MH: What is your recipe?
Grant: When Lahey Clinic came together with Northeast Health System, we made a commitment to do everything we could to keep patients in the community hospital setting whenever possible and only have patients come to the higher-cost setting, Lahey Hospital and Medical Center, when absolutely necessary. Our system, which added Winchester Hospital several months ago, is already seeing a significant increase in the amount of care delivered in the community setting, and only patients that absolutely need to be in the tertiary setting are coming to Burlington for that care. It's resulted in superb quality at lower cost.
MH: You recently helped put together a coalition to protest the expansion of Partners HealthCare. What has that coalition done and why?
Grant: When the original proposed settlement was announced between Attorney General Martha Coakley and Partners, most providers in the commonwealth were stunned by the proposed scope of Partners' growth. We spent the next month talking with health plans, consumer groups, religious groups and employer groups, trying to understand the settlement. It became clear the settlement would result in the cost of care continuing to go up at an accelerated rate and that the growth of Partners would be even more pronounced. So the coalition of providers came together and tried to educate the public about it. A judge recently decided to put off any final resolution pending an opportunity to further investigate the many comments from various groups. She noted that this was not just the coalition that might have a competitive concern, but also other disinterested parties that were concerned about the implications for costs. The next stage of the process was put off until Nov. 10, after the election.
MH: What challenges and successes has Lahey's accountable care organization experienced?
Grant: Population health is where most healthcare providers need to move as quickly as possible. The great challenge all organizations face is moving to risk in accountable care while still participating in the care of many patients in the old fee-for-service structure. And it's a big challenge coming up with the resources necessary to build the infrastructure for managing a population of patients better.
We're investing probably $200 million in the installation of an Epic Systems electronic health record. We've had some success in our risk contracts, though we did not have as much success as we would have liked in one component of the organization in the first wave of the Medicare Shared Savings ACO. Our initial predictions for 2014 suggest much better performance.
MH: How does Lahey's collaboration with the CVS MinuteClinic retail clinics fit into the ACO plan?
Grant: We're pleased that CVS also is in the process of installing an Epic EHR system so we'll have easy communication between the CVS sites and Lahey's primary-care physicians.