Leadership Symposium: Pioneering​ approaches​ to​ population​ health

Ugwueke: Our six-hospital system is based in Memphis, Tenn. Five of those hospitals are in Memphis, one in Mississippi. Unfortunately we have very high poverty in the community. And you can go down the list of every health ranking—we tend to rank toward the bottom, so that presents its own challenges. And our market also is still very much fee-for-service. There is really no alignment or incentive to drive traditional population health initiatives. In spite of that, we—a faith-based, not-for-profit healthcare system—realize that our job is not just limited to taking care of people in the hospital. So one issue is asthma in children. About 3,500 kids come to our emergency department every year because of asthma-related issues, so we embarked upon a $2.9 million innovation project through the CMS. It's called CHAMP, or Changing High-risk Asthma in Memphis through Partnerships. And through care coordination, we have navigators who work with families and patients or kids with asthma. We were able to significantly reduce the incidence as well as ED visits. And now kids are able to stay in school.

Harrison:​ We can't really help people through community health if they're not economically in decent shape, right? And when healthcare is too expensive and we're having people pay for things that don't really need to be done, we're hurting them. And my provocative statement to all of you who run systems is you've got to wean yourself off the volume. You have to go to your boards and tell them that you're going to have less revenue next year because you're going to stop doing things that people don't really need. And particularly, in an era of high-deductible plans, these are real people who are paying out of their pocket. It's not some nameless, faceless payer. And we're hurting them, and we're hurting community health because we're making them pay for stuff they don't really need.

How​ do​ you​ make​ sure​ you're​ screening​ for​ social​ determinants?

Choucair: The first thing is to get into the discipline of screening and asking for those questions. The second piece is empowering doctors and nurses and social workers and medical assistants with solutions. The third piece is particularly important for us; we need to get to a point where we can predict which members are at risk of homelessness, food insecurity, lack of transportation, etc. And that's, I think, the space that's really promising now with a lot of the predictive modeling, not only looking at your own clinical and demographic data but adding data from public health departments. That would allow us to get really good at predicting who would need a service so you can target it pre-emptively to that person.

Harrison: It's never going to happen unless leadership actually wants it to happen. So it's really a question of how serious are people about actually doing this for other folks? Does the leadership of the system or the hospital actually care about population health, and how do they manifest that by how they set up their organization? How do they do their contracting? And it's easy to figure it out. You just say, "How much of your revenue is at risk?" And what you'll get is people will say 1%, 2%, 5%, and so they aren't going to really truly drive that home unless they have some skin in the game.

What​ will​ your​ future​ initiatives​ look​ like?

Ugwueke: We have a number of activities that are forcing us to use data and evidence. So this will really force us as a system to not only reduce the noise but focus more of our energy on those things that truly make a difference in the lives of people in our community.

Choucair:​ We've learned that in Colorado, 6% of our seniors—those are Kaiser Permanente members—have food insecurity issues. We surveyed two of our pediatrics clinics and they had 12% and 16% of kids who are dealing with food insecurity. So we've done all this amazing work supporting food banks and making sure that we have a good, solid referral mechanism. We have around a million Medicaid members, and about 200,000 of them qualify for food stamps and don't get them. Think about that for a moment. At $147 per month, that's more than $350 million every year. So that opportunity to make sure those members can do better from a community perspective—and we know the relationship between food insecurity and health and healthcare costs—is something I'm extremely excited about for 2018.

Harrison: I'm excited that we're going to be the first digitally enabled, consumer-centric, integrated system in the U.S. I just named the former head of global consumer insights for Disney to be our first chief consumer officer, and we're about to make really intentional investments in a digital transformation. We will follow people when they're well, when they're managing their chronic illness, when they're acutely ill—we're going to give them power. And I think this very paternalistic, provider-centric system that most of us run is just terrible, right? It is disrespectful. It doesn't bring out the best in people. It doesn't engage them, whether they're rich or poor. I think there's never been a better time in healthcare. This is really hard, but you're going to see enormous innovation, and I'm excited that we're going to try and give the power to the people.

Modern​ Healthcare's​ Leadership​ Symposium​ is​ an​ invitation-only​ event.​ To​ request​ an​ invitation​ for​ 2018,​ visit:​ ModernHealthcare.com/2018LeadershipSymposium.