we’re removing confusion from the equa- tion,” said Samitt, upon the announce- ment of the joint venture. “Blue Cross and North Memorial Health have come together to transform healthcare in Min- nesota in a way that no others have, and the winner will be the consumer.” The two organizations are hoping to reduce overall cost of care by up to 20 percent over the next fi ve years, with a focus on wellness, prevention and health outcomes, rather than consumption of services. • At Nemours Children’s Health, based in Wilmington, Del. and with care loca- tions across fi ve states, leaders are pushing ahead to create opportunities out of chal- lenges, including the challenges facing all children’s hospitals and health systems, which derive so much of their revenue from the Medicaid program. “We’re hav- ing radical conversations about trans- forming healthcare that we arguably have never had before, and things are on the table that never were, including how we defi ne health and healthcare, and how we align incentives on behalf of the patient,” says Nemours’ president and CEO R. Lawrence Moss, M.D. “So it makes for a tumultuous time, and a lot of people are troubled by that, but I just see that as a tremendous opportunity.” Moss and his colleagues have been digging deeply into their data and fi nding huge opportunities

started in 2012 in the MSSP, and have had a strong focus not just in Medicare shared savings, but in all of our programs, trans-

failure, cirrhosis, hypertension, and dia- betes, as well as for patients who have had more than three ED visits in the past 12 months. As a result, Dang says, ED utilization has been reduced, and patients have been more carefully monitored and care-managed. Key to all of this, he says, is “making sure the data is accurate, the attribution is to the correct PCP [primary care physician], and making sure it’s understandable and actionable for the clinicians. The clinicians get overloaded with data and overwhelmed; display is important.” And, he says, “We’re using the logic in the Allscripts solution” for population health, “enabling the clini- cians to look and see where there are gaps in care, and how those can be addressed.”

Gary Stuck, M.D.

forming care, trying to improve access and patient safety. We have a lot of innovation in our care. Some examples include that we invest in predictive analytics; we have outpatient care managers and care man- agement teams that try to anticipate high risk of hospitalization or readmission.” • And at the San Diego-based Sharp Rees- Stealy Medical Group, which encompasses about 500 physicians, Trung “Andy” Dang, M.D., the group’s medical direc- tor of quality and population health, has

R. Lawrence Moss, M.D.

for improved care management, including for children living with asthma. • Results are emerging everywhere, including at Advocate Aurora Health, the 15-hospital integrated health system based in Downers Grove, Ill., and with care sites across northeastern Illinois and southeast- ern Wisconsin. Advocate Aurora Health’s three ACOs participating in the Medicare Shared Savings Program (MSSP) saved $61 million in costs in 2018, achieving the highest MSSP savings in Illinois and the second-highest in Wisconsin. Gary Stuck, M.D., Advocate Aurora’s chief medical offi cer, says, “Part of it is that we’ve had a long commitment to innovation. We

“We’re having radical conversations about transforming healthcare that we arguably have never had before, and things are on the table that never were, including how we defi ne health and healthcare, and how we align incentives on behalf of the patient. So it makes for a tumultuous time, and a lot of people are troubled by that, but I just see that as a tremendous opportunity.”

-- R. Lawrence Moss, M.D.

been leading a broad initiative around the development of patient registries, in order to support care management around both preventive screenings (breast, colorectal, and cervical cancer among them), as well as the management of congestive heart

The secret sauce: ingredients What’s the secret sauce in the success of all of these organizations, and others? Healthcare leaders in the trenches see several key elements: • Whatever type of organization is involved—whether medical group, hospital-based integrated health system, or health plan—those leading change are focusing on mission, on core business/ organizational strategy, and putting mis- sion and strategy ahead of everything else. • All the organizations at the forefront of change are also fortunate to have senior executives who are taking personal-pro- fessional risks and showing leadership in the face of the immense challenges facing all U.S. healthcare organizations. • The pioneers are committing to broad, long-term transformation—across years and even decades. • All are focusing on key stakeholder constituencies among their patient and plan member populations—primarily individuals who are high utilizers (the so- called “frequent fl yers”), who are at higher risk for ED visits and hospitalizations/ readmissions. • All are making strategic, incisive, thoughtful use of data analytics tools, and incorporating those tools into core care management, population health management, and clinical transformation initiatives.

Strategy, at a high level, that drives tactics

That focus on strategy is affi rmed by all those interviewed for this story. Anthem’s Linares puts it this way: “Let’s defi ne population health: our defi nition is a model that we call Total Health, Total You (THTY). And by total health, we mean that all the data and informa- tion available in the healthcare ecosys- tem should be put into a personalized profi le. We’re focused on a digital and


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