As healthcare providers across the country consolidate and integrate as they prepare for value- and population-based care, their ultimate success, or lack thereof, will be determined by their ability to function as an aligned system, says Robert Nesse, MD, CEO of Mayo Clinic Health System.
In his role as CEO of the system, which is the regional system of Rochester, Minn.-based Mayo Clinic, Dr. Nesse oversees more than 1,000 physicians at 70 community-based care delivery sites, including 19 hospitals throughout Minnesota, Wisconsin, Iowa and Georgia. His biggest current responsibility? Ensuring each delivery site is aligned toward providing high-value care.
"My charge is to integrate those units together and improve the value of the care we deliver," he says.
How is he approaching this major challenge? By working to develop the organization's "five fundamentals of systemness" — those attributes he says are necessary for success under value-based care.
1. A network of providers
"First, you must have a network of providers," says Dr. Nesse. "The new models of care really demand that you are able to take responsibility for and control the resources from time of presentation of the patient to after the hospital care. Primary care providers ensure access into the health system, manage chronic care and also help direct care to the lowest cost, but still appropriate, site of care — all of which are critical for risk-based models.
Health systems that lack an aligned network of both primary care and specialty providers will be unable to provide coordinated care across the continuum, which will increasingly grow in importance to payers, as well as healthcare consumers.
2. Aligned purpose
It's through Mayo Clinic's efforts to develop its primary care and community-based network that it launched the Mayo Clinic Health System. "With primary care, the community practice becomes a really big part of care delivery and is now a strategic partner with the destination center," says Dr. Nesse. You must align the work so that everyone is improving the value of care.
3. Financial alignment
"You have to have an aligned financial model," says Dr. Nesse. As hospitals across the country have consolidated, many have approached acquisitions or mergers as a way to expand their reach, with the ultimate goal of moving more patients into their tertiary care centers, he says. With value-based care, more patients in beds mean higher total costs of care — the enemy of risk-based reimbursement.
"You have to have financial models based on total costs that reward [physicians] for keeping people out of hospital beds," he says. "You have to work through that openly and transparently."
4. Care coordination
Only after a health system has developed a strong network of providers with incentives around reducing the total cost of care for a population, can care coordination efforts be maximized. Without these incentives, care coordination is more of a "hobby," where care coordinators attempt to manage care among fragmented or unaligned providers without true improvement taking hold.
"You must proactively, and with intent, align the financial systems to provide incentives and rewards for decreased use of resources," says Dr. Nesse.
A percentage of Mayo Clinic Health System's primary care physicians' pay goes into a pool that is then divvied up based on achievements around certain quality metrics, access and service delivery. In the future, as risk-based reimbursement grows, variation away from care pathways and total cost of care could also be incorporated into compensation formulas.
5. Actionable analytics
Finally, systemness requires a shared source information source on patients, their histories and conditions. "If you don't understand with great clarity what you're doing in your business basically real-time, you can't react and adapt and change," says Dr. Nesse.
Real-time analytics provide a "picture of your performance on an organizational and physician level," says Dr. Nesse. Without reliable measurement on current performance, properly targeted performance improvement is impossible. And, it is performance improvement, after all, that is most important to a health system operating in an environment where value determines success or failure.