Beyond the bottom line: Embracing outcome-centric care models

Nationwide, hospitals and health systems are accelerating efforts to shift the focus of care delivery from volume to value, with improved patient outcomes seen as a key metric. Achieving that goal requires innovative thinking that reframes care delivery from physician- to patient-focused, while still keeping clinicians deeply involved in decisions.

These were among the insights shared during Becker’s 16th Annual Meeting at a session sponsored by CSL, featuring:

• Surendra Khera, MD, president, Cleveland Clinic Florida Accountable Care Organization and vice chief, Primary Care Institute – Florida market, Cleveland Clinic

• David Meltzer, MD, PhD, chief, hospital medicine, UChicago Medicine Mitchell Hospital (Chicago)

• Chuck Nordyke, RN, president and chief executive officer, Clarinda (Iowa) Regional Health Center

• Matthew A. Warner, MD, president, Society for the Advancement of Patient Blood Management and associate professor, Mayo Clinic (Rochester, Minn.)

The panelists discussed innovative outcome-driven care models. Here are three key takeaways from the session:

1. Care quality, patient volume and hospital revenue go hand in hand

Sustained focus and effort on improving quality pays off because it brings in more patients, which grows revenue. Although this logic seems obvious, it is worth reiterating because historically healthcare organizations have prioritized volume over quality. “They all go hand in hand, but you’ve got to prioritize which one you want to achieve first,” Mr. Nordyke said.

2. Real-world care model innovations demonstrate the benefits of outcome-centric models

After conducting research that showed hospitalists made little difference, Dr. Meltzer tested another model. A small pool of patients at high risk of hospitalization were provided with ambulatory care by a small number of doctors. In an RCT with 2,000 patients, this care innovation boosted patient satisfaction from 20th to the 95th percentile, decreased hospitalizations by 15% and in some subgroups saved up to $5,000 per patient per year.

Dr. Meltzer also emphasized the importance of coordinating medical care and addressing patients’ social needs in a systematic way. “We can reorganize care to make a difference,” he said.

Another innovation was reframing patient access as a safety issue, not an operational issue. This approach, spearheaded by Dr. Khera at Cleveland Clinic’s Florida ACO — where wait times to see a PCP could be seven months — led to the creation of digital access teams, which give patients access to care while waiting to see a PCP. This approach resulted in a 66% drop in wait times to access care and a 40% increase in new patients.

Dr. Khera also focused his organization on annual wellness visits as a “keystone habit.” Over three years, this ACO increased the percentage of patients receiving wellness visits from 35% to 72%. This visit, which includes screening, identifying issues and treating, is improving outcomes.

3. Success in care innovation requires a solid foundation

That foundation includes ensuring buy-in of clinician champions, building the data infrastructure, ensuring care coordination, embedding educational initiatives into existing clinical workflows, focusing on engagement and the experience and starting initiatives small to demonstrate wins and show value.

“You need clinician leaders to direct your initiative because if you direct it from a lab or an executive office, it will fail,” Dr. Warner said.

For leaders promoting outcomes-based initiatives, part of getting buy-in is showing front-line clinicians they are listened to. “If you roll out an initiative and you’re not sitting down, talking with them and hearing their concerns, it’s probably going to fail,” Mr. Nordyke said.

Ideally, listening to provider input should be balanced with patient input. “One of the best things we ever did was create a patient advisory board,” Dr. Meltzer said. “It is useful to bring that voice into the discussion.”

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