The health care system is broken. As caregivers, we know we can provide more value, but it requires a fundamental change in the way we deliver and pay for care. Fairview Health Services has set out to do something about this. I believe we not only can do this work, we must do it—for our patients and the communities we serve.

In 2008, we embarked on a major transformation of our care delivery and core business model to create value by improving care, improving the patient experience and reducing total cost of care. Our goals have been simple but ambitious: Change care by focusing on improving the health of defined populations and delivering improved clinical outcomes at a reduced cost; change the experience of individuals by actively engaging them in the change process and holding them accountable for their own health; and change payment to align with new care models and to reward providers for the value they produce.

Fairview used a rapid-iteration process to help our clinicians redesign the way health care is delivered, with an initial focus on primary care and creating a health care home for patients. What began as a pilot at two clinics has rolled out to 40 primary care clinics. Physicians and staff are using team-based care and offering additional ways for patients to access care, including nurse-only visits, virtual care visits and group appointments for some conditions.

We've added care coordination capabilities to manage care transitions across the entire continuum with a focus on patients with multiple chronic and complex conditions. We've invested in new technologies and data systems to manage care and patient transitions more effectively—including a unified medical record for our entire continuum. And, we've engaged specialists to develop "care packages" to help standardize care and reduce costs for such conditions as low-back pain, diabetes, hypertension and prenatal care.

We are bending the cost curve. The components of total cost of care either have decreased or flattened while clinical outcomes and patient experiences have improved. We're confident these results will grow more dramatically as we continue to develop our capabilities and spread the work across our growing network of independent, employed and faculty providers.

To sustain these changes, we worked with health plans to develop payment methodologies designed to recognize the value we create—moving away from traditional fee-for-service reimbursement. Fairview has executed new shared-savings contracts with four major commercial health plans in our market. We anticipate that state and federal governments will follow suit and begin to recognize value through shared-savings contracts and, eventually, a more global payment model.

Financial sustainability also comes from increasing the number of individuals who choose Fairview as their health home and increasing the number of covered lives served by the Fairview Health Network. This is important to fully utilize capacity created by reducing variation and inappropriate utilization of services.

Health care systems like Fairview should be held accountable for the care they provide—no one but the caregivers can change the way care is provided. I believe that purchasers of care will recognize enhanced value. This is fixing a broken health care system.

Mark A. Eustis is president and CEO of Fairview Health Services in Minneapolis.

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