Dr Tim Ferris, Medical Director at Massachusetts General Hospital and Vice President of Population Health Management at Partners HealthCare, talks about using population health management to improve the quality of care and health outcomes while lowering the overall cost.
This presentation was recorded at our Integrated Care Summit on 11 October 2016.
We are laying off teachers and shutting down elements of public health and reducing our housing subsidies in order to pay, mostly for acute medical costs. So, this is the rate of inflation of acute medical costs in my state, Massachusetts. And everything else that a state does, is actually going down. That is not a sustainable situation. We need tactics that will successfully reduce the rate of growth of the costs of care. I would say the external pressures that federal government, the state government and the commercial insurers, would say to us, tomorrow is not soon enough for you to fix this problem.
When we turn around to the people delivering care, they say, you know, you can’t shut down, re-tool and then restart the factory, you’ve got to be delivering care as you change care. And my job, is to balance those two competing forces and, by the way, I know what I’m doing okay, when I’m failing at both of those.
When you sign a contract, that holds you accountable for money, like a lot of money, and spending it wisely, you’re thinking becomes a little clearer when next year’s budget actually depends on meeting a cost reduction target this year. We were organised right from the board, all the way down to the management structures, to deliver volume, because that’s how we got paid. We signed contracts that said actually, volume is bad, and we were asking our chief financial officers at all the different organisations within our umbrella. Your performance is based on two spreadsheets, and by the way, if you’re doing better at one, you’re probably doing worse on the other. Right. And so, the response back from the CFOs was how do you propose we do that? I’d say we have a direction, but we don’t have an answer.
But our work, falls into three basic buckets: network composition – who do we need inside this ACO in order to make progress? How do we flow the incentives? We call that the internal performance framework. And then very specifically, the investment and population of management infrastructure. This is what you’re doing to actually change care. We have 350,000 people under commercial contracts. Thirty thousand in Medicaid. A hundred thousand in Medicare. And then we self-insure for our own employees. That means that sixty per cent of our primary care patients are in risk contracts. That means that when we design the delivery of primary care, we are designing them for risk contracts. If you aren’t doing something difficult, you need to do something that is aspirational and appeal to the intrinsic motivation of the people who are actually with the patients. I don’t know of any clinician who wouldn’t want to deliver better care. They are just really cautious about someone else telling them, what better care is. We had to have a whole series of retreats in our organisations to get to figure out what our strategy was. But it’s our strategy.
So, we are partners, health care, primary care, acute, post-acute and speciality care. And we want to achieve the quadruple aim. And so, then what we did, is we, said how do we get from there to there? Well, the first thing we did, is we identified what we believe our largest opportunities, to save money and improve patient care, are. We came up with ten and they go after the big cost drivers: unnecessary hospitalisations, unnecessary use of post-acute care, more use of home care and more use of primary care. And we just said, we are just going to start and do it. We don’t know exactly how it’s going to work, but we are going to just start doing these things and we’ll figure it out as we go. So, we’ll make progress. And that progress is measured against outcomes. At the bottom here, all this data and analytics that services these outcomes, but very importantly these process measures. Because these process measures basically just say, are you putting this in place and are you making progress? Are you delivering on it? Are you getting the work done? And then the outcomes measures say – Is the work producing the result you want? And, if it’s not, then you’ve got to go back to rejigging it. A lot of these things we put in place, we did not get the outcome we were hoping for at first. But we fixed it. You go back and you say we learned some lessons. We go back and we fix it. It’s the commitment to the journey and not the commitment to exactly the way you designed it, to launch it, that was critically important. And then, we have some evidence that we are actually achieving the triple aim, with this. Some of our programmes, our primary care doctors absolutely love, our care management programme. We have saved over fifty million dollars on an annual basis this year. We are expecting, two years from now, to be saving a hundred million dollars annually. That’s our goal. And we’re doing it because we’re replacing the way we delivered care before, more and more, with much more efficient ways of delivering care, using a lot of technology to enable that more efficient delivery.