Hospitals aren't the only ones in the health care field aggressively moving beyond sickness toward the new business of health and wellness.
Acknowledging an ongoing trend its members are facing, the Illinois Hospital Association last month named its first-ever chief health officer, Jay Bhatt, D.O., former chief strategy and innovation officer at the Chicago Department of Public Health.
In this new world of population health management, hospitals will need to form partnerships with all sorts of folks outside their four walls, including public health departments, and Bhatt hopes to help the IHA and Illinois providers to make that move. [For more on hospital-public health partnerships, here are 11 steps to integrating with public health.]
I recently spent a few minutes with Bhatt talking about initiatives on the horizon for the IHA.
What first attracted you to this position?
There are really three reasons why. First is the opportunity to play an important role in the health care landscape in Illinois, and to help hospitals and health systems succeed in this era of transformation and reform. There's a lot of opportunity to drive impact and, coming from the public sector, that was important to me. Second is really the chance to work with an extraordinary team that has been proven to provide value to its members and to the health care system in Illinois. As you may or may not know, earlier this year our hospital engagement network reported nearly 16,000 patient harms prevented with cost savings of more than $160 million. Those are big numbers and that requires a strong team. [IHA CEO] Maryjane Wurth is an extraordinary leader and it was important for me to be working with someone like that to help move health care forward in Illinois and deal with the challenges we have. And third is because of IHA's commitment to investing in health. To be successful in this era of health reform, you have to be committed to a longer term vision of managing population health, and that includes thinking about how we use data and analytics effectively, and how we drive unique partnerships outside the walls of a hospital or health system.
In general, do you think that state hospital associations and their members need to be moving more aggressively into the health, rather than sickness business?
I absolutely think that we should, and the hospital association should take a leadership role. Doing this work is hard for hospitals and health systems. There is pain and loss that come with this change process and the association can help to manage that pain and empower hospitals to succeed and take advantage of the opportunity that health transformation is presenting. The United States is the costliest health care system in the world, and we shouldn't be. Our outcomes don't reflect the amount of money we spend on health care and a lot of that resonates from misalignment of incentives and not having the right tools. Physician engagement, provider engagement, interprofessional care team collaboration are all critical, and then making the data actionable is critically important, too, so that we're making good decisions for the right people at the right time. Health reform has raised this question: Does being healthy pay? We should be at the forefront of trying to help answer that question, and I think the answer is that we have to invest in health.
What lessons can you bring from your previous position with the Chicago Department of Public Health?
We need to be aggressive about learning from other sectors and industries and applying those lessons to the challenges we face in health care. One of those is predictive analytics. Amazon, Netflix and commercial industries have been doing this for a long time, and at the health department we applied that technique to look at how we predict children will most likely be exposed to lead, and then integrate that information into the delivery system so that it's an actionable point of data to get out in front of something that has long-term implications for children's health as they move to adulthood. So in that process: What are the right questions? What are the data that we need? How do we use open data and integrate it with the data that a health system or hospital may have? And how do we leverage existing federal regulations, such as meaningful use and other opportunities to make this easy, to make it revenue-generating, to make it part of workflow and, ultimately, improve the health of patients?
The second lesson is that you need partnerships. We started to build out a framework for health system integration that means bridging the gap between public health and health care delivery. That gap has been wide for many years; health reform has really given us an opportunity to close this gap. The incentives, the experiments all are working to that end, and so we've developed a health system integration office. The kinds of partnerships and strategies needed to bring public health and care delivery together are lessons that we can apply to the work we do at the hospital association around decreasing readmissions, and connecting people with social, economic and community resources that they need to stay healthy.
And the third lesson is around financing. If we want to invest in health, promote behavior change and try these unique models of population health and care delivery, what are the resources we have to do it? This is about community benefit, and the restructuring of the community health needs assessment. We need to get hospitals to collaborate with overlapping service areas so that, if multiple hospitals are finding the same issue as a need, they should pool resources to address that area. In fact, then that has upstream impact on their readmissions or the health of that particular population of patients.
At the CDPH, you also worked with others to foster multisector collaborations to advance population health. What sorts of collaborations with others will the IHA need to foster to succeed in this new world of health care?
We've really worked hard in Chicago at the health department to say that issues around transportation, education, and other city agencies are not just issues related to that agency, but are health issues, too. We created an interagency task force around enrollment, engaging small business employees at our airports, connecting patient navigators to uninsured artists, and enrolling taxi cab drivers in health care coverage while they were waiting for their permits. This is an approach of looking at the world differently outside of the four walls of a clinic or hospital. We are also working with the Chicago Public Schools to understand how we change the environment and provide healthier options in the cafeteria. We know food security has implications for the health of an individual or a family. So we brought together people across sectors, corporate folks like Wal-Mart and Pepsi; big employers; we brought together entrepreneurs and startups that are using technology to address this issue; we brought together community-based organizations like the food depository; we brought together Access Community Health Network, which is a health care delivery group, and then had a conversation about their challenges and how we could leverage the resources of each other to keep people healthy and out of the hospital because they are food-insecure. We tell people to take this medication with food, but sometimes they don't even have the food to take the medication with, so then they're noncompliant and showing up in the ER, where their care is much more costly.
One of the initiatives you are working on is tied to better aligning physicians with Illinois' hospitals. Could you talk a little about how important physician alignment will be in this move toward population health?
Hospitals aren't going to be able to transform care unless they bring the physicians along, and we aren't an association that is going to help the hospitals succeed in this era of transformation unless we empower, engage and educate physicians around the tools and resources they need to do the things that the health care delivery and payment environment are asking hospitals to do. That's one area of alignment, and the other is really supporting interprofessional collaboration to achieve improved health care outcomes and decreased costs. To do that, there has to be physician alignment with the hospital as well.
The other is around using data. There are larger data that the hospital or health system looks at, but then there are data that physicians have at their fingertips. Doctors can look at a panel of their patients for trends and patterns, and then help to make some of those connections back up to the hospital level about what's happening on the front lines of care delivery. That's valuable information. The other is how physicians are involved in an effective way with discharge planning, so that we don't send people back to the conditions that make them sick. We also have to empower physicians to use the electronic health record. That's something hospitals are being asked to do, but we've got to bring the physicians along in that process. The EHR can be a powerful tool for surveillance and it can also give you information at the point of care that helps you ask different questions. For example, if I see a patient who has allergies or a headache and I rule out anything emergent, then if I have in my EMR a heat map of air pollution density from where they're coming from, then I might ask them about what their environment is like. I'll ask them about where they live. Do they live in a basement? Is there mold? What's their work history? Their environment has implications for their health as well. For many patients, the moment they leave the physician's office, there is a lot going on in their lives external to that. How do we keep health in the focus for these patients when they've got their lives to live?
Any other advice for hospital leaders trying to figure out this business of health?
I would say that hospital leaders should be mindful and open to opportunities that may not seem apparent to them, such as the use of data and the engagement of unique partners. There's help out there. The IHA is certainly a resource, and they're not in this alone. There are a lot of people struggling with how to do population health effectively, and that's OK.