Population Health in a Post-Fee-For-Service World, with Grace Terrell at Cornerstone Health Care

Grace TerrellAre you ready to escape the “tyranny” of the 15-minute office visit?

Grace Terrell is the CEO of Cornerstone Health Care, a 250-physician, multi-site, multispecialty group practice in the Piedmont Triad region of North Carolina; it’s an Accountable Care Organization, and it is in value-based contracts with 100% of its commercial payors. Spread out over 85 different practice sites in a largely rural area, it sees 250,000 patients annually. All of these factors come together in a way that allows Cornerstone to practice population health, and to address chronic disease in a holistic manner that is not usually done in a traditional fee-for-service practice.

In discussing cost and quality, Dr. Terrell focused on diabetes:

One of the things, obviously, that is one of the biggest challenges in population health has to do with diabetes and its enormous impact that it has on quality for life for patients and its increasing prevalence, particularly as the population is aging.There’s not a contract out there that we have that doesn’t focus on diabetes as the first and foremost population health issue to tackle within the context of both the cost as well as looking at quality parameters.So a lot of the focus that we have seen has been evaluating what sort of ways we can put things in place to really address that part of our patient population.

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Surrounding the Patient … In a Good Way: Osagie Ebekozien and the Whittier Street Health Center

Osagie EbekozienWhittier Street Health Center, a community health center in the Roxbury neighborhood of Boston, MA, runs a grant-funded, community-based model of diabetes care that brings best practices to the community by letting community members tell their own stories. Osagie Ebekonien, manager of quality assurance and performance improvement at Whittier Street recently spent some time with us, opening a window into the program that he manages. The program has the twin goals of improving access and improving clinical outcomes.

Whittier Street pays stipends to “health ambassadors” who live in a public housing development near the health center.  The health ambassadors spread the message among their neighbors. This initial communication leads to increased attendance at health screenings sponsored by the health center. Once someone is identified as a person with diabetes, other aspects of the outreach program kick in.

The health ambassadors maintain contact, modeling healthy behaviors, and telling other patients about choices they’ve made that improve their health. It’s a health communication model built on storytelling.

(Read/listen to the full conversation after the jump)

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Give the people what they want: Alan Glaseroff’s radical approach to patient empowerment

Alan Glaseroff MDIf you were to show up in Alan Glaseroff’s office as a person with diabetes and, let’s say, numerous complications, putting you into that group of 5% of Americans whose care consumes 50% of the national health care spend, he would ask you: What bothers you the most? in order to start developing a patient-centered plan of care. The visit would likely end with a discussion of the question: If things go well, what do things look like a year from now? What are your goals?

By focusing on the patient’s goals, and developing a multi-pronged approach to helping patients achieve those goals, Glaseroff and his team are able to introduce behavior change that will improve a patient’s health, and help patients achieve better-than-avergage adherence to new, healthy behaviors, and a significant reduction in the burdens of disease. Glaseroff says:

[To quote] Don Berwick . . .  “People need to become citizens in the improvement of their own work.” . . . I think self-management is the similar idea that patients need to become citizens in the improvement of their own health — [as] subjects rather than objects  . . . . [This can allow] you [to] design very specific workflows for patients that much better meet their needs than telling people what to do — which is usually the model of medicine practiced in the context of chronic illness.

Join Alan Glaseroff at Diabetes Innovation 2013, and hear more about his patient-centered approach to primary care and chronic disease management.

Have a listen to our interview (press play); read the transcript after the jump.

Alan Glaseroff MD (Stanford Coordinated Care) Diabetes Innovation Interview 08 2013

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Dexter Shurney MD promotes a 360-degree approach to lifestyle change to manage chronic disease

Dexter ShurneyWorksite clinics providing intensive lifestyle interventions are good business for some forward-thinking employers. They lead to measurable improvement in the health status of employees with chronic conditions, and — in the case of Cummins, Inc., according to CMO for Global Health & Wellness, Dr. Dexter Shurney — some of the key interventions tend to pay for themselves within six months.

The health status improvement also tends to not be limited to the chronic disease that is the subject of the intervention. Diabetes interventions lead to improvements in diabetes (some people with diabetes going off insulin entirely), but also to improvements in controlling hypertension, cholesterol and other conditions.

Come hear Dr. Shurney discuss his experiences in implementing these interventions at Diabetes Innovation 2013.

Dr. Shurney used the metaphor of a vegetable garden in our conversation: If you have a healthy plant, it’s because: “The roots are healthy. The stem is healthy. The leaves are healthy and it bears good fruit.” Changing the overall environment, through the heavy lifting done in the primary care medical homes at the Cummins worksite clinics, yields improvement across multiple conditions.

(Listen to our conversation, and read a transcript, after the jump.) [Read more…]

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DI speaks with Rushika Fernandopulle, CEO of Iora Health: Managing chronic disease with primary care on steroids

Rushika F I recently spoke with Rushika Fernandopulle, co-founder and CEO of Iora Health, a company based in Cambridge, MA which is building “an entirely new model of primary care.” He will be a panelist at Diabetes Innovation 2013.

In order to improve the health care system, Rushika says we can’t fiddle around the edges. Instead we must take bold steps and start from scratch, beginning with three key elements: (1) Payment redesign, (2) Delivery system redesign, and (3) Health IT systems redesign.

Iora Health has started from scratch and has reinvented primary care for the populations it manages on behalf of large self-insured employers. Rushika acknowledges that he can’t do it alone (even though his company got a nice infusion of capital earlier this year), and wants Iora Health’s model to be emulated by others even as the company expands its reach within its existing geographic markets. The secret sauce is an intensive primary care service staffed with health coaches in addition to the usual suspects. The primary care service costs participating employers about twice as much as typical primary care services, but the results are anything but typical. In fact, they result in a net health care cost savings in the 15% range.

(Listen to our conversation, and read a transcript, after the jump.) [Read more…]

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