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Analysis

5 Ways Health Systems Can 'Advance to the New Normal'

By Melanie Blackman  
   October 29, 2020

CommonSpirit Health's Rich Roth and Dr. Nichole Stine outline the steps hospitals and health systems can take to thrive in a post-COVID environment.

Editor's note: This article is based on a keynote presentation from the HealthLeaders' Healthcare System of the Future virtual roundtable discussion sponsored by Optum, SOC Telemed, and Vizient.

The COVID-19 pandemic created the opportunity for hospitals and health systems to innovate in a short amount of time. Learning how to advance and scale those opportunities will be the key to redesigning the health system of the future, said CommonSpirit Health Senior Vice President and Chief Strategic Innovation Officer Rich Roth, and CommonSpirit Health Senior Vice President, Enterprise Population Health, Dr. Nicholas Stine in their keynote address at the HealthLeaders' Healthcare System of the Future virtual roundtable in September. Roth and Stine shared five considerations hospitals and health systems must take to "address opportunities in the new normal."

Rich Roth, CommonSpirit Health Senior Vice President and Chief Strategic Innovation Officer (photo courtesy of CommonSpirit Health)

Dr. Nicholas Stine, CommonSpirit Health Senior Vice President, Enterprise Population Health  (photo courtesy of CommonSpirit Health)

1. INCREASE DISRUPTIVE RESILIENCE

Hospitals and health systems will have to focus on prevention, preparedness, and shifting to virtual care and value-based care models. This will include being proactive in connecting with the community and its needs. It will also include being prepared for the next wave or next pandemic through ensuring a correctly stocked and distributed supply chain, and structuring a command center to properly face future disasters.

"We know that various types of disruptions, whether they be related to a pandemic, or natural disasters, or political context, we need to be able to buffer and be intact through a lot of those different changes," Stine said. "We've been thinking a lot about what that means for some of our strategic priorities. I think that looks like a number of different ways, but certainly for us, reinforces the importance of having a strong, proactive, preventive approach to population health management."

"Building that out from the perspective of primary care and community partnerships, we spend a lot of time developing work with our teams and community health members and other partners within our organization around our connective community network approach and building a comprehensive stakeholder environment in our communities," Stine said.

2. MAKE HEALTH EQUITY A TOP PRIORITY

The pandemic revealed health disparities across the nation, and hospitals and health systems will need to address social determinants of health (SDOH), support community health, and address the health disparities in their communities.

"This has been a really challenging experience for all of our patients, but particularly our most vulnerable patients and those experiencing layered on health frailty with vulnerability related to losing their job, or economic circumstances around them, or racial injustice, or all the different things that contribute to poor health," Stine said. "The pandemic has amplified those and we're seeing that. We still have a lot to learn about the implications and how we most effectively respond to them, but the pandemic has taught us a lot about ourselves that we didn't know we'd want to acknowledge, certainly when it comes to disparities and equity. And so, I think it's a call to take that even more seriously."

3. ESTABLISH A ROBUST PRIMARY CARE FOUNDATION with personalization and extended access

In the future, primary care should not be a one-size-fits-all model. Through a personalized primary care approach, hospitals and health systems can better serve the differing needs of their patients and communities.

"I kind of think about primary care as ice cream," Roth said. "I think one of the opportunities we have for better engaging people in their health is offering more choice … we serve a lot of vanilla to communities. One of the things that we've really been working on is thinking about offering different and unique choices."

"Ultimately, we think primary care needs to have this level of differentiation. There will definitely be a consistent allcomer type of model like we have today, but if we can accentuate that with models that engage people differently and are not just a similar shade of gray. We think that we can do better in accessing care and really speaking to people as to who they are personally," Roth said.

This can include offering community-centered care for seniors, focusing on women's health, excelling in cultural competency, and investing in behavioral health.

4. ADAPT TO CHANGES IN SCALE

About 18 months ago, Dignity Health and Catholic Health Initiatives merged to create CommonSpirit Health. In doing so, "two large organizations [became] one of the largest nonprofit health systems in the country," Stine said. "That's a lot of scale, a lot of different stakeholders, a lot of complexity. No market is like another market."

"Healthcare is deeply local, fundamentally, but there are also things that we can do together that we can't do on our own," Stine said.

Roth and Stine said that CommonSpirit took a number of steps to identify opportunities of scale while respecting local expertise, including:

  • Putting the needs of their patients first
  • Building trust across the system because "change happens at the speed of trust"
  • Utilizing data for decision-making
  • Being transparent and making data accessible

"A lot of things that insulated us and buffered us about that scale, and a lot of ways in which to make a large health system like ours work, takes that hard up-front work of relationships, attention to detail, adapting to different markets … if you don't do that, you end up with a whole bunch of pilots that never scale, or good intentions that don't drive the kind of outcome we want," Stine said.

5. BUILD PROACTIVELY FOR A CHANGING PAYMENT ECOSYSTEM

To sustain the funding model for population health and mission capabilities, hospitals and health systems need to increase the need for "resilient value-based agreements."

"I think back to the payment model frame of proactively building a changing payment ecosystem. This, too, is something that we've been pushing toward and coming from [a] historically hospital-focused company to a [population] health and care continuum­–focused organization," Stine said. "That's a big change, that takes time, but I think we have a lot of tools and assets in that direction, particularly because we're an organization of deeply mission-driven people, as people are in healthcare."

"We're trying to harness that tradition of community engagement as sort of the engine and the fuel for that payment transformation and then both for the reasons of mission alignment, for the reason of resilience, for the reasons of just the inevitability of where healthcare is going in terms of payment," Stine said. "This is an area where we really need to build for where things are going, and trying to line up the incentive structure as well as we can in that direction, to support the work that we think is most meaningful."

"We believe [connected networks] are the next generation of value-based care, but it's value-based care in a way that engages the community and recognizes that significant capacity has been built in a community to serve these diverse needs, and that needs to be better coordinated with the medical care system, but we don't need to replace it," Roth said.

This includes proactively moving certain investments into "center stage," to help transform the payment ecosystem, including investing in:

  • Home care
  • The integration of "lab and pharma" into the value-based care models
  • Virtual care

“I kind of think about primary care as ice cream. I think one of the opportunities we have for better engaging people in their health is offering more choice … we serve a lot of vanilla to communities.”

Melanie Blackman is the strategy editor at HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

Primary care models should reflect different patients' needs.

Changing the current payment ecosystem will require moving certain investments "center stage."


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