Feature article

Case Studies and Lessons Learned Implementing Value-Based Cardiac Care at American Hospitals and Health Systems

Value-based care is a top-of-mind consideration for hospitals and healthcare professionals, especially in the United States where the passage of the Affordable Care Act created programs designed to reward providers who delivered positive outcomes at lower cost. Value-based care is especially important in cardiology, where costs are often quite high. 

As physicians and healthcare professions are adjusting to the new landscape, they are taking lessons from cardiac centers that have already achieved success in adapting their practice to a more value-based model. One of the most effective strategies for shifting from fee-for-service to value-based care has been to reorganize the care delivery continuum from vertical independently operating siloed units to horizontally integrated cardiovascular service lines.

Case Studies

Cornerstone Health Care

Based in High Point, NC, Cornerstone Health Care transitioned to value-based care from the traditional fee-for-service model by first implementing a cardiovascular care line in a specialized heart clinic designed to address the top 20 percent of their chronic heart failure patients1In the first three years of operation, the cardiovascular care line experienced a per-patient cost-of-care savings of $5,500 and an overall cost-of-care savings of $1.7 million for the 321 patients enrolled in the program. 

To achieve these savings, the Cornerstone heart clinic put together a comprehensive team of cardiologists, nurse practitioners, embedded behavioral health providers, pharmacy services, health navigators, and nutritionists tasked with developing individual treatment plans tailored to patient needs. In other words, resources and experts not available under the old model.

By streamlining processes and improving outpatient management to achieve savings, Cornerstone was able to bring in clinically integrated networks, nurse navigators, social services and community resources to improve quality of care and patient outcomes.

Mayo Clinic

At the Mayo Clinic, the medical team determined only a minority of cardiac surgery patients truly required individualized treatment plans2. To address this finding, a modified service line referred to as a focused-factory care delivery strategy was implemented by developing a standardized approach for a limited set of high-quality products. When patients received focused-factory care, the Mayo team found 67 percent of patients experienced better outcomes, which included reduced risk of sepsis, pneumonia, and renal failure.

Accountable Cardiac Care of Mississippi

Cardiology Associates of North Mississippi (CANM) and Magellan Health formed Accountable Cardiac Care of Mississippi (ACCOM), a venture created specifically to explore how to learn to succeed in a value-based reimbursement environment3. Currently, physicians, nurse practitioners, and staff at CANM provide and manage patient care, while data analysis, case management, utilization management and clinical decision support systems, as well as behavioral health screening tools, are delivered by Magellan.

Thomas Jefferson University Hospitals

In Philadelphia, Thomas Jefferson University Hospitals' cardiovascular (CV) program was restructured by unifying programs at 11 hospitals after a merger. A single clinical leader was appointed to handle the continuum of care from outpatient to inpatient to intraoperative. By standardizing care, CV surgeons could move among the 11 campuses and deliver the same high-quality patient outcomes4.

Another major focus for Jefferson was exploring various types of partnerships in order to develop a strategy that better positioned the hospitals from a payer perspective. Ownership of all the entities involved in care delivery wasn’t necessary, but a complete confidence in the provider, whether a skilled nursing, rehab, home care or hospice environment was essential because Jefferson would ultimately be accountable for care delivered in terms of reimbursement.

WellSpan Health

WellSpan Health, a regional healthcare delivery system in York, Pennsylvania designed a horizontal cardiovascular service line organized to break down silos4. Cardiologists, anesthesiologists, intensivists, cardiac surgeons, perfusionists, and nurses were all actively involved via multidisciplinary committee. Through various committee initiatives, WellSpan has streamlined numerous processes and practices that translate to a seamless patient experience.

Lessons Learned

When disruption of an entrenched business model is at stake, nothing is more imperative than building trust, and that's especially true in the traditionally siloed world of healthcare. At the heart of everything, it is imperative that cardiac service lines maintain transparency in communication, data, and objectives. 

Cornerstone Health’s CV line faced an early challenge in their transition to a value-based model because primary care physicians initially resisted referring patients to the CV clinic because these physicians were used to the old model where they were responsible for everything, everything revolved around the office visit, and referring patients felt like they were “giving up1.” When primary care physicians could see what was happening with their patients in the unified health record and that they continued to be part of the story this resistance faded away1.

A key takeaway to ensuring a successful service line for WellSpan is having every cardiovascular care line team member seated at the committee table4. This approach ensures collective engagement and awareness of Wellspan’s market share and what’s happening in the industry by the entire committee4. As a result, it drives timely recommendations for improvement, identification of best practices, decisions about where to focus attention, and the most informed strategic and operating plans4.

At Thomas Jefferson University Hospitals, a single leader to guide the standardization of care across all delivery points to ensure the optimization of patient incomes and reduction of waste and redundancy has been a key driver of success for this 11-campus healthcare leader4.

Transitioning from an entrenched vertical fee-for-service model to a horizontally integrated value-based service line is proving to be well worth the disruption for many cardiac care centers pioneering the way in the U.S. Given the ongoing focus on care quality and savings, value-based approaches will likely become increasingly popular for cardiac care centers across the U.S. 

References:

  1. The move to value-based care in medical practices: Effect on cost and quality. American Medical Association (AMA) Wire. https://wire.ama-assn.org/practice-management/move-value-based-care-medical-practices-effect-cost-and-quality Accessed March 16, 2018
  2. From ‘Solution Shop’ Model To ‘Focused Factory’ In Hospital Surgery: Increasing Care Value And Predictability. Project HOPE Health Affairs Journal. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2013.1266. Accessed March 16, 2018.
  3. Value-based reimbursements and the future of healthcare: A Q&A with Magellan’s Gina Vehige. Magellan Health, Inc. http://magellanhealthinsights.com/2018/01/22/value-based-reimbursements-and-the-future-of-healthcare-a-qa-with-magellans-gina-vehige/. Accessed March 16, 2018.
  4. Q&A: Growing Service Lines in a Value-Based Environment. Healthcare Financial Management Association (HFMA) Leadership+Magazine. http://www.hfma.org/Leadership/Archives/2016/Summer/Q_A__Growing_Service_Lines_in_a_Value-Based_Environment/. Accessed March 16, 2018.