Advancing population health largely depends on patients receiving quality care across the continuum, so Florida's NCH Healthcare System focuses on performance improvement in both inpatient and outpatient settings.
Spotting a link between positive health behaviors and lower healthcare costs, Naples, FL-based NCH Healthcare System is investing in expansion of its ambulatory and outpatient settings and care coordination for at-risk groups.
Frank Astor, MD, MBA, FACS |
To improve the health of its various patient segments, NCH crafted a strategy that provides care delivery tailored to targeted groups to address their different health concerns.
"We define population health as the health outcome of a group of individuals. And we need coordination of this group through disease management, case management, and predictive modeling," says NCH Chief Medical Officer Frank Astor, MD, MBA, FACS.
To achieve its objective, NCH established group coordination for two large population samples within its system. One is a consortium of physicians, hospitals, and clients, which harbors approximately 25,000 lives. "We're looking at those 25,000 lives as a population—from neonates all the way to geriatrics," says Astor.
The second is NCH's employees and their dependents, which totals about 6,500 lives. NCH has partnered with a payer to oversee coordination of their healthcare.
On February 23, 2016, HealthLeaders Media will meet with the leaders of NCH and discuss their blueprint for success during the live web event, "Population Health: Lowering Costs and Improving Health Through Clinical Reinvention, Promoting Wellness, and Managing Risk." Register now.
To identify patients who require more care, the organization looks at those with major chronic illnesses such as diabetes, hypertension, and cardiovascular and pulmonary diseases. Among them, patients with frequent admissions, readmissions, polypharmacy, and individuals with a high total cost of care are singled out.
"We stratify individuals who practice wellness behaviors and prevent them from becoming complicated, or progressing into chronic disease management," explains Astor. "Those with significant complications—which shouldn't be more than 6% or 8% of the population—will be classified by the data and defined as a frequent-utilizer category," says Astor. "Therefore, we will be much more active in his or her healthcare."
NCH Healthcare Reduces Costs by Fostering a Healthier Community
Patients with one or more chronic diseases, but who are doing well, will get care coordination depending on the amount they need—anything from literature, to phone calls, to home assistance in various areas. The organization also provides education on health prevention and helps other employers promote healthy habits, such as smoking cessation and weight loss.
Advancing population health largely depends on patients receiving quality care across the continuum, so NCH focuses on performance improvement in both inpatient and outpatient settings. One initiative aims to increase efficiencies in reducing length-of-stay in the hospital.
"We're working with our ancillary departments to make sure we're staffing adequately, not only during the day, but also during swing shifts and evening and weekend shifts to make sure that patients get their testing done in an efficient, timely manner," says Phillip Dutcher, chief operations officer at NCH. "And then, [the focus is on] having the results produced and available to the attending physician. Therefore, physicians can discharge the patient, if it's appropriate, sooner than waiting two or three days for the ancillary test to be done, because we only run MRIs from 8 AM to 5 PM."
Another performance improvement initiative is a pilot involving two inpatient units, one on each campus, to identify disruptions to the caregiver in their daily routine of caring for patients.
"We have a hypothesis that a nurse gets disrupted multiple times during the course of a day, which potentially delays the appropriate care," says Dutcher. "If those disruptions were eliminated, how much better and more efficient and effective care could be delivered to patients?"
Michele Thoman, RN, MBA |
Michele Thoman, RN, MBA, system chief nursing officer and chief operations officer of the North Naples Hospital campus, says that while the organization has always focused on the continuum of care, a closer scrutiny of population health management has prompted it to test new ideas.
How NCH Promotes Health Among a Widely Diverse Population
"We're developing a program for our congestive heart failure patients—doing remote patient monitoring for those at high risk or potential readmissions, and making sure they're following their postdischarge treatment plan and working toward becoming healthier," she says.
"We have one nurse assigned to the program who follows them from an outpatient case management role to utilize the remote patient monitoring equipment, such as a pulse oximeter, daily weights, and blood pressure [readings], to make sure they're adhering to their treatment plan. And then providing any consults, or opportunity for education post discharge.
Of the 15 Medicare patients enrolled in the study, only two returned within 30 days of being discharged. Says Thoman: "We're in the early stages of the program, but are cautiously optimistic that we're making some headway."
And while NCH doesn't provide home healthcare services, it calls patients after they've been discharged to ensure they have follow-up appointments. Thoman says that NCH has found its transient population of 65- to 85-year-olds, the so-called snowbirds who live in South Florida during the winter—are hesitant to establish a physician relationship because they have a physician back at home.
"We've been working with our physician group to open after-hours clinics," says Thoman. "Therefore, patients don't have to have a permanent relationship with physicians and can get a checkup postdischarge to make sure everything's OK."
On February 23, 2016, HealthLeaders Media will meet with the leaders of NCH and discuss their blueprint for success during the live web event, "Population Health: Lowering Costs and Improving Health Through Clinical Reinvention, Promoting Wellness, and Managing Risk." Register now.