For years, the health care industry has focused on patient-centered care and alignment; these days, accountable care is making headlines. Delivering on the promise behind these words is the challenge. At Sentara Healthcare, we have committed to transforming care in a radical way. Redesigning primary care and chronic-disease management are the underpinnings of transformation. Ad­vanced care planning, enhanced self-care, telemedicine and informatics are all necessary to make this happen. Central, too, is the patient experience—ensuring the patient is involved and empowered.

The imperative to transform care was affirmed in our 2006 strategic plan, which built on earlier strategies to create an integrated delivery system capable of delivering the full continuum of care. Today, the Sentara system consists of multiple hospitals, ambulatory campuses, home care, nursing homes, a 430,000-member health plan, a 500-provider medical group and a medical staff of 3,000 physicians all with the same strategic imperatives.

A central key is our electronic health record, Sentara eCare®. Prior to installing this technology, Sentara looked within the system and identified 100 clinical experts who accepted full-time positions with the information technology staff. The clinicians and IT staff redesigned 18 important processes across the care continuum before configuring software. Every process from patient-arrival management to medication reconciliation focused on improving the patient experience, outcomes and cost.

An extensive cost-benefit study showed a 10-year cost of ownership for Sentara eCare at $237 million, and a realized cost savings of $357 million for the period.

Once Sentara eCare was deployed, the clinicians returned full time to their clinical work sites as superusers to support the EHR implementation. This unique ap-proach of transforming care while designing and installing an IT system earned the HIMSS Level 7 status during the first year of eligibility, the Davies Award and the CEO IT Achievement Award in 2010.

Sentara eCare already is offering dividends as a clinical-decision support tool. In 2009, when H1N1 appeared, Sentara monitored in real time the fluctuation of flu patients, relocated staff and supplies to meet demand, and provided physicians instant access to the latest treatment plans and guidance. Our data showed the geographic movement of H1N1 before either the health department or the CDC had surveillance information. Now and in the future, we will be focusing on predictive modeling, establishing systems that alert caregivers when the first trend toward sepsis begins, matching antibiotics to prevent infections by nursing unit, and connecting doctors to patients in their homes.

Adapting the financial systems to transformation will be tricky. Maintaining balance while straddling between fee-for-service and outcomes-based payments is possible knowing that high-quality care ultimately costs less. Optima Health, the Sentara wholly owned health plan, is the platform on which we are learning how to rebalance the economics. In many ways, the integration strategy Sentara adopted in the 1980s was designed for this moment.

During the next five years, health care leaders will transform care, moving from being paid by volume to being rewarded for outcomes. Ultimately, doctors and hospitals in every community will be accountable for ensuring that care is enhanced, cost is moderated and community health is improved.

David L. Bernd is CEO of Sentara Healthcare in Norfolk, Va.

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