Clearly, the focus of risk for managing population health is shifting for all of us, and the pace of this shift is accelerated by healthcare reform. As new regulatory and financial realities evolve, like our peers, we are re-aligning around new strategies to improve clinical performance and contain costs.

When I joined Ochsner Health System in New Orleans 18 months ago, we had become the dominant player in the market, with eight hospitals and 38 facilities. That said, we definitely couldn’t rest on our laurels in terms of quality and cost improvements.

In terms of taking on risk and capitation, historically we have welcomed both. We had our own health plan until 2004, when we sold it to Humana. But we’ve maintained a risk contract for 30,000 Medicare Advantage seniors for several decades now. And while our situation might differ from others, we are undergoing the same transition that everyone else is experiencing.

Turning Transactional Data to Enterprise Intelligence

At Ochsner, we’ve used electronic health records for decades. Now, the objective is to turn that data into actionable clinical information. With the growing pressure to control costs and improve population health, data becomes the silver bullet. You can’t manage risk without it. These days, most providers have robust data warehouses.

Now, we are transitioning to a new electronic health record and have just deployed our new population registry solution. In addition, we will continue to add tools that help us slice the data for meaningful views, helping us study practice variation to reduce costs and improve care.

Synchronizing Strategy and Sharing Accountability

In many respects, finding the right information technology solutions is less of a challenge than re-defining the delivery of care. For us, creating a synchronized strategy to align all physicians around population management is the big challenge.

In terms of our physician relationships, most of our admissions come from community rather than employed physicians. In addition to our capitated lives, we are one of the new accountable care organizations (ACOs) that started January 1, 2013, adding another 22,000 seniors to our network. Our organization is also self-insured for all of our employees and we are involved in a clinically integrated network as well.

Like many of our peers, we are focused on affiliating with community physicians, and we are looking to an accountable care model to help us align our employed and community physicians to create value.

Process Improvement and Innovation

Physicians perform their jobs very well, so our intent is not to disrupt that. Instead, we’re embedding a variety of case managers, health coaches and social workers in their practices to help manage population health in a patient-centered medical home model.

One of the biggest challenges for physicians is acclimating to the team environment. They’re clearly going to be the leaders and drivers of this team, but they’ll see other caregivers delivering a sizeable portion of the care.

Our approach is a work in progress; we’re currently developing innovative models and improved processes designed to advance us in a holistic way. Recently, I met with a group of orthopedic surgeons, together with staff from decision support and finance, as well as project management and Lean Process engineers. On many fronts, we’re using a 360-degree view to take systems apart and rebuild them for value.

We also are introducing panel bonuses to our primary care doctors. We are teaching them to look beyond today’s 25 patients and recognize that they are responsible for about 2,000 patients. We’re incenting them accordingly and providing them with teams and tools to better manage the health of their patient populations. Our approach to the use of technology in primary care is transformational.

Toward Standardization and Specialization

Changes in the market are happening even faster than our ability to build new models. We predict that almost every payer will have us on a variety of new pay-for-performance models within two to three years. It’s a massive change, and we are working quickly to be ready.

When we anticipate taking 15% to 20% out of the costs of a large integrated delivery system, we need to rethink what everyone is doing. As an example, we’re consolidating our obstetrics services and neonatal intensive care unit within one facility, and we are doing the same for our Spine Center.

There is a saying in this region that ‘people won’t cross a bridge for medical care.’ But I believe those days are drawing to an end. To raise quality and lower costs, we need to specialize and standardize our care. Other industries have done it successfully, and so will we. It is imperative for us to re-align around new strategies to improve performance and cut costs in order to successfully manage the demands of health reform.

Philip M. Oravetz

About the author

Dr. Philip M. Oravetz is medical director of Accountable Care for Ochsner Health System in New Orleans, La. Dr. Oravetz has extensive experience in both regional and national capacities in physician practice management, medical group/IPA and health plan administration. In addition, he brings particular experience in medical management, including the application of information technology to population health management and physician decision support systems. His current role at Ochsner Health System is based both on medical management for accountable care arrangements and clinical integration for the health system