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The combination of unsustainable healthcare spending and the rapid growth of value-based reimbursement revenue models is driving the shift to patient-centered care across the continuum-or continuum-centered care.
The traditional hospital-centric healthcare delivery system is a thing of the past. The combination of unsustainable healthcare spending and the rapid growth of value-based reimbursement revenue models is driving the shift to patient-centered care across the continuum-or continuum-centered care.
According to the 2014 National Health Expenditures report, U.S. healthcare spending grew 5.3% in 2014, reaching $3 trillion or $9,523 per person. As a share of the nation’s Gross Domestic Product (GDP) health spending accounted for 17.5%.
Here is a look at how U.S. healthcare spending compares with other countries:
Source: Centers for Medicare and Medicaid Services, December 2015
In January 2015, the Department of Health and Human Services (HHS) announced clear goals and a timeline for shifting Medicare reimbursements from quantity to quality of care, setting a goal of tying 30% of Medicare payments through alternative payment models by the end of 2016 and another 50% by the end of 2018.
HHS also set a goal of tying 85% of all traditional Medicare payments to quality or value by 2016 and 90% by 2018 through programs such as the Hospital Value-Based Purchasing and Hospital Readmissions Reduction programs. In March 2016 HHS announced that nearly a year ahead of schedule, an estimated 30% of Medicare payments are now tied to alternative payment models that reward the quality of care over quantity of services provided to beneficiaries.
It is clear-healthcare providers need to be on the path to continuum-centered care. This new model offers patients more personalized care and is focused on providing care at the right time and in the right place, not just in the acute care setting.
Patients have expanded access to primary care, including wellness, chronic care management and rehabilitation. Today’s successful healthcare leaders are making significant progress toward providing care to consumers well beyond the traditional hospital experience.
Vermont offers a great example of how healthcare providers are uniting to offer continuum-centered care. Northwestern Medical Center (NMC), a Quorum Health Resources client hospital in St. Albans, Vermont, has launched several innovative initiatives to help manage and improve the health of Vermont residents:
OneCare Vermont offers Vermont residents access to a continuum of care to meet their healthcare needs. The ACO includes academic medical centers, most hospitals in Vermont, more than 400 primary care physicians, specialists, federally qualified health centers (FQHCs), rural health clinics, a statewide vendor neutral archive, a skilled nursing facility, mental health and substance abuse resources and a partnership with VITL, a clinical data management tool. CHAC primarily includes FQHCs across Vermont.
Notably, the RCPC aligns the members of Vermont’s ACOs to deliver evidence-based best practices throughout the patient’s care journey. The council is composed of physician practices, hospitals, governmental agencies, FQHCs and community health groups and has a goal of tackling major issues, including:
In addition, the goal of collaborative regional planning is to provide a coordinated healthcare network that will improve quality, increase efficiencies and lower costs of healthcare.
“Northwestern Medical Center is dedicated to improve care locally through ongoing wellness and prevention,” says Jill Berry Bowen, CEO of Northwestern Medical Center. “This is both a challenging and exciting time in healthcare as we are getting to the core of improving health for our community, while providing high-quality care and lower costs.”
Another example of innovation is the unique collaboration between four independent critical access hospitals (CAHs) offering collaborative care in New Hampshire. A new healthcare system, North Country Healthcare, was launched in early 2016, and includes Androscoggin Valley Hospital, Littleton Regional Healthcare, Upper Connecticut Valley Hospital and Weeks Medical Center.
The hospitals operate independently and have retained their names, but have joined together to combine resources and reduce costs, with the goal of providing sustainable access to care.
Specifically, North Country Healthcare collaborates in the areas of planning, administration, purchasing, human resources, marketing, finance and contracting.
Mark Kelley, former chair of Androscoggin Valley Hospital’s board and current chair of the North Country Healthcare board, says, “I’m excited that we’ve reached this point. Now we can roll up our sleeves and get to work to build a health system that makes life better in the communities our hospitals serve.”
To personalize patient care and achieve higher patient satisfaction, Quorum Health Resources client hospital Pioneers Medical Center in Meeker, Colorado, formed The Meeker Family Health Center.
Located inside the hospital, patients can address a variety of care needs under one roof, such as primary care, minor office procedures, diagnostic services, follow-up care through home visits, physical therapy and long-term care. In addition, The Meeker Family Health Center employs a community case manager who helps patients manage complex cases.
Albert Krueger, MD, medical director of the health center, describes the culture as unique and important in today’s healthcare environment. “We focus on each individual patient. This individualization of care is really critical for all providers to embody as healthcare is focused on patient’s entire health journey as opposed to episodic care.”
Characteristics of successful continuum-centered care models
As these healthcare leaders demonstrate, providers are moving at a fast pace to achieve continuum-centered care. In general, these leaders are focused on the following:
Moving away from the traditional hospital-centered model to a continuum-centric care model is a challenge for healthcare organizations, but necessary to achieve a sustainable future. The path toward transformation varies, but changes in reimbursement require that every organization find its way.
Bob Teague is vice president of Medical Transformation at Quorum Health Resources, a hospital management and consulting firm that provides services to more than 150 non-affiliated hospitals across the country.