In the Know

Better Health Care at Lower Cost? You Need a High-Performance Network

01.22.2018 John Stites, Vice President, Affiliated Networks, St. Joseph Hoag Health

The U.S. health care system is undergoing a fundamental evolution.

You may have heard about the shift from “volume to value” or moving from “fee-for-service” to “pay-for-performance.” These phrases all underscore the two key drivers of health care transformation—value and performance.

These drivers are also the basis for St. Joseph Hoag Health’s new High-Performance Network, or HPN.

Delivering Value-Based Care

St. Joseph Hoag Health’s High-Performance Network is a powerful combination of health insurance coverage and a dedicated network of health care providers.

We’ve partnered with leading insurers, Cigna and Blue Shield, to offer two group health plans—the St. Joseph Hoag Health Select and BlueShield Trio HMO plans.

Combined with an exclusive network of high-value physicians, facilities, and health management tools, HPN is designed to provide more cost-effective care and improved health outcomes for employers in Southern California.

We call it delivering “value-based care.”

HPN leverages proven population health management strategies, best clinical practices, and targeted care—enhanced by insights gained through large-scale data analysis. This is crucial—especially for employers with diverse workforces.

Population health management treats different groups differently within the larger employee pool, according to their health needs for a given episode of care. The small percentage of employees/patients that require disease management or complex care account for the overwhelming majority of overall health care costs. Healthier employees, meanwhile, can best maintain their health though preventative services and wellness support.

Utilizing population health management principles, HPN prioritizes resources more efficiently and effectively to deliver the right care at the right time to the right people in your organization. This reduces overall medical costs and improves outcomes at the same time.

How is HPN Different?

We measure the success of our High-Performance Network in terms of the Triple Aim—the recognized ideal for optimizing health system performance. The Triple Aim entails the simultaneous pursuit of:

  1. Quality
  2. Affordability
  3. Patient Experience

Ordinary health plans are rife with wasteful spending. Usually, there is no real coordination of care. Patients are left to make many difficult decisions on their own. Care is reactive and often inconsistent from one physician to another. And there is a lot of “low-value” care—interventions where the added cost of, say, an expensive piece of diagnostic equipment adds no meaningful outcome improvement.

Quality suffers, costs escalate for everyone involved, and nobody is very happy with the product—especially employers and their employees (aka patients).

Contrast that with our High-Performance Network. St. Joseph Hoag Health offers proactive care, highly coordinated, and rigorously managed. We use mountains of data—patient histories, claims data, doctor scorecards, industry benchmarks, and more—to guide care programs for all our enrolled patients. Focused-care teams deliver right-sized care for every patient, based on their specific health needs. The Wellness team provides prevention, early screenings, and well-being programs. The Acute & Chronic Team delivers active monitoring and proactive therapies. The High-Risk Team focuses on early diagnosis and recovery.

It’s all about driving for the best possible outcome per dollar spent while also delivering care that delights our patients—your employees.

How Are We Doing?

To measure the success of our High-Performance Network, we conducted a simple before and after study. We took a small sample of patients and “quantified” their health care experience for 6 months before and after being transitioned into HPN. We chose metrics generally acknowledged to be the major determinants of quality and cost of care.

The results speak for themselves:

  • 9% reduction in ER visits
  • 56% reduction in hospital admissions
  • 50% reduction in length of stay (LOS)
  • 60% reduction in overall readmission rate

These are astounding results—which yielded a substantial reduction in health care costs, across these patients. Just imagine what savings like these could do for your organization and employees.

We built our High-Performance Network with a very clear vision—to dramatically improve the quality and reduce the cost of care we provide to organizations and patients in our communities. And we use big data and best clinical practices (like population health management) to provide access to the right physicians and facilities to best coordinate a patient’s care—managing every aspect of their health with a holistic approach.

Is HPN Right for You?

If you think our High-Performance Network might be a good fit for your organization, let’s talk. Email us at foremployers@stjoe.org or call us at (949) 381-4777. Together, we can decide which HPN option works best with your plan portfolio.