For St. Luke’s and other hospitals and health organizations across the country, the shift from the fee-for-service way of delivering care is transformational, entailing a different philosophy and focus. It also requires new ways of thinking about and managing illness, and a true patient-centered approach.
Here is Communications Coordinator Chereen Langrill with a report on ways that St. Luke's is keeping patients at the center.
- David C. Pate, M.D., J.D.
In the world of value-based care, prevention is king and care coordination is essential. Within St. Luke’s Health System, new processes are making it easier for providers to connect patients with resources that will allow them to live healthier lives.
The concept is not new, but has been reframed and expanded, and represents the next big step in population health among patients covered under value-based agreements between St. Luke’s Health Partners and patients’ insurance providers, their employers or the Next Generation Accountable Care Organization.
The patient-centered approach means the care experience can be more personal, in that it enables providers to work with specific patients to identify and coordinate the type of care they need.
That’s where St. Luke’s Health Partners comes in. Those contracts are managed through the St. Luke’s Health Partners network, which encompasses St. Luke’s employed providers and independent providers, including skilled nursing facilities, home health agencies, behavioral health providers and urgent care centers.
The network also has a deep well of resources available to help patients get the type of care they need. Whether that requires a health coach, a care manager or in-home monitoring through telehealth technology, the goal is to support the patient. Unneeded trips to the emergency room, better management of a chronic condition and avoided complications are among the many benefits possible through the approach.
St. Luke’s Health Partners serves value-based patients through a coordinated network of supporting staff. Clinicians and others within the network work together to track progress or watch for problems that need to be addressed and review data to identify areas where patients may need help.
“One of our goals is to increase the supporting services, so that the primary care physicians and hospital physicians feel secure in the fact that there is a whole other layer of team members to help them,” said Dr. Alejandro Necochea, a medical director with St. Luke’s Health Partners.
Armed with information, the network can determine what it would take for a patient to achieve better health. Team members talk in depth with patients about patients’ own goals.
An important first step is to determine whether the patient has a primary care provider. Building a relationship with one provider and his or her team helps a patient establish goals and identify concerns, and allows the provider to monitor the patient’s progress in addressing those concerns or goals. From there, the provider can help the patient find the right resources or address concerns. For example, a patient diagnosed with pre-diabetes might meet with a health coach to reduce his or her weight and improve his or her A1C levels, potentially heading off the need for insulin and other costly treatments.
“We have always been accountable for quality, but we have not had visibility or accountability for value,” said Dr. Laura McGeorge, medical director of St. Luke’s Health Partners ACO and division medical director of medicine and subspecialties.
“With these patients, not only do I have to do a good job providing the best care to that patient, I also have to pay attention to the value of the care that we have provided.”
The historic fee-for-service model of health care meant that multiple tests, multiple provider visits and lengthy stays in the hospital or in a skilled nursing facility were reimbursed, even if they didn’t necessarily advance a patient’s care or treatment.
In the value-based world of health care increasingly being considered across the country, providing high-quality care, preventing disease and providing care in the most efficient ways possible are all key. Providers spend more time helping patients prevent future disease, understanding that warding off complications and other problems are the efficient and effective way to proceed.
“One of the things I think is so exciting in this change in the reimbursement system is that finally there is alignment around what we as a health system are getting paid to provide,” said Bonnie Hollenbeck, vice president of St. Luke’s Post-Acute Care Division. “Being paid to actively support patients in staying healthy is something we as health care providers have dreamed of doing for years, and now we are doing it.
“We are putting more resources behind that effort of keeping patients healthier. It finally aligns the goals of those of us as health care consumers and health care providers. Everyone has the same goal, and that is keeping people healthy.”
Providers like Dr. McGeorge are also mindful of unnecessary or frequent visits to the emergency department. When patients go to the emergency department for treatment involving a minor issue (a lingering sore throat or chronic back pain, for example), it is costly and might not help the patient get to the root of the problem.
A value-based approach would have the patient see his or her primary care physician instead, and from there, pulling in additional help from other members of the care team. Patients are encouraged to collaborate with a primary care physician before problems arise, so they can set a baseline for their care needs.
“It’s about getting a primary care physician and building a relationship,” Dr. McGeorge said. “Even an introductory one is helpful, to make sure there are no health concerns you aren’t aware of and that your doctor knows about you, so that when something comes up you have a consistent team that knows you and knows what to do that is best for you.”
A care team gives more value-based care because it can be targeted to what the patient needs. Care managers and health coaches can help patients reach goals by spending more one-on-one time talking about what is meaningful to a particular patient.
“All of our care managers have been trained in motivational interviewing to help patients move into more of an active state that they can change,” Dr. Necochea said. “In order for a patient to change, they have to be able to see that they can change. It’s harder to make that happen only with physician visits every one to three months. The programs we are implementing are designed to help move people along between physician visits.”
Each person has a different definition of health and quality of life. For one patient, that goal might be getting healthy enough to walk to the end of the driveway to get the mail. For another, it might be about maintaining independence to continue living at home.
“Health care is personal,” Hollenbeck said. “Our goals change, our situations change. Walking side by side with patients and having the conversations as their situations change, that’s the kind of journey we are on with these patients.”
Chereen Langrill is a former communications coordinator for St. Luke’s Health System