Women's Health Services Hold 'Significant' Potential in ACOs

Mary Anne Graf, vice president of Women's and Children's Services at Bon Secours Richmond Health System asked her audience at HealthLeaders Media Rounds on Women's Health Strategy in Richmond, VA last week to look closely at her Power Point slide.

"Examples of Obstetrics: Outstanding EMR (electronic medical records) Integration Experiences."

That empty space represented what Graf believed were those hospital obstetrics programs that initiated EMR programs, but were happy with their experience. Zero. "That's the list," Graf said, noting that she had spoken to many hospital executives around the country about the lack of EMR for obstetrics programs.

"It's a problem," Graf added. A hospital may invest millions into EMR, and the bulk of the business goes to medical-surgical units, she added, not obstetrics. The lack of electronic medical records could have dire consequences for patients. "You can lose a woman or a baby very quickly in the operating room, [or] in labor-delivery" without the proper medical dosages. "It's a very difficult issue that we're coming to grips with. Everywhere there has been an issue," Graf explained.

Indeed, the question of EMR integration is an issue that healthcare facilities must confront as they step up implementation of programs for women's service lines, which has significant potential for growth, Graf says.

Whether launching perinatal care programs or trying to harness electronic medical records, health systems must tap into innovative programs to realize the potential for growth in women's health programs, Graf and other panelists told the HealthLeaders Rounds audience.

Other speakers were Michael Spine, senior vice-president, business development, for Bon Secours, and two officials from Geisinger Health System, Danville, PA: Harry O. Mateer Jr., MD, FACOG, director of obstetrics and gynecology, and Ruth Nolan, PhD(c), RNC, vice president of operations, women's health service line.

"Gender-specific care for women is just now starting to be explored," Graf said. "It has significant potential in an ACO environment."

Nationally, maternal fetal medicine (MFM) procedures expect a 9% volume increase; including a 16% increase in telemedicine, and 20% increase in high-level ultrasounds. There also are anticipated increases in gynecological subspecialties, such as pelvic floor disease, 27%; ovarian cancer, 10%, and uterine cancer, 11%, according to Graf. 

Those figures buttress reports that 55% of health systems expect women's service lines to become more significant, he added, with "continuum of care in obstetrics" becoming more important.

Bon Secours is working to improve its perinatal program in a model similar to that initiated by the Geisinger Health System. Graf noted that Bon Secours is considering a co-management program to engage private and employed providers in an accountable care organization type structure, in an effort to increase revenue and generate improved patient outcomes. "There [are] margins out there, but in areas we have yet explored," Graf said, referring to profitability potential within the service line.

Geisinger initiated Perinatal ProvenCare, a program to improve efficiency and outcomes in obstetrics care, says Mateer.

Before launching the program, hospital officials weren't satisfied with performance of their perinatal program. "There was a lot of variability in the system," Mateer said. "We decided we had to redesign, from the ground up, all aspects of provider workflow." The Geisinger system handles about 5,000 pregnancies and 4,500 annually, with 75 clinicians at 24 clinic sites.

Under the Perinatal ProvenCare model, at least 100 "evidence-based elements of care are incorporated, measured and tracked for compliance," according to Mateer. That includes EMR. For instance, the hospital system created a record system known as eForms that enable nurses and providers to complete documents that reflect care coordination, for instance, Mateer said.

"It's about tailoring care specific to the patient. That also helps us avoid waste. We don't just throw this blanket out there and try to do the same thing for everyone," Nolan said.

The hospital system has increased patient safety, reduced documentation redundancy, streamlined patient education and reduced costs, Mateer said. Implementing improved education programs, one of the Geisinger hospitals, the Geisinger Wyoming Medical Center, Wilkes-Barre, PA, reduced caesarian section deliveries by 32% from 2008 to 2010. 

Generally, to improve care, health systems need to initiate change, but it's not easy, Nolan said. "It's about doing things very differently than what we have done in the past," she said. "Another unfortunate truth in healthcare is the assimilation of best practices is painfully slow."

"All of us are facing the same challenges, clinically integrated networks or accountable care organizations integrated delivery models, " said Spine, the senior vice-president for business development at Bon Secours Richmond Health System. "The reality is the same: most of the government, state, and federal as well as (payers) want high quality at the lowest possible cost."