Hospitals are under increasing pressure to improve care, and at the same time, reduce costs. The right population health management
(PHM) strategy can accomplish both.
But executing a successful PHM strategy on a fixed budget requires more than just careful planning and coordination. It requires physician leadership.
CEP America is helping administrators leverage physician leadership and PHM to improve care and reduce costs. To learn how, join CEP America Vice President of Operations David Birdsall, MD, and colleagues on Tuesday, Sept. 13, when they will present a webinar titled "How Physician Leadership and a Population Health Strategy Boosted Savings for a Fixed-Budget Hospital.”
Presenters will include:
- David Birdsall, MD, Vice President of Operations at CEP America
- Adrian Long, MD, Former EVP and Chief Medical Officer, Saint Agnes Hospital (Ascension Health)
- Pascal Crosley, DO, Vice President of Practice Development at CEP America
- Benjamin Frizner, MD, CEP America Partner and Ventilator Unit Medical Director, FutureCare Irvington
In today's post, we'll explore what it takes to succeed on a fixed budget, how to implement a successful population health strategy, and why physician leadership is necessary to achieve both.
The Challenge of a Fixed Budget
In 2014, hospitals in Maryland began voluntarily operating on fixed annual budgets as part of a five-year state fiscal experiment aimed at reining in healthcare costs.
Baltimore’s Saint Agnes Hospital
, a full-service teaching hospital with 251 beds and nearly 90,000 visits to its emergency department each year, decided to employ a population health management strategy. The plan was twofold:
- To improve population health by helping patients manage chronic conditions and reduce preventable illness.
- To manage care transitions in order to decrease the number of preventable admissions and readmissions.
CEP America, Saint Agnes’ ED management partner, was more than up for the challenge of helping the hospital succeed on a global budget. “As a multispecialty group, we are well positioned to help the hospital improve care coordination and transitions — both internally and beyond its four walls,” says Pascal Crosley, DO, Vice President of Practice Development at CEP America and former Chief of Emergency Medicine at Saint Agnes. “One of the best ways healthcare organizations can contain costs is to strengthen the continuum of care.”
CEP America physicians worked with hospital administrators to apply innovative management strategies to two high-risk patient populations: frequent users of ED and inpatient services and chronic respiratory patients.
Care Plan Committee
CEP America ED physicians started by forming a Care Plan Committee to manage a population of patients from the West Baltimore area who had been identified as frequent visitors to Saint Agnes. From a cost containment perspective, addressing the needs of this patient group first made the most sense, as care for many of them was found to be upwards of $150,000 a year.
In collaboration with providers across the hospital, the Care Plan Committee created individualized histories and recommendations for each one of the patients. In order to improve care continuity, it embedded these care plans into the hospital EHR and regional HIE.
The positive impact on patient care was almost immediate. According to Saint Agnes’s Former Chief Medical Officer Adrian Long, MD: “We learned that many of our frequent utilizers were actually in their final months of life. Through this process, we were able to connect them with helpful resources like our palliative care team.”
Better care also translated into lower utilization. One patient, recalls Long, had a chronic condition that was greatly exacerbated by his use of narcotics. “With improved pain management on the care plan,” Long says, “he went from spending 250 days a year inpatient to zero.”
In fact, Long was so impressed by the care plan implemented by CEP America’s ED team that he spearheaded its expansion to the rest of the hospital. Today at Saint Agnes, three disease-specific teams handle care plan creation, each with representation from emergency medicine, primary care, specialties, and care coordination.
“CEP America is unique,” Long says. “It requires physicians to get involved in hospital-wide committees and initiatives.”
“They’ve had a positive influence across our organizations that previous ED groups have not.”
Among the nearby healthcare facilities from which Saint Agnes admits patients is FutureCare Irvington
, which has a 50-bed ventilator unit. And as Dr. Crosley notes, the ventilator patients are very complex.
“In the past, when they were admitted to Saint Agnes, their average length of stay was six days. So our goal was to reduce admissions through improved care coordination.”
To that end, CEP America physicians proposed staffing the ventilator unit at FutureCare with a full-time CEP America Medical Director. FutureCare agreed, and former Saint Agnes hospitalist Medical Director Benjamin Frizner, MD, was recruited for the task.
Frizner had strong relationships with both the hospitalist and ED teams. Under his watch, continuity of care has greatly improved between Saint Agnes and FutureCare.
Frizner works with his CEP America colleagues to coordinate care for patients who need to be transferred to the ED and works with the hospitalist team to reduce length of stay. Though as he notes, “Because I can provide a fuller clinical picture as onsite Medical Director, we can often avoid an admission.”
Frizner also attends ED meetings, where he educates his colleagues about this unique population.
In the meantime, IV antibiotics, diagnostic testing, and specialist consults can now be delivered at FutureCare, reducing the need for ED transfers and admissions overall.
When appropriate, Frizner also helps to coordinate direct admissions from the ED to the ventilator unit. The implementation of joint clinical protocols both ensures smooth transitions and helps to prevent patient “bounce-back.”
The partnership has more than paid off. In just a few months, Frizner and his team reduced admissions to Saint Agnes from FutureCare’s ventilator unit by 300 percent.
The Critical Role of Physician Leadership
None of the successes of the Saint Agnes-CEP America partnership would have been realized to the same degree without physician leadership.
“Physicians are not only the front-line providers, but as leaders, they listen to other physicians,” says David Birdsall
, MD, Vice President of Operations at CEP America. “Which is why when they take on leadership roles, physicians are the ones capable of encouraging change and championing new ideas among their colleagues.”
Indeed, data may reveal variances in physicians' practices where improvement is needed. But that data is useless unless it becomes actionable. It’s physicians who can get other physicians to change their practices.
“Given the chance, physician leaders can influence other areas of a hospital or health system and help accomplish big-picture goals,” says Birdsall. To identify physician leaders, he recommends administrators take the following steps:
- Look for individuals who are personable, respected, have a record of gathering support among their colleagues, and who “get it.”
- Keep your eyes and ears open. Potential leaders may be right under your nose: in committee meetings, on administrative rounds, even at community events.
- Sponsor leadership seminars for physicians on topics such as healthcare reform, hospital finance, and leadership in general.
- Identify young and/or unofficial leaders by listening to what they say, watching how they carry themselves, and noting the impressions they leave on others.
- Talk to nurses, staff, and other admin, as well as other physicians, to find out who they consider leaders or those with leadership potential.
And once you do identify a leader, be sure to encourage them, in particular to acknowledge their skills. “Mentorship and encouragement is key,” Birdsall says.
Ready to implement a physician-led population heath strategy at your fixed-budget hospital? Register today for CEP America's webinar
"How Physician Leadership and a Population Health Strategy Boosted Savings for a Fixed-Budget Hospital”
Tuesday, September 13th, 2016
10 am PT/12 pm CT /1 pm ET