Rebooting the Quest for Value

After an acquisition, integrating new principles across a health system takes time—and a plan. SSM Health's new value-based task force pulls innovation and expertise out of their silos.

St. Louis, MO-based SSM Health bought into the value-based revolution quite literally when it bought Dean Healthcare, a Madison, WI-based leading integrated delivery system, complete with clinic, hospital and health plan, in September 2013.

The acquisition was seen by many as an attempt not only to expand the four-state health system's footprint, but also its eventual transition to value-based care and population health, led by many of the lessons and strategies Dean had incorporated into its model as an integrated delivery system.

But such a transformation involves culture change, so it wasn't that simple. Over time, SSM President and CEO Bill Thompson learned that buying into value-based purchasing and population health principles isn't the same as integrating them into a system that is more attuned to fee-for-service reimbursement and all of the operational differences imbued in the two opposing models.

Integrating new principles, and the structures that encourage them, across a health system takes time—and a plan. That's where the newly unveiled value-based task force comes in.

"We've actually rebooted our whole value-based purchasing process because we found it difficult to get it off the ground and working well," Thompson says.

This time, Thompson, and the man he selected to lead the planning and implementation of a new structure based on value, believe they are onto something.

Shane Peng, MD, was named executive vice president and president of physician and ambulatory services at SSM in 2013 after serving as vice president and senior medical director at Sentara Medical Group in Norfolk, VA. Like many other integrated health systems that are struggling to find footing with respect to population health and value-based care, he says SSM tended to get distracted with projects and experiments around the edges of value-based care.

Approaching the transition essentially as a series of trial-and-error experiments prevented fully committing to the coordination and communication needed to transform the entire organization, he says.

The second struggle is related to the first: Because of the scattershot approach to value-based care in the recent past, SSM lacked the right focus to show improvement because what expertise the system had in value-based reimbursement and clinical practices resided in silos, says Peng.  

"That expertise sits in care delivery, hospitals, in postacute care and IT, and finance and strategy have to support it," Peng says. "But the challenge has been it's hard to integrate all those key folks to approach it from a holistic fashion."

In short, he says, SSM has a "huge opportunity right now," and its doesn't have the luxury of building out the infrastructure that's needed to compete for that opportunity over many years. Instead, it has to transform quickly.

To kick-start the transition, Peng called a system-wide summit in late 2015.

"Remember we are in six markets and four states, and we have care delivery from the acute side, medical group side, and postacute, along with all the supporting structure, like finance, strategy, and HR."

5 Working Groups
That summit brought a decision to break into five working groups based not on the departments individuals were in, but on a wide cross-section of talents. They are:

1. Value Contracts Optimization
Led by the system CFO and contracting professionals, within the group are operators and clinicians from the hospitals, medical group, care delivery and people from strategy.

"This is a very diverse work group that really calls into question each region's current list of value-based contracts and how much money have we left on the table with them, how much we're at risk for payback or penalties."

Their task was to develop a grid with the key metrics to gaining value across all the contracts.

"Now we know the key indicators we have to move to achieve those dollars," says Peng. "It will allow us quantify and monetize the activities we need to do to be successful."

2. Metrics and Analytics
Led by the regional president of the physician's organization, this group includes members from IT support, a variety of clinicians, again, individuals from contracting, and people from SSM's current analytics infrastructure, including representatives from Dean Health Plan.

"Being a payer, they have actuaries and can analyze risk data," Peng says. "Their task is to say hey, now that we know these metrics are the ones we have to improve on for success in this particular contract, what does care delivery need from analytics to drive the changes necessary?"

3. Care Management
Care management is led by the president of hospital operations and supported by leaders from the hospitals, the physicians' organization and postacute care.

"Within care management we have a great deal of variation even within the same city," Peng says, noting that hospitals may not be standardized on discharges or other functions. "The challenge is [whether stakeholders can] create that standardized approach for care management, which is the most critical part of value based care," says Peng. "It's hard to make improvement amid variation."

4. Core Competence and Infrastructure
Led by the president of physician and ambulatory services, this group's role is to evaluate and develop the core competencies, infrastructure, and processes required to drive success in value-based care.

5. Information Technology
Led, not surprisingly, by the system chief information officer, this group includes representatives from a wide swath of responsibilities within the clinical and management areas at SSM and is charged with assessing, developing, and deploying the information technology necessary to ensure the value-based care initiative is successful.

One breakthrough from the groups in just three months of work, Peng says, came in the form of a grid created from the input of all five working groups. All SSM contracts are listed by region and are broken down into opportunities to monetize, Peng says.

Executing on all of it should add up to around $40 million—straight to the bottom line. That grid is used by the analytics and metrics work group to understand how the contracts actually work, and helps SSM understand how best to "reverse engineer" its care delivery by creating processes that will lead to success in 2016 and beyond.

Once again, Wisconsin is the model region for SSM because it has what Peng calls "all three legs of the stool"—hospitals, physicians, and its own health plan.

"When the three units integrate and function as one, it's a very powerful organization," he says.

While the reality is that some regions within SSM will never have all three components of the integrated delivery network, Peng says they will learn what health plans want delivered through intimate knowledge of Dean Health Plan.

"That puts us in a better position to partner with any health plan, government or otherwise, to drive better care for our patients," Peng says.

"There is opportunity for us to industrialize the process. For example, we have [Medicare Shared Savings] ACOs in three markets. They're the same contract. In the past, each region kind of did their own thing and tried to reinvent the wheel. By looking at it from more of a system perspective and discerning what kind of value a centralized support function brings versus regional activity, there's great opportunity to bring in efficiency standardization and ultimately higher performance."