Reimagining healthcare through innovation and collaboration

Every February I head to a warmer climate. Not for vacation, which, after a few cold months in Philadelphia, I could use.

This is different. For the past 10 years, I have travelled to Haiti, first on my own joining other teams, and more recently as part of our Blue Sky Surgical team, operating on patients who have so little and need so much. I'm part of a multi-disciplinary team that brings together professionals from four regional health systems. Every trip drives home how lucky I am to be a health care professional in the United States. To Haitians, our system is the ultimate in care. And in lots of ways it is. But talk to many U.S. doctors, health professionals, and consumers, and you're likely to hear a different story – and for good reason.

You'll hear exasperation about why Americans can't get the basic care they need to live a healthy life. You'll hear frustration as to why our nation spends approximately $9,900 per person on health care per year – 50 percent more than other developed nations – yet we're no healthier. We have shorter life expectancies, higher rates of disease and one of the world's highest infant mortality rates. And everyone seems to agree that we must find a way to rein in medical costs, which are growing twice as fast as the rest of our economy.

But there is a silver lining. Although our current health care system has serious flaws, we can and are already making great strides to fix it.

At Independence Blue Cross (Independence), we're leveraging our expertise and collaborating with area health systems and doctors to re-imagine how health care is delivered. Through a model we call Facilitated Health Networks (FHN), we aim to create a healthier population by improving the quality of care delivered and reducing health care costs through proactive, coordinated care.

The Independence FHN model uses many of the successful principles of rewarding doctors and hospitals for the quality and outcomes of care they provide, not the quantity. And while these reimbursement business models are now gaining acceptance, they are only one piece of our overall strategy. Setting our model apart are essentially three things:

Constant engagement that ensures doctors and health systems share in the value they create as they provide the right care, at the right time, and in the right place so their patients get and stay healthy. We're arming doctors with new targeted, multidisciplinary clinical and cost data so that they can become true stewards of the care resources available to their patients. Information such as which of their patients they haven't seen in more than a year, helps doctors proactively reach out to people who may need care. Our shared goal of keeping patients healthy and out of the hospital when they don't need to be there also increases the opportunity for higher quality incentive payments. Since we started sharing these reports six months ago, the number of Independence HMO patients who have not seen their doctors in more than a year dropped 30 percent.

Real-time, robust data that enables physicians to make informed decisions that influence appropriate care. For example, we provide doctors with reports highlighting their referral practices for inpatient and outpatient facilities and how each of those facilities ranks in cost. We also provide data that addresses issues such as drug prescribing patterns and potentially avoidable emergency room visits. In addition, Independence helped launch HealthShare Exchange of Southeastern PA, Inc., a health information exchange that securely transmits health care data among hospitals, doctors, and other health care providers to improve communication and quality of care.

Patient-focused clinical care that empowers doctors to provide better coordinated care and identify gaps in care. Through the Independence FHN model, a Clinical Care Transformation Team is focused on face-to-face discussions with providers, bringing them tools and reports that help them manage cost efficiencies by showing the comparative cost ranking – low, middle, and high – for frequently performed procedures. The tools also highlight where doctors currently send their patients for those procedures. By sharing these reports, we've seen more appropriate referrals to the specialists performing their procedures in lower cost settings. For example, comparing July through December 2015 with the same period in 2016, we saw an 18 percent increase in general surgeries performed in ambulatory surgery centers.

Our goal is to work in collaboration with doctors and hospitals for our members and their patients' best interests, something we all agree on, but haven't always been able to effectively deliver. Despite all the changes ahead of us in a somewhat uncertain health care environment, one thing that won't change is our commitment to our members and our participating health systems and doctors. We are determined to innovate and collaborate until our health care system truly is the world's finest.

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