From WellSpan's early experiences managing risk to the value-based model it operates under today, embracing cultural change has been a major key to our success.
In the business world, introducing a new product requires a sensitivity to market desires and the capabilities to meet customer requirements. Many innovative products have failed for lack of initial customers who didn't understand or desire the product or because the product could not be provided in a market-valued manner.
In the early 1990s, York, Pa.-based WellSpan Health faced this dilemma when we began operating and offering our own health plan. We created a preferred provider organization (PPO) with third-party administrative services. The new health plan was part of a larger vision for an integrated delivery system. This system would bring together WellSpan's acute-care hospitals, a medical group, a distributed ambulatory network and post-acute services.
The preferred provider organization hit the market at just the right time as local employers sought a preferred provider organization with local medical management capabilities. We were committed to exploring new concepts in care management and to improving care. WellSpan provided this plan to its own employees and developed a risk-sharing model that it seeks to offer to local businesses as it continues transforming itself towards a value-based model.
Today this health plan is named WellSpan Population Health Services, and our organization is on a glide path to a value-based model. The organization is responsible for both the cost and quality of the population's care.
Ongoing efforts in population health management have been supported by innovative collaborations involving several payers. WellSpan Population Health Services is now the lead group for value-based contracting in collaboration with Aetna for commercial-insured clients and with Geisinger Health Plan for their Medicare Advantage product. Working with Aetna and Geisinger enables WellSpan to use its claims and clinical data analytics systems, enhancing our capabilities in population health management.
Currently, WellSpan has nearly 700 physicians and ancillary providers who comprise the WellSpan Medical Group. They are joined by an additional 200 independent physicians who together make up the WellSpan Provider Network. That network serves as the preferred group of providers in the Aetna and Geisinger products.
A history of cultural change
From WellSpan's early experiences managing risk to the value-based model it operates under today, embracing cultural change has been a major key to our success. As we grew, innovative programs and initiatives helped shape a culture accepting of change.
Many of these initiatives were foundational elements of a successful transition to value-based care. Each change yielded important "lessons learned" that helped shift our culture to support the current value-based model.
Funding from grants. WellSpan invested in a "Super Utilizers" program and achieved superior results. CMS defines Super-Utilizers, as "enrollees with complex, unaddressed health issues and frequent encounters with providers."1 The lessons learned from this program drove major changes to align care management with the patient-centered medical homes rather than solely with the hospitals.
Beginning in 2011, all primary care practices within the medical group transitioned to PCMH organizations. A grant from the Robert Wood Johnson Foundation through the Aligning Forces for Quality program provided a major catalyst for cultural change. The grant provided funding to engage providers, payers, employers and consumers. These stakeholders focused on strategic initiatives involving transformational care delivery and improving care treatment. This program helped support the PCMH transformation, through the following successes:
- Promoting transparency in reporting.
- Enhancing quality measures.
- Facilitating payment reform.
Executive leadership changes. Our executive leaders had to adopt a new way of thinking centered on a population health-based business model. This was critical for making investment decisions. Cultural change at the executive level also helped ensure the pace of overall change was appropriate for our organization and staff.
In 2005, we established a physician leadership academy to improve physician culture and to recognize and elevate the role of executive physician leadership across the organization. The academy offered courses in change management, negotiations and quality improvement. More than 100 physicians joined the first year. The program also helped transform physician culture to align thinking towards caring for a population of patients.
Organization-wide cultural changes. A number of organization-wide cultural changes took place at WellSpan, including:
- Breaking staff out of their individual practice "silos" encouraged every staff member to see the care experience through the eyes of a patient.
- Mapping clinical processes and working with teams across the organization helped create a unified continuum of care for patients.
- Developing a clear communications plan promoted teamwork. Collaboration was actively encouraged to maintain a patient-centric focus.
- Requiring providers in the network to adopt EHRs made workflows more efficient
Success in value-based care requires leadership to embrace change
Based on the past 20 years of experience, we recognize effective leadership requires support of on-going cultural change. Because change can be difficult, leadership must determine the right pace of change for the organization, gauge the pace of change and adjust as necessary.
Our leadership team strives to provide clear, consistent communication and encourage collaboration. WellSpan's experience has shown that every leader, at every level, must continuously promote teamwork. Developing physician leadership and placing those leaders at the top of the organization remains a strong focus for us.
Lastly, WellSpan's ultimate goal is being highly responsive to continuous assessment of the organization's delivery of health care in real time. Leadership is focused on a goal of all care being planned, programmed, standardized and measured. With a commitment to continuous innovation, industry-leading collaborations and a culture supportive of change, we continue on the glide path to a value-based model.
1 Center for Medicare and Medicaid Services, July 2013, http://www.medicaid.gov/federal-policy-guidance/downloads/CIB-07-24-2013.pdf.
Charles Chodroff, MD, is the senior vice president, population health and chief clinical officer of WellSpan Health.