Dr. Rhonda Medows of Providence Health: ‘We embrace that old adage: It doesn’t count unless you measure it’

How do you manage population health at a community level with an organization as large as Providence, where you have facilities spread out across several different markets?

We are both large and small. We truly believe that healthcare is delivered at the local level with the individual patient, their caregivers and healthcare providers. At the same time, we leverage our size. We span seven states. And that means that when we are going out and finding the expertise, the tools, the procurement, the investments—we can leverage our size to do a better job of using the resources that we acquire. But when we deliver the actual care, it’s at the local level.

What technology do you use to identify the areas of need within each community?

We have a great number of people who have helped us create a proprietary platform we use. You use the electronic health record, but you also use claims data to get an idea about how frequently they access care. You can also use that to supplement information about utilization of care.

We supplement that with social determinants of health information, both publicly and privately available. And then we actually ask people how they perceive their health outcomes, how they perceive their access to care and what we could do better.

It’s a combination of a lot of resources coming together, and we put it into a common platform, so that all of our team members can access it at an appropriate level. That platform is called Community Pathways to Health. It has been helping us get through not only COVID-19, but every area of work that we have to do as we try to resolve health disparities.

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How do you put those insights to work?

First, we got everybody educated on what is actually happening in their communities. That was really important, because not everybody understood what health disparities were, which populations were impacted and how they were impacted. We took that information and built out a five-year strategic plan.

We focused on COVID-19 and a whole host of very clearly defined health disparities impacting various populations. From Alaska to Texas, we are taking care of people from all nationalities, ethnicities, races, languages, gender identities, levels of disability and levels of mental health.

We took that information and used data-informed interventions to measurably improve. Some of those improvements involve the social determinant factors in the community, like homelessness, access to food, access to transportation for medical care, or access to telehealth-type services. Some are directed toward the actual care for a specific condition, such as colon cancer screening and treatment, breast cancer screening and treatment, diabetes, hypertension, heart disease, mental health and substance use disorders.

When we build out these interventions at a local community level, we also make sure we embrace that old adage: “It doesn’t count unless you measure it.” So the data informs, but the data also tells us about our progress and whether we are being effective. There has to be a measurable improvement, and part of that measurable improvement is not only the clinical and medical indicators, but also how people are perceiving their own health. And that means actually having consumer input on their experience.

“The place where we struggle most (with outcomes) is mental health. And it’s not for lack of trying; it’s for lack of resources.”

When you are checking all this outcomes data, where have you seen the most success and where have you struggled the most to make a difference?

The places where we’ve seen the most success are in the chronic conditions where we actually have a long-standing history of understanding what works, like hypertension, diabetes, heart disease and asthma. The whole idea is to focus on whether we are improving how patients feel about their health and well-being, and also, are the conditions better controlled. Is their blood pressure better controlled? Is their glucose level better controlled? We can measure it, and we are seeing a very slow improvement, but one that is occurring nonetheless.

The place where we struggle most is mental health. And it’s not for lack of trying; it’s for lack of resources. We can’t get enough mental health professionals engaged fast enough. We don’t have enough access points. We’re not the only health system with that struggle. It means that we’ve had some very unconventional discussions: “Do we need to go to high schools and colleges and start recruiting and paying for training there? Let’s stop talking about it and let’s start doing it.” We have a long way to go. But quite honestly, that’s part of our responsibility.

All of this takes big investments. What advice would you give to another executive in your shoes who needs to pitch this kind of work to their chief financial officer and CEO?

I’ve worked with a lot of different CFOs over the years, and they are not all the same. I have a fantastic CFO with Providence, who actually understands the mission, vision and guidance of what we’re trying to do, so I may be a little bit lucky. But when I’m having to talk with other CFOs, who embrace the mission but are solely focused on whether or not we’re going to be financially sustainable, they have honest questions.

I usually talk to them about how we are moving away from fee-for-service billing. We are still bridging it a little bit; we have a foot in fee-for-service and a foot in value-based care. Part of value-based care is actually delivering three components: quality, experience and affordability. You can’t say that you are addressing quality and experience for your populations if you’re not actually addressing the needs for all of your population.

That takes investment. That takes time. So we make the case by saying, “If we’re truly going to deliver on value, if we’re going to be successful in our performance in value, if we’re going to actually reap the rewards financially, then we have to do it really, really well.” It’s a matter of taking the good intention and translating it into an action that is measurable. Normally, we start the conversations about population health, we talk about health disparities, we talk about achieving health equity, and we incorporate the key messages on value-based care.

[CFOs] have to understand that this is part of the model of care. This is not just goodwill, this is actually part of our business responsibility. When we do that, and they can see that our value scores and our value incentive payments improve, that’s when the little lights go on. That’s when they go, “Well wait a minute, maybe there’s something to this.”