Recently, 10 states were recognized by WalletHub for having the best healthcare. Here, leaders of four systems based in four of those states share what program or practice they implemented to provide quality care without increasing costs.
To determine where Americans receive the best or worst healthcare, WalletHub, a personal finance website, compared all 50 states and the District of Columbia across 44 measures linked to cost, accessibility and outcome.
Becker’s asked leaders, “What is one program or practice your team implemented that had big results for health outcomes without raising costs?”
Editor’s note: Responses have been lightly edited for length and clarity.
Joanne Conroy, MD. CEO and President of Dartmouth Health (Lebanon, N.H.): One of the most vulnerable populations for serious mental illness in women is during the period after giving birth, commonly referred to as the “fourth trimester.” Heather Martin, one of our Dartmouth Health Children’s employees, has been instrumental in building and improving our response to maternal mental health. In January 2020, with the support of Dartmouth Health Children’s leadership, Heather, who at the time was a pediatric medical assistant, launched a mental health screening survey for postpartum women bringing their infants in for check-ups. At the appointment, the mother is given an electronic tablet to answer a series of questions to determine if she is in need of mental health support. Based on her score, she may be connected with a mental health professional to get her the help she needs.
The cost of implementing a program like this is nominal, if not free — most clinics already have multiple iPads on hand, and this process can even be done with a pen and paper.
Heather’s mental health screening program has been such a great success that it is now her full-time job. This year, she started Dartmouth Health Children’s maternal mental health navigator program — the very first, not just at Dartmouth Health, but at any pediatric practice, hospital or health system in the United States. Through the program, she is expanding the mental health screenings she started in Manchester, educating her Dartmouth Health Children’s colleagues about the importance of perinatal mental health, and working toward building a team of navigators who can provide this critically needed support to women throughout the Dartmouth Health system.
Jill Tice, MSN, RN. Vice President of Quality, Safety and Risk Management at Monument Health (Rapid City, S.D.): Our journey towards high reliability and the launch of our Safety Culture Framework in 2019 have been instrumental in achieving significant improvements in patient safety and quality at Monument Health. The framework was designed to create an environment where caregivers feel empowered to report improvement opportunities and are acknowledged for their problem-solving contributions. As a result, we have successfully transformed our approach to patient safety and quality enhancement, and effectively enhanced health outcomes without raising costs.
Key components of our framework include:
- Tiered safety and quality huddles: These huddles ensure that quality and safety concerns or issues are addressed promptly to minimize disruptions to patient care.
- Strategic goals alignment: By aligning our strategic goals with department-level actions, we have further strengthened our quality and safety-oriented culture throughout the organization.
- Medical staff alignment: Prioritizing the alignment of medical staff with hospital-level priorities has fostered a collaborative environment and improved support for our safety initiatives.
Sharese Van Sloten. Vice President of Operations for the Cardiovascular Service Line at UnityPoint Health (West Des Moines, Iowa): We’re focused on investing in practices that increase access to high-quality care for the patients and communities we serve. About a year ago, we introduced cardiovascular telemedicine in one of our markets to fill a need in the surrounding rural communities. Telemedicine allows our patients to see cardiologists close to home. This means patients avoid spending extra time and money to travel to a facility farther away.
Through virtual visits, our UnityPoint Health cardiologists provide routine cardiac services to patients, including taking vitals and listening to their heart via a digital stethoscope. They also review test results such as ECGs and manage prescriptions to help ensure patients maintain a healthy heart.
Richard Zane, MD. Chief Medical Officer and Chief Innovation Officer at UCHealth (Aurora, Colo.): From a vertically integrated perspective, every single service that exists in bricks and mortar also exists virtually, whether it’s orthopedic surgery, primary care, or rheumatology. Our horizontal component is where we’ve built technology-enabled care across the entire spectrum from the sickest of the sick to patients who are recovering at home. We use surveillance in a non-intrusive way to predict deterioration and intervene before escalation to the ICU or emergency department is needed.
All of our virtual care is centralized, which allows our teams to intervene from a distance. For example with sepsis care, we centralized care across 14 hospitals and have critical care nurses evaluating patients for sepsis in real time every few minutes. By doing this, we’ve been able to become more precise and intervene faster. If sepsis is detected in a patient in Yampa Valley, hundreds of miles from Denver, or in the Denver metro area, we can intervene from our virtual health center by ordering fluids, antibiotics, whatever is needed. And we apply the same model to deterioration more broadly, inpatient and outpatient. If someone is deteriorating, we can activate a Code Blue or other response centrally.
The virtual health center allows physicians to cover multiple hospitals, which allows us to spread costs more efficiently, be more nimble with FTEs and technology, and scale routine monitoring tasks. That lets our people focus where they’re most needed while expanding the reach and efficiency of our care.
