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St. Luke's Strategy: Transformation, Not Tweaks

By Dr. David C. Pate, News and Community
October 3, 2013

Recently, Tony Tomazic, St. Luke’s Health System chief transformation officer wrote a guest blog piece in which he introduced our strategic plan and branding campaign. 

I want to explain our strategy in more depth, so this is the first part of a two-part look at what we’re doing and why.

Mission

St. Luke’s Health System exists to improve the health of people in our region. Our mission statement explains our purpose – why we exist. 

There is something important here. Our mission statement doesn’t say that our purpose is to improve just the health care of sick people. We are to improve the health of all people in our region, including those who currently are not patients, to minimize the chances of them becoming patients. This is the first aim of our Triple Aim: Better Health.

We are also to improve the care of those who are patients, with the goal of returning them to a state of health, or for those with chronic illnesses, improve their health and keep them as highly functioning as possible and out of the hospital through care coordination. This is the second aim of the Triple Aim: Better Care.

Vision

Our vision statement is an attempt to describe succinctly what we would look like if we accomplished our strategic plan and reads, “St. Luke’s Health System will transform healthcare by aligning with physicians and other providers to deliver integrated, seamless and patient-centered quality care across all St. Luke’s settings.” 

There is a lot that is packed into this vision statement.

First, St. Luke’s Health System will transform health care. We established this vision statement in March of 2010, weeks before the Affordable Care Act became law. 

We chose this word in part to distinguish it from the reform being considered in this law, which St. Luke’s did not believe would, in and of itself, achieve the needed changes to curtail government healthcare spending and lower healthcare costs for the people of Idaho. 

St. Luke’s believed that nothing short of a transformation of the clinical model and a transformation of the business model would cure what ails the American healthcare system. 

With respect to the former, my blog was created so that everyone could follow our journey to transform the clinical model. Here, you have read stories relating to innovations in our care model, such as Project Zero, our Diabetes Education and Management (DEaM) program, the patient-centered medical home in Baker City, the preoperative medical management clinic and hospitalist program, the Congestive Heart Failure Clinic, our newest innovation – the Metabolic Syndrome Clinic, the YEAH! Program, our Center for Spine Wellness, and many other efforts that St. Luke’s is making to improve health and improve care, the first two aims of the Triple Aim.

These innovations, over time, will help us to reduce healthcare costs by improving outcomes, preventing expensive complications, reducing avoidable hospitalizations, and reducing expensive duplication of services or the provision of low-value services through care coordination and management of care transitions. This is the third component of  the Triple Aim.

You also have read about our early efforts to transform the business model through our innovative and first-of-its-kind relationship with SelectHealth.

Our vision statement goes on to say that we will accomplish this by aligning with physicians and other providers.

This is critical. I do not believe that health care can be transformed to achieve the Triple Aim without the engagement and alignment, clinically and financially, with physicians. Health care in America is fraught with misaligned incentives that compromise the value that could be provided to Americans. The fee-for-service reimbursement methodology rewards providers for doing more services for those who are insured, regardless of the value and regardless of the outcomes. 

This is a misalignment, and not what we all say we want from health care. Further, the American healthcare delivery system is so fragmented that in many hospitals and health systems across the country, providers do not talk to each other to plan a patient’s care.

Because of the lack of incorporation of evidence-based medicine and incentives to do so, physicians often order tests that are of questionable value, and often repeat these same studies when they cannot access the results because of the fact that there is no integrated medical record with all the results and care being provided by other providers.

St. Luke’s has achieved an enviable alignment with physicians that few other hospitals and health systems have. We are in the process of aligning the incentives to reward value, not quantity of services provided to patients.  We are training physicians in leadership and management skills, and it is truly inspiring to see the many physician leaders in our System. Aligned physicians, equipped with actionable data, are the recipe for success, and why I am so confident that St. Luke’s will be able to transform health care and fix what is wrong with health care today.

The phrase “and other providers” is also extremely important. Physician alignment is a necessary but insufficient step. There are simply not enough physicians to care for all the health needs of Idahoans. St. Luke’s also realizes that those patients with chronic diseases and/or multiple conditions can more effectively be treated by an interdisciplinary team working together to coordinate and improve the care our patients receive. 

We are incorporating physician assistants, nurse practitioners, dieticians, social workers, therapists, patient educators, and others as part of the care team. Our new care model also calls for new roles, such as health coaches, nurse navigators, and care coordinators.

The next part of our vision statement states that we want to deliver “integrated, seamless” care.

What does it mean to a patient to have care integrated and seamless? Integrated care means that the caregivers all have access to your complete medical record and the care is coordinated among these caregivers.  

Whenever one caregiver prescribes a new medication or orders a test, all the other caregivers involved can be aware of it, to reduce the potential for drug-drug interactions or double-prescribing of the same medication, and all providers will have the test results so the test does not need to be repeated just because one of the providers does not have access to a prior test result. 

We all have experienced going to different doctors or parts of the hospital and having to register multiple times, and then the records from one physician are not available immediately to another.  Seamless care is when we fix all of this, when you only have to register once and your record is available to everyone providing your care. The exchange of information will be seamless, and it will be comforting to know that everyone involved in your care has all of the information.

The vision statement also refers to “patient-centered” care, which means placing the patient at the center of everything we do. 

How is that different from what happens in the American healthcare system today? 

Here are several examples. Patient education usually is not customized to meet the needs of particular patients and families are often excluded from the education, even when they are the support for the patient. 

But individual patients have ways that they learn best. I am a visual learner; my wife is an auditory learner. And some patients might learn best by listening to a CD, while others might prefer a booklet. Some patients might prefer a one-on-one counseling session, whereas others may prefer the socialization of a class or online education in private. We are working to meet all these different styles and needs.  

Another element of making care patient-centered is to set goals with the patient and not for the patient.  We need to seek out from patients what their own goals are and what their specific motivators are.  Then we need to plan for how we can help patients achieve their goals and invite them to revisit and revise their goals later on. 

When I first started my own journey to better health, my goals for exercise needed to be much more modest than they are now that I have incorporated exercise into my daily routine for the past two years.  Setting aggressive goals, such as the personal trainer I hired years ago, only served to discourage. This approach can possibly even hurt patients and reinforce what they already think – there is no way to be successful. 

One more example of being patient-centered is our work on electronic health records. We have created patient portals that permit patients to see their electronic health records online. This has been a tremendous success, and patients truly value this. 

In addition, patients can email their physicians and request appointments online. And we have partnered with Healthwise, an Idaho health information organization, to add patient education materials to myChart so that patients can better understand what they are seeing in their medical records. 

Finally, we come to “quality across all St. Luke’s settings.”

This speaks to the value we bring to the people of our region when we approach quality from a system-wide approach, rather than on a hospital-by-hospital basis. St. Luke’s has identified irrational variation as a significant barrier to optimal quality, safety, and outcomes. In 2009, we began this shift to a system approach to reduce intra- and inter-hospital irrational variation in our care. We now do process improvement as a System and work to identify hospitals or practices in our System that have a best practice so that we can incorporate those best practices at our other sites. 

These efforts are paying off. We became the only health system in Idaho to be named a Top 50 Health System out of all the health systems across the country! Our Treasure Valley hospitals have been accredited by The Joint Commission as a primary stroke center of excellence, and we expect that our Magic Valley Regional Medical Center will achieve its certification this fall. 

Triple Aim

Better Health, Better Care, and Lower Cost. These are the principles of accountable care, and St. Luke’s designation as Idaho’s only federally-designated Accountable Care Organization means that we are working diligently on all three components of this Triple Aim.   

Better Health refers to our efforts to help those people who are currently healthy remain that way and to identify those who are currently not ill, but have high risk for becoming ill, target their risk factors and increase the chances that we can keep them healthy for as long as possible. 

Better Care means that we ceaselessly and tirelessly work to achieve the best quality outcomes, while decreasing the risk of harm to patients to as close to zero as we can. In addition, for those patients with chronic illnesses and/or multiple conditions, it means that we coordinate their care to ensure better control of their disease, reduce the risk of complications, and reduce the frequency of avoidable hospitalizations. 

It also means that when a patient leaves one part of our System to go to another part, a facility outside of our System, or their home or assisted living center, that we manage those transitions of care so nothing falls through the cracks.

 Finally, St. Luke’s knows that while healthcare spending and insurance premiums in Idaho are among some of the lowest in the country, too many cannot afford their insurance premiums and rising insurance premiums, and healthcare costs are becoming a greater and greater burden on employers. St. Luke’s seeks through our innovative programs to improve health, through our enhancements to the care model to improve outcomes and reduce complications, and through our efforts to change the business model to help eliminate no-value and low-value services from being provided.

As a result, our efforts will result in lower insurance premiums for those who chose to receive their care as part of our network. It is hard for people to understand healthcare costs, but, everyone understands what they pay for insurance premiums, which incorporate the costs of anticipated care. Our stated goal of Lower Costs simply means your insurance premiums will be lower, and that is an easy way for people to see if we are being effective in our efforts.

Population Health

Population health reflects the change in mission when we look further than just treating patients to actively managing the health of people who may be healthy; people who may be healthy today, but are at risk for future illness or injuries; patients with acute illnesses or injuries; and patients with chronic, and often multiple, illnesses. 

It is a focus on better education, screenings, preventive services, counseling, behavior modification, care coordination, and management of care transitions. It is a focus on really understanding the health of the population that we are privileged to serve, as well as subpopulations of people with specific illnesses. 

And, since there is not currently a reimbursement system in place that rewards providers for focusing on people’s health, critical to the success of population health management will be a change in the business model, from fee for service to pay for value.

Our goals and objectives cannot be attained through simple tweaks, the healthcare reform law as it stands today, or by doing the same old things the American healthcare system has been doing for the past decade. 

Healthcare is in need of transformation, and that is what we at St. Luke’s are focused on every day. We are not talking about having the latest and greatest new piece of equipment or technology, regardless of its cost and whether it will add any true value for patients. We are talking about total transformation.  St. Luke’s must transform the experience into one in which consistently exceeds expectations, transform the clinical care model as I have described above, and transform the business model to support the new care model and a focus on improving people’s health.

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.