Anil Keswani, MD, discusses the outpatient setting, patient safety, and value-based care.
Scripps Health has split the health system's chief medical officer position into two roles.
In August, Anil Keswani, MD, was appointed as chief medical officer for ambulatory and accountable care at the San Diego–based health system. He had previously led population health efforts at Scripps and earlier served as vice president of medical management at Chicago-based Advocate Health Care.
Also in August, Ghazala Sharieff, MD, MBA, was appointed chief medical officer for acute care, clinical excellence, and experience.
Keswani recently talked with HealthLeaders about the outpatient setting and value-based care. The following is a lightly edited transcript of that conversation.
HealthLeaders: What are the primary strategies to manage the shift of treatment from the inpatient setting to the outpatient setting?
Anil Keswani, MD: First, we are creating ambulatory facilities and hubs that provide primary care as well as specialty care, imaging, infusion centers, and much more. In essence, we have created hubs of care that can do a lot more than a primary care clinic.
The most recent supersite we created in Oceanside has primary care, specialists, an ambulatory surgery center, and an infusion center with beautiful views. It is really a health center with everything built into it. This kind of site not only helps prevent people from getting sick, but also eliminates the need to go to a hospital for services that can be done on the outpatient side such as colonoscopy and orthopedic procedures.
The second strategy involves moving from hospitals and even ambulatory centers to the home. Last year, we launched a program in conjunction with our physicians that allows us to do house calls. These are not the house calls of years ago; they are house calls with a system of support built around them to make sure that the patients who are most vulnerable or frail receive care in the home for everything from the primary care they need to advanced care planning. It is a way to keep people happy and healthy in their home, and to prevent the need to go to an acute care setting.
The third strategy is a digital strategy with remote patient monitoring. This is incredibly important for us to be sure when people are at home that we have a continuous touch point with them. Again, this helps prevent patients from needing care in an acute care setting.
HL: What is a primary strategy for ensuring patient safety in the outpatient setting?
Keswani: Epic is our electronic health record, and we have Epic wall-to-wall throughout our clinics and our hospitals. When we look at patient safety, breakdowns are often related to breaks in continuous information or communication between people.
One of our primary patient safety strategies is to use Epic appropriately and properly to make sure that we have connected our entire system of care. We want information to flow from imaging to doctors and everything in between. We use MyChart to make sure we are transparent in sharing results with the patient.
This has become a different way of engaging the patient in their healthcare. It provides another set of eyes to make sure that patients are also ensuring their own safety.
HL: Where are the biggest opportunities to improve the value of medical care?
Keswani: There are three hot opportunities, and they probably are timeless.
One is access. As long as I have been in leadership, we have always had a focus on access. Years ago, the focus was on primary care access, then the focus was on specialty care access. Now, the focus on access is not just on the ability of a patient to physically come in for a visit—it is how we use care coordination, how we use remote monitoring, how we connect with people by email, and how we connect with patients where they want to be.
Access is an important process measure that speaks to the Triple Aim.
The second hot opportunity to improve the value of medical care is the patient experience. At Scripps, patient experience is deeply rooted in our culture—we want to improve how patients are heard and their connection to the health system.
For example, more than a year ago, we created Scripps Health Express, which is express clinics built within our health centers using our existing electronic health record. Scripps Health Express is not just a pop-in-and-pop-out setting to get an antibiotic. It has everything from nurse triage by phone before a patient comes in, to being seen the same day, to 100% of patients getting a follow-up call the next day.
Scripps Health Express is an access measure, but it is also off the chart as a patient experience measure.
The third hot opportunity for improving value is making healthcare affordable. Years ago, healthcare professionals were not interested in talking about the total cost of care. Now, Scripps is looking at total cost of care as an access measure—meaning that if we are unaffordable people cannot come to us.
So, whereas quality and experience are absolutely important, they have to be balanced with whether we are providing an affordable total cost of care. We need to make sure we are using the right generic medications and we are using the right protocols.
HL: From the healthcare provider perspective, what are the keys to success in value-based contracting?
Keswani: First, you must have a health system aligned and committed to want to deliver on value. It takes executive leadership and physician leadership to say, 'Yes, we are going to lead toward value.' Doing the value-based contracting without a value-based culture is a fool's errand.
I also have found that bringing the operations team and physician leadership to the table in the contracting is incredibly important. When we talk about value-based contracts, if there is a quality metric, it is important to know whether that quality metric is valuable and measurable. Oftentimes, it will be our physician leaders and operational leaders who will guide us through these contracts.
You also need a strong contracting team to make sure we are successful in the contracting process. Then you need to deliver on the contract, with the infrastructure set up well to make sure you can deliver.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
One of the primary strategies to manage the shift of care from the inpatient setting to the outpatient setting is creating "supersite" health centers, says Scripps Health Co-CMO Anil Keswani, MD.
Keswani says that these kinds of sites help with patient wellness and eliminate the need for patients to go to the hospital for outpatient services such as colonoscopies.
Using the electronic health record to ensure a continuous flow of information helps ensure patient safety in outpatient settings, he says.