Scott & White Healthcare, an aligned, integrated healthcare delivery system based in Temple, Texas, recently announced that it had joined forces with Walgreens to develop an accountable care organization (ACO) under the Medicare Shared Savings Program. 

The Scott & White Healthcare Walgreens Well Network, which was approved by the Centers for Medicare & Medicaid Services, will help improve care coordination for the 32,000 Medicare patients served by the health system by giving pharmacists access to ACO patients’ medical records and putting pharmacists in closer contact with these patients’ physicians. 

The collaboration could improve patient care and outcomes by giving pharmacists the information they need to ensure that goals related to medication use are met. It will help to reduce costs related to prescriptions and prescription management. It will also provide Scott & White with robust data-capture methodologies currently used by Walgreens and could ultimately enable Scott & White physicians and nurse practitioners to share space within Walgreens stores.

The collaboration is just one example of efforts Scott & White has undertaken to better manage population health.

For the past 30 years, the health system has owned its own health plan, and it employs more than 1,000 physicians who work in its hospitals and medical centers. The health system encompasses one of the largest multispecialty physician group practices in the nation.

“Our health plan, which is a wholly owned subsidiary of Scott & White Healthcare, pays the hospitals and clinics on a capitated basis, so we are financially incentivized to provide the treatment patients need at the lowest cost possible,” says William Galinsky, FHFMA, CPA, vice president, governmental finance for Scott & White. “Our focus is on making the most of those capitated dollars. In this kind of payment environment, where we’re receiving per-member-per-month payments rather than fee-for-service payments, the more we can do to keep our volumes down by helping patients maintain or improve their health, the better off we are as a system financially.” 

About 18 months ago, Scott & White formed an Operational Assistance Group to help departments tap into patient-level care cost data and identify opportunities for improvement related to both quality and costs. The group is composed of clinicians, operations managers, and finance professionals, as well as the health system’s vice presidents of operations and finance and its chief medical officer.

“Some of the questions we were getting both in finance and in operations were, “How can we better provide care or service? Could you help us understand our data and determine ways to make improvements?” Galinsky says. “So we embarked on creating a team that could support clinicians and other staff members in these efforts. In some ways, the members of the Operational Assistance Group are firefighters: If they notice that a department or a division is struggling and experiencing increased cost or decreased revenue, they respond quickly to determine what is driving that, how the department or division could better manage cost, and whether staff are capturing all the revenue they should be capturing for the services they are providing.

“The results have been very positive,” Galinsky says. “In fact, we used some aspects of our Operational Assistance Team in modeling the ACO partnership that we just entered into with Walgreens.”

Scott & White has received national recognition for its efforts to improve quality of care and reduce costs for patients and purchasers.

  • At one time, Scott & White Memorial Hospital in Temple rate of readmissions was among the highest of hospitals in Central Texas, with 18.3 percent of Medicare medical patients being readmitted after 30 days in 2009 and 12.9 percent of surgical patients being readmitted in the same timeframe. Now, Scott & White uses “transition coaches” to provide post-discharge direction and support, while pharmacists provide bedside consultation prior to discharge. Now, readmission rates are lower for specific patient populations and efforts in this area continue.
  • In 2010, when Scott & White’s health plan discovered that members were not receiving timely follow-up appointments with physicians after discharge, the health system’s “VitalBridges” post-discharge transition programs developed a 24-hour program that makes follow-up appointments with and for patients. The program significantly decreased the amount of time patients wait for a follow-up time after discharge. The VitalBridges program has achieved an 85 percent contact rate on targeted patient populations. Of those contacts, 35 percent have resulted in follow-up assistance in either meeting the patient’s immediate needs, assistance with future appointments, or assistance with other support programs.
  • Scott & White developed a task force to reduce the incidence of ventilator-associated pneumonia, which can add $40,000 in hospital costs per patient—and reduced infection rates from 4.87 per 1,000 patients in 2008 to 1.24 per 1,000 patients in 2009. The initiative also decreased length of stay and days on mechanical ventilation for ICU patient. Scott & White remains focused on driving down the incidence of ventilator-associate pneumonia further.

Other quality improvement initiatives currently taking place at Scott & White include efforts to reduce the incidence of catheter-associated urinary tract infections and bloodstream infections, reducing unnecessary radiation from procedures, improving emergency department patient flow, and providing excellence in stroke care, chest pain care, and palliative care services.

One of the lessons Scott & White has learned as it works to better manage population health: Determine who owns the data and have access to the data, and establish levels of control regarding how data can be sorted and manipulated. “Two people using the same data site can come up with completely different pictures of what the data mean. Through our efforts in decision support, medical informatics, and other areas, we’ve really tried to limit how different those pictures can be,” Galinsky says.

For more information, see Jeni Williams "A New Model for Care: Population Management", hfm, March 2013 

Publication Date: Friday, March 01, 2013

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