Barbecue, Honky Tonk…. and Value-based Care

By Dr. Gajan Srikanthan, Director Clinical Pathways, Lumeon

A couple of weeks ago, I was lucky enough to spend a week in Tennessee as part of an ABHI (Association of British HealthTech Industries) mission to promote up and coming U.K. health technology companies. Why Tennessee, you may ask? I wasn’t entirely sure before arriving, but it became abundantly clear on day 1.

Tennessee, and Nashville in particular, is arguably the centre of healthcare delivery in the U.S.A. There are many health system providers headquartered in Nashville, including HCA, Vanderbilt, Community Health Systems, and AMSurg. In total, 55% of hospital beds in the U.S. are managed by a health system based in Nashville, having a $48bn/year impact on the local economy. HealthTech innovation is key, with a vast number of disruptive companies also based in and around Nashville.

Memphis was our second stop. The focus here revolved around medical device industries, and the expertise they had developed on how best to support up and coming medical device technologies.

There was definite evidence of a wealth of experience amongst everyone we met, and an openness to explore innovative new solutions. There was also a co-ordinated approach between local healthcare, technology, and commerce forums to make sure both Nashville and Memphis were able to sustain further growth.

Highlights

St Jude Children’s Research Hospital, Memphis – St. Jude treats the toughest childhood cancers and pediatric diseases, combining onsite translational research and clinical expertise to drive development of new treatment modalities.
Baptist Health eICU – continuous monitoring of critical care units throughout the Baptist Health system from one central command center
Nashville Entrepreneur Centre – if Carlsberg did HealthTech incubators/accelerators!

Over the week, we were lucky enough to visit and speak with C-suite executives from 10 health systems. This was fantastic access, and really allowed us to understand some of the key challenges and priorities they are facing.

One thing was clear, the movement towards value-based care is a complex one. The majority of hospital providers operate on quite tight margins, typically in the region of 3-5%. Fee-for-service payments make up the vast majority of revenues and therefore key considerations are how to optimise throughput through patient access/marketing programs, and how to deliver these in the most efficient and cost-effective way possible. For big IDNs, standardisation is important – once they have perfected a delivery methodology, how do they roll it out across their network?

Many hospital systems are making their first foray into value-based care by setting up special projects. Needs assessments have helped to prioritise areas of focus with multi-disciplinary teams assembled to develop and deliver the new services or models of care. The resources to do this aren’t necessarily new but are extra asks of already overburdened staff.

As teams are designing these new value-based services, they may or may not realise, they are actually developing care pathways, that look to standardise care across care settings and clinicians. Interestingly, different health systems were working on similar projects, making me wonder if there was an opportunity for cross-collaboration to avoid “re-inventing the wheel”. Another option is to source these templates from care pathway experts, such as Lumeon, where much of the work to develop and maintain the pathways has already been done, with local teams needing to expend much less effort to customise the pathways to their local protocols.

What care pathways look like is dependent on the evidence base, but also what local insurers are willing to remunerate for. Indeed, one of the most salient points I took away from the week was the impact of the local insurer landscape on a providers’ propensity towards value-based care. Where there was a significant number of competing payor organisations, there seemed to be more of an impetus for transformation and change.

As providers look to develop new and innovative ways to deliver care to patients, I was struck by the number of times they cited their EMR system as an obstacle to progress. New clinical workflows to support new ways of working, new data and reporting requirements, integration of new 3rd party systems, and interoperability between different EMRs were all key requirements for providers. Originally designed to alleviate problems with paper records, EMRs have become so entrenched and inflexible as to be part of the problem in the shift to new integrated operational models.

I’ve spent much of my first few months getting up to speed with what Lumeon offers, and it was exciting to see how our proposition and capabilities support some of the key strategic needs of U.S. health systems, be that from:

Automation and virtualisation of operational processes to promote efficiencies of care, maximising throughput whilst reducing unwarranted variation
Embedding the latest evidence-based recommendations into local practice to drive quality improvements and improved clinical outcomes
Optimising the patient experience through improved communications and patient-centric car
Improved co-ordination of clinical teams to deliver new integrated models of care
Transforming care services by the use of data and analytics

All in all, a great fact-finding trip to Tennessee.