When I was asked if I would blog about pushing the healthcare industry into a new era, I agreed based on my own personal experience. At the time, I wasn’t aware of Don Berwick’s recent commentary in the Journal of the American Medical Association on the subject. Fortunately, I can certainly relate to his commentary since I have been living his “Era 3” for the last several years.
Berwick states that healthcare needs to be pushed into a new era. He writes about Era 1 when medicine was good and depended on self-regulation. Then Era 2 evolved once the flaws and contradictions of Era 1 became apparent. Era 2 saw the need for accountability and measurement. Era 3, though, will require a combination of Eras 1 and 2, but emphasizing less measurement related to cost and volume and more measurement related to quality and value; moving away from maximizing revenue; focusing on care improvement as a core competency for healthcare leaders; and complete transparency with the communities that we serve.
At Western Maryland Health System, Era 3 has been evolving over the last several years. In 2011, we transitioned to a value-based care delivery model, and care improvement has been at the core of our care delivery model ever since. We have to maintain market share, but otherwise we are expected to bend the cost curve, which we have achieved each year since 2011.
We deliver care in the most appropriate location and partner with many who previously were our competitors. We have reduced use rates, emergency department visits, readmissions, unnecessary admissions and use of observation beds. We have added primary care practices throughout the region, embedded care coordinators in our physician practices and established a pay-for-performance initiative for our physicians to better align incentives. We provide medications for 30 days to any patient upon discharge, follow up immediately with discharged patients and have dramatically expanded our Home Care program. We also work in partnership with our area skilled nursing facilities, and we address chronic conditions such as diabetes, COPD and hypertension at no cost to the patient through our Center for Clinical Resources
Our quality measures focus on a host of hospital-acquired conditions and potentially preventable conditions, but our performance measures such as readmissions, length of stay and mortality rates are equally important.
Over the last six years, we have become a very different organization by moving away from volume and focusing on a value-based care delivery system that embraces the components of the triple aim of health care reform. It wasn’t easy, but we are now very well positioned in an Era 3 healthcare landscape as well as for an ever-challenging healthcare landscape in the future.