C of 2.0, according to data collected thus far.
Teresa L. Dail, chief supply chain officer at Vanderbilt University Medical Center, is working to ensure that, when care transitions to the home, patients have the high-quality tools they need to maintain their health, including medical equipment, transportation, food or medicine. Traditionally, this can involve a plethora of third-party partners. Dail’s team decided that many of these services could be brought in-house to optimize quality, ensure compliance and limit clinician burden.
“We need to be managing all of this, and if we’re not doing it ourselves, we need to be managing the relationship and expectations of whoever those providers are,” Dail said.
At Oregon Health & Science University, the home has been branded as the academic health system’s “next campus,” said Darren Malinoski, MD, FACS, OHSU’s chief clinical transformation officer. The system’s elevated location on Marquam Hill serves as an accurate metaphor that it can be difficult for some patients to access care.
“OHSU is located above the clouds, but we need to make sure we’re gridded on the ground, providing care where people are,” Malinoski said.
OHSU has launched a systematic effort to bring care closer to patients through both virtual and in-home care as well as through its new health system, OHSU Health, which now includes four medical centers, 2,000+ providers and 52 physical sites distributed throughout the Portland Metro region. Driven in large part by the system’s value-based initiatives and contracts, Malinoski’s role at OHSU is to rally employees around value-based efforts, ensuring that “purpose motives” remain connected to “financial motives” that allow the system to continue to thrive and support its three missions of education, research and patient care. Clinician engagement has been centrally guided, jointly decided and locally led, all with the goal of keeping patients out of the hospital and providing care where they want it.
“A lot of providers came to us because they didn’t want to focus on finances—people here came to teach and chart a new path forward,” Malinoski said. “Connecting to someone about financial metrics who has that mindset is very difficult. It’s alienating. Instead, we are focusing on ‘days at home’ as an outcome, for it truly represents a patient-centered metric that also has total cost of care implications.”