How Saint Francis Hospital bridged the gap between the promise of digital health and real-world operational success

Providers are facing a surge in demand for total hip and knee arthroplasty procedures. By 2030, annual total hip replacement volumes are expected to grow by 171 percent, while total knee replacements are projected to grow by 189 percent, according to a study presented at the 2018 Annual Meeting of the American Academy of Orthopaedic Surgeons.

The demand, paired with innovations in alternative payment models and emerging strategic alignments between physicians and hospitals, has created an opportunity for providers to build distinguished Centers of Excellence. Although doing so demands excellence in many domains, providing patients with what they want — a connected and transparent healthcare experience — is surely high on the list.

Digital health is one investment providers are making to improve patients' surgical experiences. But in the rapidly growing digital space, it's challenging for providers to evaluate which digital tools will yield the greatest return on investment. 

During a March 3 webinar hosted by Becker's Hospital Review and sponsored by Force Therapeutics, experts discussed how one center of excellence — the Connecticut Joint Replacement Institute at Saint Francis Hospital in Hartford — bridged the gap between digital health and operational excellence. The webinar presenters were:

  • Bronwyn Spira, CEO of Force Therapeutics
  • Stephanie Kelly, RN, executive director of the Connecticut Joint Replacement Institute 
  • Steve Schutzer, MD, medical director of the Connecticut Joint Replacement Institute 

How CJRI capitalized on the growing demand for joint replacements 

In 2006, 10 surgeons who were members of five competing practices came together with a vision of creating a world-class destination site for total joint replacement surgery. They formed a management company, the Connecticut Joint Replacement Surgeons, that subsequently entered into a co-management agreement with Saint Francis Hospital in July 2007.

"There is unquestionably a trend toward fewer, larger health systems controlling a significant portion of a given market. But then within these complex systems there is a potential to create highly specialized centers of excellence," CJRI's executive director Ms. Kelly said.

By becoming a center of excellence, CJRI grew into the highest volume arthroplasty facility in Connecticut. Its surgeons have performed more than 38,000 joint replacement procedures with a rate of 3,500 cases per year.

Becoming a successful center of excellence required, initially, overcoming significant and longstanding personnel and operational challenges. Entrenched obstacles included misalignment between hospitals and physicians, chronic inefficiencies and unnecessary waste.  And, more recently, lack of a digital health strategy. 

It's a process that Dr. Schutzer said requires a massive cultural shift but also emphasized "every challenge can be turned on its head and inverted into an opportunity." In the end, he said, the cultural shift is the behavioral manifestation of the organization's new core set of values. 

Cultural transformation isn't easy, and often takes years, Dr. Schutzer said. The experts identified three solutions to accelerate cultural and organizational change: 

  • Align your leaders by co-creating a unified vision and a model that holds the entire team accountable 
  • Activate your strategy by using evidence-based, actionable data to drive decisions
  • Scale new efficiencies by delivering on the promise of digital health

"The right model should hold the team accountable, not just an individual," Ms. Kelly said. "In a successful alignment model, you share the risk, as well as the reward, with your partners. If you don't succeed, you learn and improve together."

With their new cultural foundation, CJRI began exploring digital health opportunities to scale across its organization. They created a task force composed of a diverse group of stakeholders from across the continuum of care including a core of "digital native" young members. The task force decided CJRI should strive to use technology to create a single source of truth for all of its providers and patients. 

CJRI chose Force Therapeutics to collect and evaluate patient reported outcomes and to compare them with industry benchmarks. Force Therapeutics has worked with 60-plus health centers like Danville, Pa.-based Geisinger and Scripps Health in San Diego, and facilitated more than 3 million patient interactions. The platform allows patients, like those who just underwent joint replacements, to connect with physicians from home. They can report pain information through the platform and use video-based education and rehab to guide them through their recovery.  

"If done right, the delivery of prescriptive digital care plans can empower patients to be active, autonomous participants in their recovery. It's a tech-enable world, so patients have come to expect some type of digital access to their care team," Force Therapeutics CEO Ms. Spira said. 

Force Therapeutics' episode-based digital care platform allows CJRI to receive data, like peak pain levels, to anticipate patient pain before it becomes an issue. Providers who use the digital tool have witnessed a 32 percent reduction in post-acute costs and a 28 percent reduction in readmissions, according to research conducted by Force Therapeutics' Clinical Consultants.

This is exactly the type of digital experience patients are demanding in 2020.

"Our relationship with Force Therapeutics has been a key driver in our success with engaging patients in independent self-care delivered virtually and conveniently," Dr. Schutzer said.

To access a video recording of the webinar, click here.

To learn more about Force Therapeutics, click here.

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