Thanks to research from our Intelligence Unit, we know that care coordination is one of the top strategic challenges for healthcare leaders. It's difficult, time-consuming, and while it's unquestionably good for the patient, the details of bringing together disparate sites of care and the practitioners who operate them are intimidating both from a cultural and financial standpoint.
You won't find many senior healthcare leaders who will argue that better care coordination is essential to solving some of the cost and overutilization issues in healthcare. But for the individual hospital or system, making the investments to ensure better coordination involves expensive infrastructure improvements. These come in the form of information technology investments, higher labor costs in the form of care coordinators, and often, investments in partnerships or ownership in primary care, rehab, hospice, skilled nursing or a host of other possible sites of care.
It's a huge commitment, and those choices have to be made in an environment where return on investment for the organization is unclear—even though it's positive for society as a whole. Making these types of high-dollar, high-transformation decisions could spawn multiple career-limiting events. That's not the kind of risk-return ratio that most hospital executives are willing to undertake. But what if you could eliminate some of the variables?
Clearly, the US Army is not under the same type of business equation, but the challenge of care coordination is the same.
Maj. Chris Warner, MD, has been in the Army since graduating high school, so he's not the person to offer advice on ROI, but he can certainly tout the benefits of his work in coordinating mental health with primary care, not only for the patient, but for the Army itself. After four years at West Point and then medical school, he completed a five-year residency at Walter Reed Army Medical Center in Bethesda, MD. He's had two deployments in Iraq, and recently became deputy commander of U.S. Army Medical Department Activity-Alaska, where he oversees medical care for more than 39,000 beneficiaries across three Army installations.
But it's his team's work on the battlefield between 2005 and 2009 that really informed his philosophy on care coordination.
"It was an excellent opportunity to prepare for the clinical integration of mental health into primary care," he says, noting that both are key specialties for operational and deployed medicine. "This was exciting work because I was able to work with developing policy and initiatives that could help soldiers overcome the stigma of seeking help."
At Ft. Stewart, he formed a team of psychologists and social workers in preparation for a deployment to Iraq that covered an area the size of West Virginia and included more than 70 small patrol bases.
"Many of our mental health personnel are deployed on a regular basis," he says. "Therefore, IT is very important to help find balance in developing the team. As an administrator, I look to set a pathway to put in evidence-based processes and refine the processes to gather evidence to do the right things."
Here's where what the Army is doing to coordinate care will start to sound a little familiar.
"There's a couple of key lessons," he says. "The Army is about the largest healthcare practice in the country. We have a coordinated EMR, so care delivered elsewhere can be viewed anywhere else."
In integration of primary care and mental health, Warner has developed programs in which nurse case managers serve as the bridge to primary care physicians.
"This represents one of the largest benefits we've seen and can be incorporated in any healthcare system," he says.
In short, with a captive audience of service members who will access military healthcare for a number of years, the Army has embraced a population health model, Warner says. The Army's Healthcare Effectiveness Data and Information Set (HEDIS) helps care coordinators make decisions on early intervention based on population health metrics and screening soldiers for exposures, disabilities or problems coming from their deployments, including depression and PTSD.
"This allows us the ability to identify conditions early, which in the long run, decreases the amount of healthcare costs they will require," he says. "We feel we've done a good job on prevention as opposed to treatment."
That's fine for the Army, you might be saying to yourself, but civilian hospitals don't have the assurance of hanging onto a captive population where such early interventions are practically guaranteed to reduce treatment costs through prevention. Or do they?
Most hospitals are the largest employers in their immediate area. All of the people who work there tend to do so for long periods of time. Focusing on that group might possibly provide valuable experience and a stable population for hospitals to begin their population health and care coordination journey, no?
Philip Betbeze is the senior leadership editor at HealthLeaders.