Leadership I

What Physician Practices Need from Hospitals

Article · September 28, 2016

Atrius Health is the Northeast’s largest nonprofit, independent medical group, with its own home health and hospice agency. We have been recognized as a national leader in delivering high-quality, patient-centered, and coordinated care for our 675,000 adult and pediatric patients across eastern and central Massachusetts. As an early participant in Medicare’s Pioneer ACO program, Atrius Health takes both financial and quality risk across the continuum of care, including hospital-based care. Approximately three-quarters of our revenue is earned through global or shared risk agreements, including commercial insurance, Medicare, and Medicaid contracts.

Collectively, our patients are admitted to hospitals across the region more than 40,000 times annually, and they use hospital-based emergency departments and ambulatory services extensively. We collaborate closely with 15 hospitals preferred for their high-quality, lower-cost care. We are always seeking to coordinate better with these hospitals. What does Atrius Health need from these hospital partners in the future to provide even better care for our patients?

Six Keys for Collaboration

First, we want our hospital partners to utilize well-documented, reliable, and consistent protocols and processes around ED and inpatient visits and discharges. Between 12% and 19% of admitted Medicare patients are readmitted within 30 days, and 3–9 % of all patients return to the ED within 3 days. Readmissions rates are improved by better patient handoffs, post-discharge follow-up with a primary care clinician within a week, accurate post-discharge medication reconciliation, clear patient communication, and action plans for “what if” scenarios.

With more predictable processes, hospitals and Atrius Health could improve the patient, provider, and hospital experience as well as level workloads and reduce costs. Even within a single clinical system, there is unnecessary variation that results in unnecessarily high readmissions and returns to EDs. Clear, reproducible, reliably deployed, measureable practice guidelines and consistently followed protocols would improve outcomes.

Second, embedding these improved protocols into the EMR would clarify care expectations, reduce unjustified practice variation, and likely shorten length of stay. Our longitudinal electronic record is a trove of information, with bidirectional connections to 16 regional hospitals. The better that hospitals connect with Atrius Health about their standardized protocols, the easier it will be to leverage our tools to improve care and follow-up.

The third key for improvement is real-time, accurate electronic notification and data access at the time of admission and discharge. This would allow Atrius Health to activate our care management systems as well as track the effectiveness of interventions.

Atrius Health has a strong primary care foundation, with about half of our physicians working in adult, pediatric, or family medicine. These primary care clinicians have developed long-term relationships with patients. Knowing our patients well helps us provide better care and enable prevention strategies. We can help hospitalists and other inpatient specialists make shared and complex decisions with our patients and their families, particularly in areas like end-of-life care planning and complex chronic disease management (such as cancer or end-stage renal failure). Engaging our primary care physicians in this kind of decision-making would improve patient and family experiences as well as medical decision-making. In teaching hospitals, it would also improve resident training.

As an ACO, Atrius Health has invested a great deal of time and energy in developing preferred services. These include our own VNA Care, which offers home health, palliative care, and hospice services, and a large specialty practice. We also partner with and frequently staff a group of skilled nursing facilities and collaborate with outside specialists. This network is integrated with our primary care practices to optimize coordination and communication in the care of our patients. Hospitals can help leverage this system of care by referring patients to our integrated care system at the time of discharge.

Boston hosts several medical centers of excellence. At the same time, there is considerable price variation for the exact same care across hospitals. While there are legitimate and historic reasons for some of this variation, patients don’t understand why, which leads to confusion, occasionally higher out-of-pocket patient costs, and provider frustration. Creating competitive pricing and transparency would help Atrius Health and our patients with decision-making, referral management, and total medical expense management.

We are fortunate to live in an area with some of the best hospitals in the nation. The approaches I have outlined for improved clinical and data processes, better engagement of clinicians and patients, collaboration, and price transparency hold great promise for Atrius Health, our partner hospitals, and patients alike. Atrius Health is committed to leveraging our lean tools and systems of care to work collaboratively with hospitals in order to improve outcomes and lower total medical expense.

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