No one understands the rising cost of healthcare better than the entities providing it, and that includes Parkview Health. Aiming to satisfy both patients and insurers, health systems like Parkview continually seek to offer care that maximizes value at the most effective cost. While controlling costs often dominates the conversation, the ultimate goal is to achieve better patient outcomes.
“Doing the right thing by our patients leads to greater value,” says Greg Johnson, DO and Chief Clinical Integration Officer at Parkview Health. “Improving patient outcomes will reduce the overall costs of care.”
In a paradigm that has traditionally embraced a fee-for-service model, care becomes a series of transactions, with charges for each component, from supplies to medications to services. The more services, the higher the bill and nearly everyone ends up dissatisfied. Essentially, a transactional paradigm contains few incentives to actually keep people healthy.
Jason Row, MD, holds the position of Care Design and Optimization Physician Executive for Parkview Health; it is his job to find ways to change that.
“A focus on price as the primary target is really short-sighted,” says Dr. Row. “As a family physician, my career revolves around long-term relationships. The long game is not price, but total cost of care. By doing the right thing to keep people out of the hospital, that’s where the real value lies.”
Shifting from a price-volume paradigm to one based on total cost of care makes sense, say Drs. Row and Johnson, because incentives begin to align. For example, according to Dr. Johnson, it costs $1900 less per year on average to take care of a patient whose diabetes is well managed. The patient requires less intervention and providers are rewarded for keeping patients healthier and performing to national benchmarks. It’s a win for everyone.
“But here’s the really important thing,” says Dr. Johnson. “The patient is doing better.”
Row leads Parkview’s care design and optimization (CD&O) team, which spearheads an initiative to apply lean management principles that decrease variability, reduce costs and improve outcomes. Because health care has traditionally been taught in a mentor/apprentice model, the nuances of a patient’s care often depend on where or how a physician was trained. The CD&O team leverages technology to identify where such variations may exist and then pulls together groups of providers to determine the most effective, consistent care model for Parkview. It has worked with service line and institute leaders on projects defining protocols that reduce side effects of medications for Cancer Institute patients, leverage technology in the home for Heart Institute patients and reduce the time of labor for inductions at the Women and Children’s Hospital.
A specific effort involves surgical preference cards. Each surgeon keeps on file a list of all the supplies he or she wants to have available for a surgery. With each procedure, these supplies are opened and readied for use, but often many are not used and must be discarded. The CD&O team has begun tracking the unused items as well as sharing preference card data with other surgeons. Collectively, they can see what their colleagues are doing and look for best practices. Although the program was just getting off the ground when the global COVID-19 pandemic caused the cancellation of elective surgeries, Row estimates it will reduce costs by several hundred thousand dollars annually. It will also create more consistent practices which, in turn, can help improve safety and quality measures.
Having access to relevant information and using it to make appropriate decisions is critical to the success of such initiatives. Parkview uses the information it already has within its system, including claims data, to build predictive models. It also shares that information with care teams so they can use it to make informed decisions.
“One of our foundations is to have line-of-sight with data,” says Dr. Johnson. “It also helps us be very proactive in not waiting for something to happen and reach out to patients.”
While keeping patients healthier keeps costs down, Parkview remains equally focused on the patient’s experience.
“A focus on price alone isn’t enough,” says Dr. Row. “Patient experience has to be part of the equation. One of the key components of our mission is to tailor a personalized health journey for each individual.”
Instead of just a physician providing information for the patient to follow, Parkview builds a team around each patient. The team includes doctors, nurses, dietitians, pharmacists, clinicians, care coordinators and others as determined by the individualized care plan. Having these resources available to help a patient navigate his care plan makes getting healthy more manageable and staying healthy becomes more affordable.
“We’ve always been good at putting together care plans,” says Dr. Johnson. “Where we’ve fallen short in healthcare is that we’ve not really been accountable to help the patient execute that plan. Now we’ve changed that thinking and our care teams help execute.”
It helps, says Dr. Johnson, that Parkview operates a fully integrated healthcare system, and it has not happened by accident. For more than a decade, Parkview has worked to set up an infrastructure to drive success around total cost of care.
“It takes a lot of focus and resources, but that infrastructure is so important,” says Dr. Johnson. “It was tough to talk about reducing admissions and ER visits seven or eight years ago, because a financial team may have seen that as reduced revenue. But to use a hockey metaphor, you have to skate to where the puck is going.”
Now Parkview offers an integrated delivery system that includes hospitals, physicians’ offices, walk-in clinics, virtual visits and other settings where patients can receive care. In 2019, these efforts resulted in thousands of reduced emergency department visits, meaning less cost to patients and payers.
“It’s not that you’re not delivering the care,” says Dr. Johnson. “It’s that you’re delivering the right care at the right time in the right setting.”
The model has started to pay off. Parkview’s readmissions have decreased, and the health system is performing better than state and national benchmarks.
“If we can reduce our cost to provide care,” says Dr. Row, “then ultimately, we can reduce your cost to receive care. But we can’t just look at cost alone; it has to be cost and quality of care. At the end of the day, we want you to feel like you’re getting what you pay for.”
Address: 10501 Corporate Drive Fort Wayne, Indiana 46845
Phone: (260) 373-7000