Dale Maxwell recently was named president and CEO of Presbyterian Healthcare Services, Albuquerque, N.M. He has been with Presbyterian since 2000, and has been serving as interim CEO since January. With 12,000 employees and eight hospitals across New Mexico, Maxwell is leading the health system in a number of innovative initiatives. H&HN recently spoke with Maxwell on his plans as CEO, the success Presbyterian has seen with its patient navigation model and the system’s approach to treating rural communities through telehealth.
Are there any programs or initiatives you’re excited to start now that you're CEO?
I have a few things that are important to me. I've had the opportunity to talk with many of our providers, get out and see many of our facilities, talk with our board of directors and I'm really focusing on three key areas that I think are critical to our future success and what we're trying to accomplish.
The first is our people. They are the foundation and the face of the organization. My focus is how to equip them better through development programs so that they can do their jobs better. Health care is a challenging environment these days and it's going to continue to change in the future. By investing in our employees, I think we'll be able to do our jobs more efficiently and create better outcomes for our patients.
The second is building consistency in our patient and member experience across services throughout the organization, and develop nationally recognized outcomes for our patients and excellent experiences for our patients and our members.
The third is growth, which is important to our long-term sustainability. New Mexico is a great state, but we are limited from a population standpoint. We have a little more than 2 million people here and we serve about 750,000 New Mexicans on an annual basis.
Growth is important for us to continue to build our revenue base as payments and reimbursement levels continue to fall. Growth will allow us to scale our fixed-cost infrastructure, and we'll create a lower cost of care for our patients and members. It will also allow us to deliver the care to which we aspire, and additional revenue will allow us to have such things as an electronic health record, investments in data analytics and continued capital for future growth.
We have two really important initiatives from the growth standpoint right now. One in Santa Fe, where we're building a medical center to serve the northern part of New Mexico which will open in 2018. Growing outside of New Mexico is also an important strategic option for us. Over the past 30 years, we’ve built expertise and knowledge in integrating the financing of care into the delivery of care; we're in a great position to export that knowledge and expertise outside of New Mexico and partner with other provider systems to ensure the move toward value-based care and population health. And in North Carolina, we’re partnering with 11 systems to bid on Medicaid as they roll out managed care and move away from a fee-for-service model.
Talk about Presbyterian's patient navigation model and its impact on care.
We started this model in 2010. It came out of the early work of looking at the data and analytics, where patients received care and the overall cost of that care. As we looked at the emergency department, it was a great opportunity to change how care is delivered and be more specific about delivering care in the right place at the right time.
As patients enter our ED, each one has a medical screening. If the screening determines that the patient is not in an emergency status, the or she is navigated to a more appropriate care setting. That could be a referral to urgent care or a primary care facility. The goal is to establish that patient with a primary care physician; then they can begin to manage the patient for future services. It’s taking a very expensive ED visit and translating it into a less costly clinic visit. More importantly, the management of the patient in the long term is going to provide better care to the patient and, overall, decrease the cost of care.
Why did you decide to expand that program to three additional hospitals?
We decided to expand it because it was successful. And in Albuquerque, one of the benefits is that we're using our ED more appropriately to take care of patients. We also reduced our 'left without being seen' statistics in those facilities. Patient satisfaction has actually increased for those patients who are being navigated, and the overall total cost of care has decreased. From a physician's standpoint, it is also satisfying to navigate these nonemergency cases out of the EDs and allow better patient flow throughout the facility.
Can this model work across the country?
I do think that it is a model that can work. We've proven that here in New Mexico. My advice to other hospital systems would be to do the right thing. Step back and look at the patient and where he or she is getting care and determine the most appropriate course of treatment. Be patient-centered and simply do the right thing for the patient.
Presbyterian started a pilot project in 2012, focusing on home and office-based palliative care. What makes Presbyterian so unique in addressing palliative care?
Our health care and home team has done a great job coming up with innovative solutions. The goal of this program is to improve the quality of life for our patients and their families. The unique piece of this is that it’s embedded into our patient-centered medical home, similar to other services like behavioral health or pharmacy management services. This aligns the care across the continuum with all of the care teams, so it's not isolated in any respect.
Can you talk about what Presbyterian has been doing as one of 11 Pallitative Care Leadership Centers in the country?
Well, you know we were honored to receive national recognition for the work that we've done at Presbyterian. This has allowed us to share our knowledge and the lessons that we've learned with other health systems across the country.
Why is sharing knowledge and data so important?
I think health care is local, but health care systems are learning on a daily basis through initiatives, just like our palliative care model. Sharing these types of learnings throughout the country and participating and learning from other systems is important. It can actually streamline and speed up change and provide better care at a lower cost in a timely manner.
Can you talk about your overall approach to telehealth and how you view telehealth initiatives going forward?
Telehealth is important to Presbyterian and, I think, to New Mexico. Our state comprises many rural areas where it’s very difficult to recruit and retain the necessary clinicians to take care of this population. We see it as a way to leverage what we're doing here in Albuquerque and we can export care, using our providers here, into those rural parts of New Mexico.
We have a couple of, I would say, established and successful programs. One is our Telecritical care program. Intensivists here in Albuquerque take care of patients at two of our regional facilities through video. By using the care teams at the point of care and a physician in Albuquerque, we're able to deliver the necessary care for the patient. He or she receives the highest-quality physicians, is able to stay in the community and doesn't need to be transferred to a different facility, so that really benefits members.
Talk about the NICU Virtual Bonding Program and how it has progressed.
This is an early-stage initiative. It’s also something that is exciting to see and can potentially lead to other possibilities as we learn from this. The program is way to connect a new mother with her baby who has been admitted to the neonatial intensive care unit. In certain circumstances, the mother is admitted into the hospital following the birth but is physically unable to go to the NICU and be with her baby. In other cases, the family may be unable to be in Albuquerque 100 percent of the time to see their child.
This is a concept that helps us via a tablet to establish a connection between the mother and the baby so that they can actually see and hear one another. The outcomes have been special. Obviously, from a mother's standpoint, it is extremely satisfying to be able to see her newborn. And, interestingly, as the conversation and interaction ocurs, we seei increased oxygen levels in the baby during that interaction.