Pediatric care represents no more than 10 percent of the total national healthcare spend, but it has a long-lasting impact—both on an individual’s quality of life for 70 or 80 years and on the healthcare costs for that individual over his or her life span.
At Children’s Hospital of Orange County (CHOC), we started a strategic-planning process several years ago to develop a “whole child” model of care, in which clinicians and care teams provide coordination and navigation of patients across the pediatric continuum. In 2013, CHOC and Rady Children’s Hospital-San Diego entered into an alliance in which we capitalize on our respective experience and strengths to enhance the care delivered to children in Orange and San Diego counties.
Our work led to our decision to jointly compete for a federal Transforming Clinical Practice Initiative (TCPI) award. Through this $17.7 million grant, we are creating a “community of pediatricians” who, irrespective of system affiliation, share an interest in advancing children’s health.
The collaboration between the two institutions served as a strong model for the wide range of physician practices that want to work together to advance children’s health in their geographies. This strategy also was a transformative shift for CHOC to channel significant investments in technologies, infrastructure, and new competencies.
Through our TCPI grant initiative, we are bringing together pediatric practices—some are recruited, while others proactively seek to join the network—that are willing to participate in a series of educational sessions, embed guidelines/protocols within their systems, share data, and participate in practice-specific initiatives geared toward measuring and improving outcomes.
We are focused on reducing unnecessary specialist referrals, tests, emergency department visits, and hospitalizations for six common pediatric conditions: asthma, bronchiolitis, community-acquired pneumonia, headache, acute gastroenteritis, and acne. We are transforming pediatric practices—both primary care and specialty—to reduce variation in care, use evidence-based clinical care pathways, streamline healthcare delivery, and build an infrastructure that supports continuous improvement through outcomes measurement.
The response from the physician community has been overwhelming. Pediatricians, inspired by the notion of a single care plan for children across the community, became the most effective ambassadors for engaging like-minded providers and staff to support our initiative.
We have physicians from five large, competing organizations participating in the program, collectively rallying around the core principles of timely access, appropriate care, and improved clinical outcomes. And we increasingly see physicians in independent practices wanting to join our enterprise.
To date, we have engaged more than 1,600 physicians in 234 practices in Southern California—a geography in which the under-18 population is larger than that of 34 states. A little over 18 months into the program, we are preparing to extract data from multiple electronic health records (EHRs) where clinical protocols are now embedded. These data are used to measure outcomes among patients grouped by disease/condition, allowing us to identify best practices and share them with other practices in our network.
We have targeted a subset of our patients who are being tracked by disease state and measured against their baseline, and results are already evident: We have reduced emergency department visits by 39 percent, reduced headache-related imaging by more than 70 percent, increased patient and physician satisfaction, and realized over $1 million in net savings. Most importantly, we have improved patient, family, and physician compliance with treatment guidelines for asthma, one of the most prevalent health conditions among children.
We have faced two challenges along the way. First, there is no single EHR platform among providers. Establishing the required consistency without changing the individual practice’s entire platform is resource-intensive and time consuming.
The second, equally important, is the lack of funds available to individual practices for retooling without seeing an immediate return on their investments. Participating physicians clearly see the benefit of the transformation but also have to deal with the reality of meeting escalating costs.
The key lesson learned through this initiative is the importance of a well-considered alignment model to bring physicians together. For decades, our industry has created organizational models with an expectation that disparate groups of physicians would promptly conform to the model. The alignment model that we have pioneered in our community requires us to substantially conform to individual practices’ needs and preferences rather than dictate what practices must do.
The response we have received thus far is positive from community physicians, but not so positive from our accountants. Like many healthcare organizations that are transforming to high-value care models, we know this will take time, and our physicians play an important role in how we jointly manage the enterprise. But we believe that good medicine is also good business and that we are on the right path.
Shahab Dadjou is senior vice president, strategy and integration, Children’s Hospital of Orange County, Orange, Calif.