I often hear people comment on the growing number of St. Luke’s Clinics in our communities. I’d like to put this into perspective.
St. Luke’s vision is to transform health care by aligning with physicians and other providers to deliver integrated, seamless, and patient-centered quality care across all St. Luke’s settings. Our strategy is to provide “accountable care,” which we define as improving the health of the populations we serve, delivering better care for individuals, and doing so at a lower cost. We at St. Luke’s know this as our Triple Aim.
This transformation requires a transition from a hospital-centered organization to a patient-centered organization that delivers an integrated model of care. It takes a lot of time and a lot of physicians, all working together, to achieve these goals.
Over the past several years, St. Luke’s has experienced significant growth. And while growth has not been our strategy, we have responded to invitations to strengthen our relationships with providers in the communities we serve when they have decided that we were their preferred partner. These relationships have helped us make significant progress toward clinical integration and our vision of transforming health care, and have brought demonstrable value to the patients we serve.
A substantial network of physicians is necessary to change the health care delivery model and to coordinate care and manage the health of a large number of people, especially when they are not all in one large urban location, but rather scattered throughout a vast geographic area that is largely rural and where the urban hub is a referral center for patients from all over the state and even adjoining states.
St. Luke’s also is preparing to apply for the Medicare Shared Savings Program (MSSP), which requires the development of a substantial physician network to adequately coordinate care for Medicare beneficiaries throughout our System service areas. To accomplish this successfully, and which will save Medicare Trust Fund money, we must have an adequately sized physician network. We are entering into this program and structuring other programs that will prepare us to take on additional payment risk.
By working together, we have achieved national recognition for our improvements to mortality, reduction in complications, reductions in length of stay, reductions in readmissions, and much more. Many lives have been saved because our physicians and other health care providers have worked together, focused on improving outcomes for patients. Initiatives around women’s health, cancer services, and children’s programs have increased access to health care for people who live in rural areas and/or who could not otherwise afford these services.
I had an opportunity last week to visit St. Luke’s Center for Spine Wellness. They are a fun group, they read my blog (Hi, Tessa!), and they are doing much to reduce the cost of spine care and addressing what statistically has been overuse of spine surgery in Idaho, frankly at St. Luke’s loss because we are seeing fewer spine surgeries that would otherwise be producing more revenue for our hospitals.
I am so proud of the work this care team is doing. It is another example of our willingness to create innovative new programs and move toward accountable care, demonstrating that St. Luke’s is taking steps to truly transform health care and lower health care costs.
All St. Luke’s employees and physicians can be very proud of what we have already achieved in our early accountable care efforts. We believe that the work we are doing to improve the health of our communities, to improve our care for patients, and to achieve lower health care costs for Idahoans is beneficial for everyone, not least Idaho’s businesses and employers. If we can provide more access to primary care, we can lower health care costs. It’s that simple, and that complicated. Accountable care will result in better health of our communities, better care of patients (as we are already proving), and lower costs of care overall. (We are already seeing this in decreased hospital inpatient volumes and decreased procedure rates.)
There have been huge benefits to our communities by virtue of the fact that St. Luke’s has been willing to employ physicians. First, we have recruited physicians that are in short supply. Idaho has a physician shortage, particularly in primary care (family practice, internal medicine, pediatrics). We have brought primary care physicians to both urban and rural areas to better meet the needs of those communities, physicians who would not have come to Idaho without the security associated with employment.
We have supported training programs from the University of Washington that provide opportunities for primary care physicians and psychiatrists in training to come to Idaho, and we have hired many physicians in pediatric subspecialties that were previously unavailable in Idaho, saving parents the time and huge expense and inconvenience of traveling to other states for physician and hospital services for their children.
We also have employed physicians to provide dedicated inpatient hospital services, a growing challenge given that fewer and fewer physicians are willing to provide these services, which often entail complicated services that are not paid well by government and commercial payers or are not paid at all because the patient is uninsured. By employing these physicians, St. Luke’s is doing all it can to ensure that Idahoans and residents of neighboring states will have access to care when they need it, the care that we would want for our own families.
It’s also happening at a time when access to physicians is increasingly restricted. As anyone who has tried to get an appointment knows, it can take a couple of weeks, or longer, to get in to see a physician. This has led to increased use of urgent care centers and emergency rooms, at much higher costs to businesses and patients, including those other patients waiting to be seen and for whom access then is complicated. We know that impaired access means patients hold off on care until conditions become more serious and expensive to treat, or seek care in emergency rooms that at times are already overburdened. And a 60 percent increase in our population, anticipated by 2030, could make this pattern much worse if we do not continue to transform health care.
Further, certain patients – those with Medicare or Medicaid and those without insurance – have a particularly difficult time finding physicians who will see them. This problem is likely to reach crisis proportions in 2014, when it is expected that the state’s Medicaid roll will swell to 150 percent of what it is today. Through our clinics, St. Luke’s essentially subsidizes care for these patients.
Yes, St. Luke’s, along with other hospitals and health systems, has hired a lot of physicians. We believe it is in our communities’ best interests and that if we did not, it would impact the health and well-being of Idahoans. We have done this because it is the right thing to do, it is better for patients, and we are not going to get health care costs down as far as possible without making substantial changes to how care is delivered. For that, we are accountable.
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.