In the Know

The High-Performance Network: A Clinician's Perspective

03.05.2018 Robert del Junco, MD, Vice President & Senior Medical Director, Affiliated Networks

In a recent post on this blog, my colleague, John Stites, talked about “value-based” care—the foundation of the St. Joseph Hoag Health High-Performance Network:

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

My post expands on this idea by digging deeper into the clinical aspects of the program. Specifically, how we partner with the best providers to optimize performance. Or, as John would put it, to maximize outcomes per dollar spent.

Delivering Innovation

It’s no surprise that patients (and employers) want the flexibility and choice of a preferred provider organization (PPO) while payers (including employers) want the predictability and cost controls of a health maintenance organization (or HMO) when it comes to health insurance.

What that really means, of course, is that everybody wants the best care, delivered in the most appropriate way, for the best price.

When we designed the infrastructure for our High-Performance Network of care, we took this mandate to heart and incorporated simple innovations that improve how—and where—we actually deliver care.

Here’s a great example.

Normally, under a conventional payer/provider plan, when a patient presents at the ER, we either admit them or we put them in observation. Each of these options can cost several thousand dollars per day. However, in many cases, skilled and attentive nursing care may be all the patient really needs.

So, we said to ourselves; “What if we introduced a third option in the ER—Skilled Nursing Facilities, or SNFs (pronounced ‘sniffs’)?” SNFs are usually more associated with senior care or long-term chronic care. But if a patient has a broken arm and really just needs pain management, why not utilize the SNF model—especially when the daily cost may be closer to a few hundred dollars than a few thousand?

Providing for Providers

Clinicians are the lifeblood of our High-Performance Network. So, we set very high standards for their participation, including that every clinician:

  • Meet rigorous quality metrics, encounter threshold requirements, and Press Ganey® patient satisfaction scores
  • Connect to our electronic medical record (EMR) system, our health information exchange (HIE), and electronically submit all claims encounters
  • Follow all clinical practice guidelines and allow us to measure clinical outcomes
  • Maintain open panel status for commercial and Medicare plans

In return, we offer copious support and ongoing coaching to help our affiliated, independent clinicians continually improve their performance.

Alongside strategic investments in clinical oversight committees, information technology, and resources to aid with high-risk patient management, we’re implementing a suite of analytics tools from industry leader RowdMap that provide powerful insights into clinician performance.

Here’s how it works.

RowdMap aggregates Medicare patient data from multiple sources to create a scoring mechanism for providers. Scores are based on key performance indicators (KPIs) like clinical outcomes and cost. Then, we add our own data into the mix.

By benchmarking providers by specialty, procedure, and geography, we are able to identify which providers reliably deliver high-value care, and then we channel patients toward those clinicians.

The net economic effect is that St. Joseph Hoag Health saves employers and patients tremendous amounts of money they would otherwise spend on unnecessarily expensive care.

But here’s where our approach gets even better. We don’t use RowdMap to penalize clinicians whose benchmarks show opportunities for improvement—as many payer and provider systems elsewhere have done. On the contrary, we have found that clinicians want this information. As highly-trained experts grounded in evidence-based medicine, they have a keen eye for objective data—based on peer group performance—that tells them how well they are practicing their discipline from both an outcomes perspective and a cost perspective.

Clinicians are inherently competitive—and don’t forget, that means they also compete with themselves. They want to be the best orthopedic surgeon or otolaryngologist or endocrinologist that they can possibly be. By providing them the RowdMap data in a respectful, fully transparent forum, we give our affiliated clinicians a powerful self-improvement tool.

As the Mastercard commercials say, that’s priceless.

In Data We Trust

You may have noticed that we talk a lot about data. In fact, data is the common denominator across all our High-Performance Network innovations.

We apply methodologies from population health management, which is a data-intensive approach to delivering health care. RowdMap analytics are all about data. And our EMR is the single source of truth that informs all our patient care management decisions.

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.