Hospitals must help create new community networks

  Health-system markets are being pushed toward a volume vs. value-payment tipping point. This is driven by the confluence of states’ moving Medicaid and state-employee health benefits to value-based (risk) contracts, corporations’  securing national contracts for high-cost care episodes and commercial payers’ creating tiered health insurance. Successful population-health (value-payment) programs, whether fixed-price bundled services for individual patients or comprehensive services for a specific population, as with ACO’s, require action based on these insights:

• Outcomes depend on patients’ behaviors over their lifetimes. Thus, patient and family participation must be increased. Success depends on getting “upstream” of medical-care needs.

• Broad local and regional communities, not individual institutions, can best allocate resources to improve the social determinants of health.

Indeed, improving community health depends more on the interactions among the parts than on individually optimizing the parts themselves. Hospitals and health systems have a time-limited opportunity to help develop community-health networks, the backbone organizations for improving population health.

To get started, leaders of hospitals, public- and private-sector social-service organizations, payers and representatives of the broader community must first frame the discussion from a policy perspective and then map linkages across the community.

Our experience with community health networks underscores the importance of social determinants of health, teamwork within/across collaborating organizations and accepting risk within global budgets. Sustained system thinking across the community’s health assets, shared insights, and much generosity and patience from every sector are critical factors for success and flow from visionary hospital leadership and community/political leaders. Case studies from Oregon and Connecticut, among others, show what can be done.

To get started, leaders would do well to convene a perspective-and-policy-setting discussion to frame context and mutual dependencies. Complex, foundational change is emotionally and organizationally disruptive. Thus establishing a fact-driven and respectful dialogue is an essential first step. We recommend that community leaders, especially hospital leaders, convene a community conversation and use linkage mapping as way to structure the conversation for progress. Based on readiness, one or more work streams would be selected to explore and improve the interactions between the parts.

This  is a summary of an Oct. 13 presentation developed by a Cambridge Management Group team led by Marc Pierson, M.D., Annie Merkle and Bob Harrington for the Society for Healthcare Strategy & Market Development's Connections conference. Oregon State Sen. Alan Bates, D.O., provided invaluable information and insights from his work as both a primary-care physician and community/political leader enlisting colleagues in all sectors.

Community networks for transforming health care

  Video: Marc Pierson, M.D., a senior adviser at Cambridge Management Group West, sets forth a practical program for creating networks of community health workers to help transform American healthcare. Dr. Pierson, a former emergency department physician and hospital executive, has a national reputation for innovation aimed at improving care while reducing per-patient costs. He discusses how real healthcare reform must encompass far more than just the medical sector.

--- Robert Whitcomb (a colleague of Dr. Pierson)

What really is meant by 'patient engagement'?

  Cambridge Management Group (cmg625.com) senior adviser <a href="http://www.cfah.org/blog/2014/what-physicians-told-us-about-patient-engagement">Marc Pierson, M.D., had some pithy things </a>to say when he and other experts were recently interviewed by the Center for Advancing Health.

Here are some of the remarks of Dr. Pierson, who is also retired vice president for clinical information and quality for PeaceHealth's St. Joseph Medical Center, Bellingham, Wash.:

<strong> CFAH: ''Here is the CFAH definition of patient engagement: 'Actions people take to support their health and benefit from their health care.' What's missing from this definition? What would you add, subtract or word differently?''</strong> <strong> Dr. Pierson:</strong> ''....Defining {patient} engagement is very much the product of who is doing the defining. If from within health care, then the key question becomes for what or for whom is 'patient' engagement primarily intended to benefit?...I would prefer thinking of 'people' engaged in their health and health care. However, I do like that this definition recognizes that both health and health care require people's active participation...Medical care is not the same as health. Health is much more than the lack of illness...We need to incorporate more perspectives from real people and ask them what they need to become more engaged with their medical conditions, their health, and their well-being.'' <strong>CFAH: ''If a person is engaged in their health and health care, what difference does that make? To whom?''</strong>

<strong>Dr. PIERSON: </strong>"Typically, engagement is defined by health care insiders as paying attention to what you are told to do and being compliant with 'orders.' The current non-system of health care plays into this by being disconnected and difficult for people to understand or navigate....

''Health care offers technology and knowledge but is set up for the people that work inside it, not for its clients' ease, safety, or affordability. Payment for health care is based on professionals managing clients' ill health, not on engaging with people to prevent illness, create well-being, or for self-care of illnesses and chronic conditions.

''People are scared of what they are not allowed to know or understand. They don't want to be more dependent. They don't want to end up going to an emergency room. Their primary relationships are with family, friends, neighborhood, and community — not professional service providers.''