The UH Approach to High-Value Care

Point-of-service scheduling, remediating gaps in care will be our focus in 2019

UH Clinical Update | January 2019

By Cliff Megerian, MD
President, UH Physician Network and System Institutes

As the New Year is nearly one month in, I thought it was an apt time to recall that 2019 ushers in the fully-phased-in Medicare Access and CHIP Reauthorization Act (MACRA).

We as an organization and specifically, as physicians, were fortunate that in 2018, which was the first year of MACRA implementation, we did modestly well. So from a financial standpoint, we are getting a 1.5 percent increase in payments from Medicare, beyond what we would have normally received. This is because our physicians took great care of our patients, and we all worked together to optimize their health outcomes and satisfaction.

But I also want to make you aware that the coming years are going to be more challenging. The Centers for Medicare and Medicaid Services (CMS) through MACRA, as well as our other payors, will be looking at UH and UH physicians to differentiate our care from other hospitals in the region and in the country, as it relates to value.

That’s why I want us to all be cognizant of the key drivers of our future success in this value-based world, one that includes MACRA, commercial ACOs and population-based health care as a whole.

In previous blogs, I discussed the components of value: quality and safety, patient experience and cost.

Now all these points are coalescing to form the equation by which we as an organization will be judged, particularly by our patients and payors. To differentiate ourselves from other providers, we must demonstrate excellence in value.

We know that we are one of the lowest cost providers of comprehensive health care in the region, so one of the simplest ways for us to manage the cost side of the equation is for all of us to commit, as physicians and providers, that we will keep all patients within the UH system.

Besides offering lower cost for care, keeping patients at UH means all of us will always know what is happening with our patients who are under the care of one of our colleagues. There is no substitute for that. It is one of the hallmarks of excellence in patient care, and it is why the era of allowing our patients to end up somewhere outside our system must be a thing of the past.

For these reasons, you will be hearing quite a bit this year about our initiative around Point of Service office-based scheduling and follow-up scheduling. This huge project got underway this month, with training held at numerous primary care physician practices, and it will continue in upcoming months.

This means that our patients, as they leave our offices - including mine - will be scheduled for a follow-up appointment (if one is necessary) and that all appointments for referrals will be made at that time. Simultaneously, improvements in the patient access process are occurring through an Access 3.1 Task Force, which is streamlining the work done in our patient contact center.

This will take time, this will take work and it will require some rebalancing of job descriptions in our offices. But this is the standard model at successful health care organizations all around the country. By doing this we ensure that specialty and referral care remains with our great doctors at UH and prevents our patients from ending up in competing health care environments at a higher cost – where they could potentially be lost to the UH system, including for their primary care needs.

If we can accomplish this, we will absolutely be successful on the cost side of the equation – our patients, their payors and employers will all benefit.

We also are working to reduce costs through another strategy by which we avoid unnecessary care:  for example, ensuring that patients do not come to the ED when a physician office visit would be sufficient and appropriate; that they see their primary care providers within a week of being discharged from the hospital, and finally, by creating a mechanism by which we can have annual physicals, especially for our Medicare advantage patients – to be performed by the end of June of each year.

Data shows that if fully implemented, this program often will catch gaps in care and adherence to screening and vaccination protocols. To put it in another way, if we can keep all of our patients within the system, and address the four major value initiatives above, we are well on our way to having one of the finest population health care systems in the nation.

This is of vital importance because it ensures the continued desire of firms like Medical Mutual of Ohio to entrust hundreds of thousands of lives to our care. In the world of Accountable Care Organizations, it also brings significant additional reward dollars to UH, which can and will flow to the clinicians and can be used for day-to-day enhancements of our offices, buildings, support staff and infrastructure.

Drs. Peter Pronovost, George Topalsky, Randy Jernejcic and I and our clinical chairs and institute leads are fully focused on this initiative – it will be the focus of our activity this year and in the coming years.

Again, the equation is a simple one: value equals quality and patient experience over annual cost of care.

The beauty is this: we don’t have do anything really different as long as we keep our patients in our system, because our costs are already low and the quality of our care is unparalleled.