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COORDINATED EFFORT Health care systems readjust on heels of Obamacare, move to integrated care and fee for value

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The health care industry this year underwent a dramatic change as it weathered through the integral stages of the most historic piece of federal health care reform since Medicare in the 1960s.

In the forefront of many businesspersons’ minds, the adjustments and changes rate as one of the top business stories in the Greater Lehigh Valley.

The 2010 law, the Affordable Care Act – or Obamacare – had its most significant reforms implemented at the beginning of this year, when millions of Americans enrolled in mandated federal or employee-sponsored health care coverage – or risked the consequences of federal fines.

This historic overhaul means consumers may be forced to pay more out-of-pocket for their health care coverage – prompting hospitals and health networks to adopt a coordinated-care, team-centered business model, shifting from “fee for service” to “fee for value.”

“In a nutshell, coordinated care has to deliver value. That means higher quality care at a lower cost,” said Tom Croyle, president of Lehigh Valley Business Coalition on Healthcare, which strives to improve the delivery, cost and quality of health care in the region. “We have to get rid of the fragmentation, inefficiencies and wide variations in both cost and quality inherent in our current system.”

In this new model of health care, the role of the primary care physician has shifted.

Physicians will now be more of a captain for a patient’s entire team of health care professionals – ensuring that communication and services for each patient remain constant — to create a smooth and seamless coordination of care.

To respond to this concept, St. Luke’s University Health Network, for example, had transitioned five of its primary care offices to patient-centered medical homes by October. Hoping to increase efficiency, the goal is to bring the vast majority of the network’s 80 primary care and specialty physician practices into the model by the first quarter of 2015.

“ … We have accomplished a great deal with regard to better coordinating the care of our patients across the delivery system,” said Dean Evans, president, St. Luke’s Physician Group. “The plan to connect care coordinators from all parts of our network, as well as with non-network-employed providers and facilities – both electronically as well as functionally – is well underway.”

Instead of focusing on treating the patient upon diagnosis, as the traditional model of health care demands, the new coordinated effort focuses more on the entire picture of health for a patient, including preventive care.

Lehigh Valley Health Network, based in Salisbury Township, created community care teams in about 20 of its primary care practices in five counties to provide more coordinated care. The teams primarily are aimed at integrating care for out-patients and high-risk patients discharged from the hospital.

At Blue Mountain Health System in Palmerton, transition-of-care teams have been formed to create a smoother handoff from one health care provider to the next.

In addition, Blue Mountain is focusing more on data-driven care to improve quality. A discharge planning team meets daily to determine better measures, creating more individualization for patients’ needs and working to decrease the number of patients being readmitted.

To create an interdisciplinary approach, Pocono Health System in East Stroudsburg, Monroe County, has established a community care network.

Disciplines that include pharmacy, dietary, respiratory, information technology and medical records are included in a patient’s care management — each playing a key role and responsibility in improving the way care is delivered.

In September, Grand View Health in Sellersville, Bucks County, unveiled a new progressive-care unit to grab a firm handle on the coordination of care for patients in order to decrease costs and improve efficiencies.

The units are designed to more gradually transition patients from the hospital to the home. They have an “at-home” atmosphere, including ample space for visiting families.

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Jennifer Glose

Jennifer Glose

Reporter Jennifer Glose covers health care, Berks County and other topics. She can be reached at jenniferg@lvb.com or 610-807-9619, ext. 111. Follow her on Twitter @jenniferg_LVB and read her blog, “Networking,” at http://www.lvb.com/section/networking-blog.

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