A few years ago, Heartland Health was looking for the next mountain to climb. The St. Joseph, Mo., integrated health care system had recently won the 2009 Malcolm Baldrige National Quality Award, yet its executives were wondering: What now?
They decided to study other innovative companies, and one really stood out: Harley-Davidson. Sure, they make motorcycles, but Harley's success stems from creating lifestyles. As one Harley executive put it, "What we sell is the ability for a 43-year-old accountant to dress in black leather, ride through small towns and have people be afraid of him."
"We asked ourselves, 'If Harley is a lifestyle company, why can't Heartland be a life-care company?'" said Heartland President and CEO Mark Laney, M.D. "And we shifted focus to our patient experience."
What emerged is a new, patient-centered health care model called Mosaic Life Care, which views a person's health in terms of life's components. By addressing health, lifestyle, career, finances, creativity, relationships and spirituality, Mosaic Life Care takes a holistic, less-expensive approach to helping people become the healthiest they can be.
Central to the model are the Mosaic Life Care centers, which provide a natural, calming effect. As fountains gurgle quietly in the background, patients are greeted at the door with an iPad downloaded with reading materials and games based on personal preferences. "People actually want to come here," Laney says.
Not long ago, a gentleman visited Mosaic complaining that he wasn't feeling well. He said his wife of 35 years recently passed away. And since she always did the cooking, his diet was suffering. Plus, his newly unemployed son moved back in with him, and their relationship was strained.
Instead of giving him an antidepressant, Heartland treated the causes of his problems: his diet and his relationship with his son. A nonclinical caregiver, called a life coach, took the man to the grocery store and taught him how to choose healthy meals; the coach also suggested topics for conversation with his son.
Today, the man successfully continues his relationship with the caregivers at Mosaic. And Heartland has seen systemwide improvements in patient satisfaction scores as a result of the Mosaic Life Care approach.
Care providers can't simply be manufacturers of health care or sick care. Whether the customer is a 43-year-old accountant draped in leather, proudly riding his Harley, or a widower unsure of his present and scared for his future, providers need to link the care people receive to the lives they lead.
Health care reform has placed an added emphasis on connecting care, and providers face a significant change imperative as they transition toward more accountable, value-based care models. Ensuring that patients are cared for in the most efficient manner — without compromising quality — is key to success.
This means more care is being shifted to less intensive and expensive outpatient care sites, with lower reimbursement rates. In fact, according to results from a recent Premier healthcare alliance survey of 530 health care executives, only 35 percent are projecting an increase in inpatient volume in 2013 compared with that of 2012, a 30 percent drop from predictions a year ago. (Respondents projecting a decrease in inpatient volume rose 28 percent over the same period.) But 69 percent believe they will see an increase in outpatient volume compared with that of 2012.
The Home Visit
Albuquerque, N.M.-based Presbyterian Healthcare Services is driving coordinated care through its Hospital at Home program. Doctors, nurses and technicians travel to patients, providing the same care they would receive in a hospital.
For program participants, clinical outcomes have been as good, if not better, than if the patients had been hospitalized, while the cost of care has dropped by an average of $2,000 per participant. Success is attributed to shorter hospital stays, when those became necessary, and fewer lab and diagnostic tests, in particular, for patients with congestive heart failure, pneumonia and urinary tract infections.
Patient satisfaction scores also have increased significantly; patients are receiving multiple daily visits from caregivers, some more than an hour long. According to the program's lead physician, Melanie Van Amsterdam, "Patients who have been in the hospital multiple times realize it is not always the healthiest place for them, and they are thrilled to be at home instead."
Patientcentric programs ultimately empower patients and their families with knowledge about their care, something that is essential to quality and efficiency. A recent Health Affairs study on patient engagement, published in February, suggests that patients most engaged in their care had medical costs up to 21 percent lower, highlighting the important role that patients play in determining outcomes.
Patient empowerment and education is central to performance improvement programs. Patients and families across the nation are being engaged by hospitals participating in the Centers for Medicare & Medicaid Services Partnership for Patients initiative. For example:
- Because recently hospitalized patients are often temporarily or permanently impaired, participating providers have adopted teach-back strategies. They ask patients or caregivers to demonstrate that they understand post-discharge instructions by explaining them in their own words.
- About two-thirds of preventable readmissions are caused by medication-related adverse events, so many providers now conduct comprehensive medication reviews prior to discharging patients. This ensures that patients understand their medications, the potential side effects, why they are medically necessary and how to take them.
These efforts are paying off. New figures from CMS show that the national rate of 30-day readmissions for Medicare patients dropped to 17.8 percent in November 2012 after being stuck for years at 19 percent.
Whether it's a motorcycle/lifestyle manufacturer or a health/life-care provider, a personcentric approach that connects to different parts of someone's life creates a brand loyalty that can only improve customer satisfaction. But more importantly, it lends itself to significant cost savings and a better quality of life.
As health care becomes more and more complex, there will always be opportunities to better connect care across the continuum, even for the integrated delivery networks considered to be the most integrated. When care is truly patientcentric, it focuses on so much more than what's provided within the four walls of a care setting. Instead, it extends well into the community, into people's homes and lives.
Michael J. Alkire is the chief operating officer for the Premier healthcare alliance in Charlotte, N.C.