Consumer-driven healthcare: How three organizations respond to the demands of patient-centered care

In response to the new healthcare reality of a consumer-driven market, many hospital and systems undertake new initiatives, including partnering with competitors to increase access to services, helping patients transition from primary care practices to medical homes, providing new access points for urgent care and using technology to improve access to healthcare and the overall patient experience.

The presidents and CEOs from Carilion Clinic in Roanoke, Virginia, Cedars-Sinai in Los Angeles and Trinity Health in Livonia, Michigan, discussed these new endeavors Tuesday at the American Hospital Association's annual membership meeting in the District of Columbia.

Nancy H. Agee, pictured, who oversees Carilion's $1.7 billion integrated healthcare system that includes seven hospitals, 1,000 physicians and 80 primary care physicians, called the pace of change in the past decade as staggering. For Carilion, the evolution, or what Agee refers to as a revolution, began seven years ago when the hospital system began its transformation to a clinic environment and divided the organization into eight departments, with a physician and non-physician chair overseeing each department.

To meet the demand of consumers, Carilion's physician leaders advocated for the organization to transition patients from primary care settings patient-centered medical homes. The practice model offers a proactive team-based approach to care, with physicians as team leaders, and a particular focus on higher risk patients with three or more chronic illnesses. If patients' needs extend beyond what is available in the practice, the care coordinator at the medical home will identify and connect patients to those resources.

The organization is now beginning to see promising results, according to Agee, including a 34 percent decrease in patients' use of the emergency department (ED) and a 44 percent decline in readmissions. Patient satisfaction rates are also up, she said, noting that they are above the 75th percentile, but Carilion's goal is to get above 90 percent.

Consumers also want fast and affordable care, so four years ago Carilion opened four urgent care centers to reduce ED visits and expand its primary care footprint. The centers are open seven days a week, accept all forms of insurance and are located in strategic areas. Within the first three months of opening the centers, there were more than 70,000 visits to the four sites. All the centers follow the same standardized policies and protocols and offer the same services. Consumers are happy because they receive good care and save money, and the organization is pleased because the urgent care centers led to 1,000 referrals to physicains with downstream revenue of a million dollars last year and are on track to double those figures next year, Agee said.

Finally, Agee said the organization has expanded access to healthcare services with an online portal and software that allows patients to self-diagnose based on their symptoms and allows inpatients to obtain information about their care and discharge instructions via interactive digital systems.

Cedars-Sinai pursues partnership

Cedars-Sinai Health System in Southern Carlifornia is in the process of redesigning its care delivery by partnering with Anthem Blue Cross and six other health organizations to expand its geographical reach and provide services to consumers that it couldn't provide on its own. The result is Vivity, which allows patients to select primary care groups and receive care throughout the network of organizations. Vivity focuses on the large employer marke, and requires patients to pay a premium and copayments, but no deductibles. "The idea is to provide predictable low costs services that are competitively priced," said Thomas M. Priselac, president and CEO of Cedars-Sinai, pictured left.

In an example of a different type of partnership, the organization also works closely with skilled nursing facilities and home care agencies in an effort to prevent readmissions. Cedars-Sinai is the largest Medicare provider in the state of California and serves a large elderly population, as a third of its patients are older than 85 and a third are also dual-eligibile. To avoid readmissions, the hospital sends physicians and nurse practitioners to associated skilled nursing facilities and home care agencies to follow up with patients who were recently discharged. "The bottom line is we've had about a 25 percent reduction in readmissions from these SNFs that we've partnered with," Priselac said.

Trinity Health goes for 'people-centered' approach

Richard Gilfillan, M.D., pictured right, said Trinity Health is "turning its (producer-centered) model upside down to make it more people-centered."  The system is based in Michigan but serves 30 million people in 21 states and includes 85 hospitals, 39 home health agencies and hospices, 81 continued care facilities, 3,300 employed doctors and 22,890 affiliated physicians.

In the past, the system focused on acute, episodic, hospital-based care. It has since refocused its strategic thinking by working on population health and expanding its community health and well-being services through patient-centered care accountable care organizations. The primary goal, he said, is to make sure care is coordinated.

"We've partnered with a bunch of other organizations to create a healthcare transformation task force to accelerate the movement to the Triple Aim," Gilfillan said.

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