BWH Leaders Address Questions about Changes in Health Care

From left: Stan Ashley, MD, David Bates, MD, Jessica Dudley, MD, Jackie Somerville, PhD, RN.

With a changing national landscape in health care, acronyms like ACO and AQC are becoming more common in everyone's vocabulary. But what do the changes actually mean in terms of day-to-day practice?

BWH leadership kicked off a series of open forums last week to address questions about the rapid transformations that will be needed to provide high quality care at a lower cost.

"It really can't be business as usual," BWPO Chief Medical Officer Jessica Dudley, MD, said to a packed audience in the Bornstein Amphitheater during the May 30 forum. "We have to be more efficient while continuing to provide high quality care."

Currently, most hospitals are reimbursed on a "fee-for-service" basis. Moving forward, hospitals serving as Accountable Care Organizations, or ACOs, (and under similar contracts with private payers) will essentially be paid for managing the health of populations of patients.

"This concept of population management has changed in Massachusetts relatively overnight," said Chief Medical Officer Stan Ashley, MD. "In addition to becoming a Pioneer ACO with the Centers for Medicare and Medicaid Services, we also re-negotiated our contracts with commercial payers Tufts, Blue Cross and Harvard Pilgrim to manage patients in a similar way." (The Blue Cross contract is an Alternative Quality Contract, or AQC.)

BWHers were encouraged to ask questions during the lively panel discussion with Ashley, Dudley, Chief Quality Officer David Bates, MD, and Senior Vice President of Patient Care Services and Chief Nursing Officer Jackie Somerville, PhD, RN. These are some of the questions and answers.

Q. How will we break down the silos that have traditionally separated disciplines to ensure that we can manage a patient's entire episode of care?

A. "Everyone will be asked to change how they are doing things so that we can cut across silos," said Bates.

Ashley agreed. "With the work we've been doing in care redesign, we've started to break down the silos and bring together every discipline involved in managing a particular patient's episode of care," he said, adding that he is part of the Partners Care Redesign group for colon cancer.

Dudley referenced the success of primary care in transforming to a medical home model, which requires similar collaboration across disciplines to be successful. "The primary care team has removed the silos in order to do this," she said. "Switching to a team approach to care for patients has been successful in pilots across the country, in terms of both quality of care and efficiency."

Q. What is the timeline for these changes?

A. "It's hard to know for certain," said Bates. "Right now, about 15 percent of our patients are in these contracts, but that number is certainly going to grow in the coming years. It could take years before there's really big change; or it could happen much more quickly. It's hard to forecast, so we must be prepared."

Many staff are already pioneering changes through pilot efforts in care redesign. "The units designated as ‘innovation units' are piloting multiple initiatives to better manage patients' transitions to other care facilities, to improve the discharge process and to prevent unnecessary readmissions," Somerville said.

"We're also piloting ways to promote medication reconciliation while the patient is still in the hospital," she said. "We want to have conversations with patients about how they will take their medications and develop a plan with them that matches their lifestyle."

Bates added that enrolling patients in Patient Gateway will help them become more involved in their care and provides an easy way for patients to communicate with their care providers.

Patient Gateway is a secure online tool that allows patients to schedule appointments with their providers, request prescription renewals and obtain test results, among other options.

Q. It seems like we're being asked to do more with less, and change is always slow. If we don't increase our pace of change, what will that do to our ability to compete?

A. "We need to be nimble," said Bates. "We need to quickly spread the successes we are seeing in some of our pilots throughout the organization."

Dudley added that data management is informing leadership as to what is working well and, just as importantly, what isn't working well. "We can quickly move on from pilots that aren't yielding a return on investment and shift our focus to other areas," she said.

Q. How will the selection of Epic as a vendor for the enterprise clinical system mesh with these other changes that are happening?

A. Bates explained that ultimately, the enterprise clinical system will support Partners and BWH in delivering higher quality with greater efficiency. For the time being, most changes to existing clinical information systems will be placed on hold, as all of these systems will be replaced by the enterprise system when it is implemented.

The senior leadership team hopes that this and future meetings in this series will provide a unique opportunity for members of the BW/F community to provide input, ask questions of and challenge leaders in a discussion addressing barriers to change as well as strategize about future needs.

The next forum is scheduled for July 31, at 5 p.m., in the Bornstein Amphitheater.