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'What we are talking about is ... caring for people'

By Dr. David C. Pate, Health and Wellness
February 18, 2014

There is no one on my team that is more passionate in their commitment to our mission than Dr. Geoff Swanson. Our mission, to improve the health of people in our region, drives our vision and strategy to achieve the Triple Aim, accountable care. We are making measurable progress, in large part due to data analytics achieved through our partnership with WhiteCloud Analytics and Dr. Swanson's strong and visionary leadership.

As you read today's guest blog piece by Dr. Swanson, I am sure you will sense his passion. Who knows? Maybe you'll become an insomniac, too, as you contemplate all that our transformation of health care entails!

A while back, I had one of those, awake in the wee hours, start thinking, can’t go back to sleep moments. Like many of us over the past few years, what with the disruption in the economy, all the changes to health care, kids approaching college, a waistline with a mind of its own no matter the lettuce I eat, increasing gray in the hair that’s left, I’ve had plenty of these opportunities. 

I got to thinking that morning about what we are doing as we go through the pain and uncertainty of transforming health care. It’s a challenge on many fronts. There are those we haven’t reached with the message of the need for change, those who don’t see the necessity, and parts of our own government that are conflicted about the necessity to systematize health care. 

The conclusion I came to really is encapsulated by our St. Luke’s mission statement, “to improve the health of people in our region.”

When you get right down to it, our mission summarizes many of the elements that maybe haven’t made complete sense to many people. I applaud those visionaries that developed this masterpiece of simplicity. 

Our delivery system can’t just be a set of hospitals and providers taking care of the sick. To do that, our mission would be better stated, “To take the best care of patients who come to see us.” 

There is no question we should do that, but our mission is more expansive. To me and the many who share the vision, it means we have to be more. We have to include doctors, therapists, skilled nursing facilities, gyms, regular people, other stakeholders, and a huge variety of the rest of us in a real system.

W. Edwards Deming, a famous historical figure in organizing systems of work, talked about a system as a series of interdependent components focused around a common aim. Without a common aim, there is no system. 

I believe firmly that our common aim is our mission statement. I think that this is what our population expects from us. 

When we talk about improving the health of people and the populations that choose us to care for them, we are talking about population health. Population health is the theme of this year’s St. Luke’s Health System Summit, and that’s as it should be. Our annual Summit, set for later this week, gives us a chance to share our best thinking.

I believe deeply in our mission statement and in the work we are doing. My various roles, as a healthcare recipient, as a dad, as president of the SELECT Medical Network, as St. Luke’s Health System vice president for clinical integration, and as a practicing primary care physician, give me a variety of unique perspectives on our efforts.

Our mission statement is what motivates me. I believe that my job in the regional healthcare delivery system is to manage the health of the population that chooses to receive care from us, just like my job as a person is to help manage my own health, my job as a dad is to help manage the health and well-being of my family, and my job as a doc is to manage the health of those people who are my patients. 

What we are talking about is more than just caring for illness. It’s caring for people, and it’s about keeping them healthy and working toward their well-being. As a physician, I believe I’ve failed in my job of population health management if you have to see me, get admitted to a hospital, or need care for a preventable illness.

In the same way, we as a system have failed if members of our population are, or become, ill with preventable illnesses, or we fail in managing the many aspects of the health, well-being, and education of the population that has chosen us as their health partner. 

So the “why” of population health ultimately ends up being pretty straightforward. We’re also beginning to get some real direction around the “how,” with the help of powerful new data analytics tools that we’re only just beginning to put to use.

One of the things I really believe is that, as the Scottish mathematician and physicist Sir William Thomson, better known as Lord Kelvin — the guy who figured out absolute zero, among other things — is widely quoted as having said, “If you cannot measure it, you can not improve it.”

That’s just what we’re starting to be able to do with the information made possible through tools we’ve developed in partnership with WhiteCloud Analytics. Measuring our outcomes, our ability to meet people’s and our population’s needs, and our individual practices are ways we are going to become a national leader in managing the health of our population, just as we’ve set out to do.

When it comes to measuring and creating actionable information around the health of our population, there are three major components to consider: assessing the disease burden of the population that has chosen us as their delivery system; helping various stakeholders, including care providers, perform to help people better manage their health risks; and helping people self-manage the issues that are important to them.  

Our world-class, innovative data tools are beginning to show us just where we should spend most of our time and energy to get the best results for the most people. This is the real value in health care.

Practicing healthcare providers and others are beginning to ask and finally get some answers to questions like, “How do people know I’m a good provider?” And an equally important question for providers, “How do I know I’m a good provider?”

I believe most of us want to be the best we can be. There aren’t many of us who wake up in the morning, go to work, and strive to do an adequate or mediocre job. 

I know many St. Luke’s providers aim to be the best. We have had access to these valuable new analytics tools for less than a year, and the information is being viewed now more than 14,000 times a month by providers just like me. 

This means, not that someone was sent a report, but that an individual provider logged in, clicked to a page that showed their individual performance, and viewed relevant information on how they were delivering health to their population. 

That’s the why and that’s the how. Now we ought to talk about the what.

What’s the appropriate, effective, efficient way to accomplish population health management?

We believe it’s an inclusive, clinically integrated network, comprehensive enough for the population we serve. That’s why we’ve organized ourselves into a structure that includes other like-minded providers and facilities, entities that share the philosophy that if you can’t measure it, you can’t fix it, and that are willing to agree to adhere to appropriate performance, quality, and value standards.

We’ve begun to organize around the care continuum, from birth to end of life, so that we can best use these powerful data tools. This can sound frightening to some who are scared of change, but will transform the way in which our network delivery system and those populations with which we partner manage their health.  

We’re also working to create and align governance and leadership structures, appropriate financial modeling and risk-taking, business processes and operations, stakeholder relationships, and fundamental changes in the way we deliver and manage care.

The success of our population health efforts rests on three critical stakeholder groups:  the people who choose us as their delivery system; our payer partners, including employers and insurers; and the physicians, facilities, and other providers who make up our network of care.

Setting up the structures, the accountability, the data tools, the access points, and so many other components is time-consuming and challenging work. As I said at the outset, it’s also the makings of insomnia.

And it’s the right thing to do. I believe strongly that our delivery system is quietly and carefully leading the transformation that’s changing health care in America. It’s an exciting thing to be a part of. Welcome aboard.

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.