After several years of testing value-based programs and payment models, Louisiana Children’s Medical Center, LCMC Health, was in need of a scalable population health system that could serve its patients and 2,000 medical staff and physicians.
“After testing value-based programs and payment models for several years, we identified the need for a partner to help improve our ability to generate quality and cost outcomes and to provide the capabilities to support the health system and our physician partners,” said Dr. John Heaton, president, clinical and system operations, at LCMC Health.
“Most notably, we needed a stronger vehicle to align with the physician community, high-quality contracts with area payers – for example, commercial payers, employers, CMS, Medicaid – and the technology and analytics to advise care interventions, clinical programs and provider incentive awards.”
The Louisiana health system zeroed in on Lumeris, a value-based managed services firm that works in population health.
The Lumeris system was designed to establish and operationalize a population health services organization. Lumeris started with an assessment of LCMC Health’s overall population health readiness and then worked with the health system to develop a tailored strategic business plan and implementation roadmap.
“When building a population health services organization, leaders must engage their senior leadership, physician champions and payers in the process as early as possible.”
Dr. John Heaton, LCMC Health
“Collaboration and communication among physician and business leaders was a priority and required the establishment of an effective governance structure for the PHSO,” Heaton explained. “New care delivery programs were established to support multiple areas such as closing quality care gaps; managing care transitions, complex care and ED avoidance; and managing pharmacy needs.”
Provider engagement also was a key strategy and included the establishment of a clinically integrated network as a vehicle to organize providers, manage value-based contracts and engage physicians to act like a unified group focused on delivering outcomes, he added.
“To ensure users had the actionable information they needed when they needed it, we implemented Lumeris’ technology platform for population health analytics and care management,” he continued. “We also reformulated our payer strategy to establish win-win partnerships that rewarded quality and cost outcomes over volume.”
There are many population health system vendors on the health IT market today. Some of these vendors include Allscripts, CareEvolution, Cerner, Elekta, Enli Health Intelligence, Epic, GSI Health, Health Catalyst, HealthEC, Innovaccer, MAP Health Management, Medicity, NextGen Healthcare, Optum, Orion Health, Varian Medical Systems and ZeOmega.
MEETING THE CHALLENGE
In partnership with Lumeris, LCMC Health established LCMC Healthcare Partners, a provider-led clinically integrated network organized around the principles of value-based care.
LCMC Healthcare Partners is governed by a physician-led board of directors that oversees the network’s strategy. To further support physician engagement at the individual physician and group levels, LCMC Health used Lumeris’ roadmap to deliver accountable primary care, focusing on the coordination of care team workflows, enabling physician leadership across the network and at the practice level, and cascading communication, performance review and best practice sharing through routine meetings, Heaton spelled out.
“Once we deployed the population health analytics and IT infrastructure, we were able to stratify populations and assign patients to specific care delivery programs to improve quality of care, facilitate care management initiatives, and manage pharmacy opportunities,” he said. “We also created provider dashboards and used analytics to track the performance of our care delivery programs.”
Some of the results to date include:
- Alignment with more than 270 primary care providers. This success is in part based on LCMC Health’s targeted approach to building the network and recruiting primary care physicians who were committed to high-quality care, Heaton said.
- LCMC Health surpassed its first-year revenue goals ($ 3.6 million versus $ 3.1 million) through a combination of quality improvements and shared savings, he said.
- Quality outcome scores improved across most primary care practices because of organized practice workflows and proactive outreach to patients, he explained.
- LCMC Health continues to focus on appropriately documenting patient risk status in its Medicare Advantage population through extended visits that allow for more proactive, comprehensive preventive care, he said.
ADVICE FOR OTHERS
“When building a population health services organization, leaders must engage their senior leadership, physician champions and payers in the process as early as possible,” Heaton advised. “By making this a priority, organizations can foster collaboration and alignment around the delivery of high quality, cost-effective care.”
When assessing the organization’s population health readiness, it’s also critical for leaders to be honest about timelines, resources and performance goals, including what is expected on the part of physicians, he added.
“Setting appropriate expectations from the start ensures that resources are appropriately allocated, that timelines and goals are realistic and achievable, and that the organization is well-positioned for success,” he stated.