Implementing the Tools to Support Accountable Care and Population Health at Bon Secours

The Richmond, Va.-based Bon Secours Health System is a $3.4 billion not-for-profit Catholic health system sponsored by Bon Secours Ministries, with 19 hospitals and numerous other facilities in Virginia, Florida, Kentucky, Maryland, New York, and South Carolina. Leaders there have been pursuing broad accountable care and population health strategies; indeed, Bon Secours physicians joined the Medicare Shared Savings Program (MSSP) for accountable care organizations (ACOs), organized as Good Health ACO for purposes of the MSSP.

Recently, Michael Spine, senior vice president of business development and managed care at Bon Secours, spoke with HCI Editor-in-Chief Mark Hagland regarding his organiation’s push forward into accountable care and population health. Spine, who manages a team of about 10 business development professionals and about 10 managed care contracting professionals, works out of Boun Secours’ Richmond corporate headquarters. His overall team is making advances in a number of areas; in that context, it was announced on Nov. 11 that Bon Secours is now working with the Richmond-based inHEALTH and the Dallas-based Phytel, using tools from both organizations, to enhance the health system’s population health work. As the Nov. 11 press release stated, “inHEALTH and Phytel announced today that Bon Secours Health System (BSHSI) has selected a combination of population health management, patient engagement and care management technologies and services to help solve one of healthcare’s most pressing problems – how to ensure that discharged patients get the care and attention they need without being unnecessarily readmitted to the hospital. “

The press release quoted Michael Spine as saying, “Patients who are recently discharged from the hospital or ED need careful attention to ensure they take medications as directed and report any health problems they may have. This program with inHEALTH and Phytel gives our facilities the choice of tools they need to ensure discharged patients are not readmitted for the same problem unnecessarily. In the process, it will help Bon Secours transition from today’s fee-for-service reimbursement system to one that is better aligned with our goal of keeping our patients healthy after they return home.”

The press release further noted that “The new offering, called Compass™, couples Phytel Transition™ post-discharge patient engagement technology with inHEALTH’s centralized care management contact center. Phytel Transition’s automated communications will contact discharged patients within 72 hours of leaving the hospital or ED and ask them to complete a basic health assessment confirming their understanding of their discharge instructions and medications. Phytel then will automatically escalate those patients who have questions or health issues to inHEALTH nurses, social workers and care managers for one-on-one counseling.”

Spine spoke with Hagland just before the public announcement. Below are excerpts from that interview.

To begin with, please tell us about your participation in the Medicare Shared Savings Program, via your physician-constituted ACO.

We’re an East Coast-based health system; we’ve historically not had a huge risk-based contracting element in our state [Virginia]. We installed Epic as our electronic health record across the enterprise—facilities, ambulatory care, and revenue cycle. And we decided to enroll our entire system’s physicians in the Medicare Shared Savings Program, with the support of the Aetna Accountable Care Solutions solution. Our application was accepted in December 2012. The name of our ACO is the Good Health ACO. It’s a physician-based ACO with about 800 physicians.

Is the establishment of Good Health ACO one of the key reasons for Bon Secours’ current focus on population health?

That was an outgrowth of our integrated clinical transformation strategy. The first step was really a focus on all of our efforts to redesign care, in conjunction with an enterprise install of our EHR. In 2009, we installed Epic across all our facilities and care sites. We call it our one patient, one record strategy and are proud of it. We have evidence-based order sets built in. And it made sense for us to get into something. The Sisters of Bon Secours are very supportive of the Affordable Care Act, as it opens up opportunities to get everyone insured. Per the order sets, we brought doctors from across our organization together with evidence-based sets, and had them work on them together; that’s a big focus for us.

What have been the challenges and opportunities in population health and clinical transformation so far, at Bon Secours?

The opportunity has been to work as a single system rather than 14 different hospitals; and the opportunity to streamline care, per the Triple Aim concept. It’s also enabled us to be more aggressive and assertive in partnering with the insurance companies, to take more risk. We understand that risk is moving forward for providers and patients. And we think we’re in a much better place today on that.

Epic maintains a data warehouse for all our patients, one very large database. Adding strength to that is the Aetna platform. What they were able to do is to take our Medicare shared savings data and focus that for us and give us reports on the care of patients across the continuum, and that began to tailor some of our strategies as well. The Aetna solution went live in the fall of 2013, and then we began to use two big pockets of data. We used our Epic repository and all the information we had on those patients, and then we began to use the CMS [Centers for Medicare and Medicaid Services] data, filtered in part through the Aetna solution, to find opportunities to improve care. Medicare FFS patients historically have accessed care in fragmented ways.

Where did you and your colleagues see areas for improvement?

Primarily, we saw gaps around prevention and wellness. Historically, that kind of care involved co-pays, which have now been stripped from the Medicare program, through the ACA. So we’ve been creating primary prevention plans for our patients. And at the other end, we’ve been focused on creating smooth transitions of care, and avoiding the returns to the hospital. So, we’ve been focused on the “pre-sick,” as I call them, people who can be helped through prevention and wellness, and then focusing on those at risk for readmission and other issues.

So the Phytel solution will help ensure proper discharge management?

Yes, that’s one element in a bigger clinical transformation platform. So some of the elements are building a good post-acute network, comprehensive care management redesign, led by our senior vice president and chief nursing officer, Andrea Mazzoccoli, R.N. And we saw Phytel as a potential solution to help us in that. InHealth is an organization that comes out of Bon Secours, along with the University of Virginia and independent physicians. And they’ve helped us develop the call center. InHealth houses our health information exchange, our health coaches, in a telephonic call center. They’ve been the ones who have helped us engineer Phytel into our medical home and now into our transitions of care work.

We’ve heard from numerous others about that element as well: ensuring a good post-discharge phone conference call is a key to averting readmissions, correct?

Yes, absolutely, and integrating that with the physician practice is so critical, too, so this is one part of an integrated solution.

What have been the biggest challenges putting this together?

I think rationalizing through all the technology solutions available, figuring out all the best solutions for each aspect of this work. Second would be communication—communication between our organization and our physicians and helping them understand how the program works, why we’re concerned about doing things that reduce admissions and reduce readmissions, and providing care on the front end and transition care on the back end.

What have been the biggest lessons learned so far at Bon Secours in pushing ahead on population health?

The biggest lesson learned I’ve seen is the importance of getting everybody on board at the beginning, in what is our purpose and why we’re doing it. I think Bon Secours did that well. We ended up getting the physicians buy in in each local community, and I think that was helpful. Still, we need to do a better job of beginning those frontline physicians and office staff members into developing the strategy. Of course, those 800 physicians are spread out all over the place, in about 400 care locations. Some of are one- and two-physician practices; others have multiple offices. So it’s not big, aggregated groups of primary care in most cases.

What would your advice be for CIOs, CMIOs, and other healthcare IT leaders, around all this?

I’ve had a conversation with our CIO, Laishy Williams-Carlson, and I’ve encouraged her not to get relegated to laying the train tracks across the United States, as I put it, but rather to also get inside the engine and help drive the train. That’s a challenge for CIOs, as everything is so clinically driven right now. But our information officers have such information and knowledge as to how things work, and they can help drive the train. And that’s something we value here, too; so they should get to the front of the train and help lead that strategy.