This is one in a series of blog posts marking the one-year anniversary of the merger of Baylor Health Care System and Scott & White Health.
Population health is the cornerstone of Baylor Scott & White Health’s (BSWH) strategy and its future.
The primary goal is to drive down the health care costs by keeping people healthy. When they do get sick, we provide high-quality, efficient, effective and coordinated care. We are preparing for when we are paid primarily for value and quality, rather than just the volume of sick care we provide. The financial reward will be for keeping people well.
Population health includes elements of public health that go beyond what are considered typical health care services, with social workers and pharmacists rounding out the team of nurses and health coordinators assisting physicians in managing a person’s care.
For example, a social worker from the care coordination team might get involved if a patient cannot afford medicine, needs transportation to physician appointments or would benefit from having the home examined for fall risks. These and other non-medical issues that often stand between patients and wellness traditionally have not been on the radar screen. With a population health perspective, we are looking at every possible aspect for keeping our patients healthy with a full continuum of care more efficiently and effectively.
Gary Brock, president and chief operating officer of the North Texas division, said, “Traditionally, we have just been a hospital provider. Now we need to integrate across full continuum of care. That has traditionally been siloed care, which has created gaps in care. We now take the different components and connect them.”
The Affordable Care Act (ACA) of 2010 encouraged health care delivery reform. The law spawned accountable care organizations (ACOs), which consist of providers who work collaboratively to coordinate health services for a specific population of patients. More than 600 ACOs were operating in the U.S. by the end of 2013.
Baylor Scott & White Quality Alliance (BSWQA), the BSWH’s ACO, embodies population health. BSWQA strives for cost effectiveness, population case management and care coordination for its sickest patients. Its vision is to be the preferred alliance of physicians, hospitals and other health care providers offering exceptional quality and value.
In the BSWQA’s first 23 months, hospital admissions per thousand among BSWQA’s 34,000 covered lives decreased 4.3 percent. Thirty-day hospital readmissions were down 18 percent. The prescribing rate for generic medicine rose and the rate of appropriate use of lumbar spine MRIs more than doubled. The total cost of providing health care to the group dropped by $13.9 million – a 7 percent savings.
BSWH chief executive officer Joel Allison said, “We know reimbursement is moving from fee-for-service to fee-for-value quickly. We know we have to move ahead of the market. BSWQA is the bridge that allows us to do that. BSWQA allows us to transform.”
Added Brock: “Physicians didn’t take an oath to be responsible for cost of care. It was their job to do everything they could to take care of the patient. If you are in the BSWQA, we are also asking them to help us be responsible for the cost of care.”
Since it began in 2011, the BSWQA has grown to more than 3,700 physicians, along with hospitals, post- acute care providers and other members of the care continuum committed to collaboratively improving health outcomes across all care settings, pursuing cost containment initiatives and increasing the value of health care for all the stakeholders.
The BSWQA network includes about a dozen home health agencies and more than two dozen skilled nursing facilities selected based on proven track records of quality. It is also negotiating with others to ensure a network that accommodates the entire family.
“We want to offer a full continuum of care, but we don’t have to own everything,”Allison said. “We can grow organically or through strategic partnerships. People are calling us (to become partners). But they have to be aligned strategically and culturally.”
BSWQA enters into shared savings agreements that reward BSWQA and the providers for providing high quality care at a reduced cost. It is governed by a physician-led board of managers.
“BSWQA is an affiliate of BSWH but it is led by physicians,” said the ACO’s president, Carl Couch, MD. “It is very doctor-driven, and that is important for doctor buy-in.”
BSWQA providers sign contracts committing to sharing outcomes, measuring themselves against their peers, collaborating to develop new standards of care and spreading best practices. Providers use more than 90 evidence-based protocols and metrics for which improvements in care can be compared and monitored. Following these protocols allows BSWQA to standardize and improve care and ultimately reduce unnecessary health care costs.