Florida Hospital recently awarded $1.5 million in grants to five local community organizations with an eye toward improving care navigation and coordination after patients leave the hospital. That includes everything from a church’s food cooperative to setting up community workshops that assist patients with chronic disease management. We recently spoke with CEO Daryl Tol, who is also senior executive vice president of Adventist Health System, and chief executive of its Central Florida Division, about these grants.
Why are care navigation and coordination so crucial?
TOL: At the core of health care's challenges is the issue of fragmentation. Health care is a cottage industry that has come together over time and now can be almost impossible for consumers to navigate. They can't figure out pricing or medications; they have a hard time scheduling and going from doctor to doctor and from place to place. It's our job to create a seamless, easy-to-use consumer experience.
Historically, we have not paid enough attention to this issue, but my colleagues and I are spending a lot of time on it now. In fact, in our system, we say that we never discharge a patient. Can you imagine any other business “discharging” a customer? You want these relationships for life. We use the term transition. Going from a doctor's office to an imaging center or from a hospital to a skilled nursing facility are transitions. Health care is full of transitions, and they're all part of a lifelong relationship and need to be seamless.
How do you hope to measure the return on this investment?
TOL: To build a really strong care navigation model, we need to work with a lot of community partners — federally qualified health centers, free community clinics, public health, other health systems. We look for organizations that have innovative ideas that we can help, through their management and good thinking, to make sustainable over time. When we provide funding for startups, in this case $1.5 million, we allocate those funds and ask the recipients to commit to certain metrics in their proposal. Each one is different, but each has measurable targets: number of patient visits, number of individuals seen at home, number of consumers navigated. Our ROI is not how much we get out of it but whether the organization that received the grant reaches the metrics to which it committed.
This time, there are five, but let me use one as an example: community paramedicine. A number of communities have started to work on this kind of project. Seminole County's health department is working to create a paramedic home-visitation process following a hospital visit. So, tied to our emergency services in a community — the fire services, for example — we have paramedics who respond to calls but also have downtime between calls during which they can follow certain patients, make phone contact, visit them at home. They're even contemplating hiring paramedics who would do that kind of work full time, depending on the caseload. The theory is that if they follow patients who need this kind of support for 30 days after discharge, readmissions will drop considerably, compliance with medication and physician orders will increase, and the home environment can be made safer. In this type of follow-up, there are a number of things we can track to understand whether this program is meeting its targets and may be worthy of growth.
What advice would you offer your peers who may be grappling with similar issues?
TOL: I would talk to consumers in an organized way. It's fascinating what you hear. For so long, we have organized around the interest and convenience of the provider, the physician, the health system and how we want to create our services, but we haven't listened enough to consumers. When we gather them in groups, we ask them to describe what it would look like if they woke up tomorrow morning and health care was perfect. The type of picture they paint is very different and gives us a lot of things to work on relative to a consumer-centered health care approach.
One individual drew a map of his experience with prostate cancer — from the physician practice where he received the diagnosis through every step of his care process, including surgery and after surgery. He put smiling faces, neutral faces or frowning faces on each stage of the process. He used this picture of his journey to talk about how, in some of our places, the care is amazing. But between places, it felt lonely, and from place to place, it often felt as though we didn't even know him. He helped us to understand that we're leaving gaps all over. Even if we have a hospital or physician practice in which service is through the roof, we're not really meeting a patient's needs until we close those gaps.