Baylor Scott & White Health is ramping up efforts to boost access to primary care and reduce administrative costs ahead of possible Affordable Care Act marketplace and Medicaid cuts.
Potential federal funding reductions have added urgency to Baylor Scott & White’s initiatives to increase efficiency and access, Peter McCanna, CEO of the Dallas-based nonprofit health system, said. The 52-hospital system is revamping operations to limit unnecessary and costly care, improving communication between providers and patients through digital and virtual mediums and bolstering partnerships with other health systems, he said.
Related: Medicaid, ACA cuts could devastate hospitals, execs say
These strategies will help Baylor Scott & White get ahead of federal policy changes, McCanna said. Republicans are considering eliminating enhanced subsidies for health insurance exchange plans and implementing Medicaid work requirements, which could lead to a spike in Americans without insurance coverage.
McCanna said in an interview Baylor Scott & White will try to leverage technology to redirect emergency department-bound patients to primary and virtual care, expand its inpatient and outpatient networks and improve hospital operations through Longitude Health, which was created by four health systems to try to streamline hospital operations. The interview has been edited for length and clarity.
How would federal funding cuts impact Baylor Scott & White?
Even though Texas did not expand Medicaid, the rapid growth in the individual exchanges became a very important factor in moderating the uninsured rate in the state of Texas. What we're worried about is, if those ACA subsidies were to go away, that would increase the uninsured rate.
As current Medicaid recipients or individual exchange insured patients become uninsured, we are concerned that would increase their utilization of high-cost services. The hope is that even if we have a persistent uninsured problem, we might be able to do a much better job of giving them access to primary care.
How are you trying to increase access to primary care?
We're shifting the system. The role here is not supply-driven where we're going to fill our hospitals and fill our clinics and declare success. It's a demand-driven model.
We launched a product called First Contact Navigation. You go through our app and interact with AI, present your symptoms and ask some questions. At some point, you transition to a live chat with a trained clinical professional. In one interaction, you go from symptom presentation to an appointment to the right care setting. At the end of that interaction we would ask, If you hadn’t gone through this navigation tool, where would you have gone? For more than 70% of the patients who used Help Me Decide, the answer to that question was to a different node in our system compared to where we put them. In almost all cases, it was higher acuity, higher cost. You run that program across 3 million connected customers on our platform today, you redesign and transform your health system.
This movement from emergency to urgent care bolstered our rationale for making an urgent care acquisition.
How does this primary care focus shift operations?
In the past, we might buy physician practices and say we created more access. In the new model, that shouldn’t be our first instinct. Our first instinct should be, what do the customers need? Then, develop that service offering.
The old model was service line driven. But when we talk to our customers, they don't think in service lines and their problems don't cleanly fall in service lines. We had a large cadre of people who have chronic headaches. So, we developed a 24/7 product where you get an evaluation with a clinician within one business day and, if needed, we will get your medication and connect you with a headache specialist. That’s a total change of model.
We have a postpartum product that gives new mothers 24/7 access to what they need from after delivery through the first year of their child's life. It can deliver services in the home. It can be a source of information on postpartum depression, where they have access to speak to someone. It’s much more targeted than the old model.
How else are you preparing for federal funding reductions?
The first thing that we have to do consistently is lower the administrative cost as a percentage of the overall cost. We’re in a position to do that with some new technology. As a growing organization, cutting administrative costs affords us a way to reduce overall costs without negatively impacting our workforce. We have to constantly be vigilant to become more efficient in our operating structure.
How are you trying to meet the growing demand for care?
You'll see us do some of the traditional growth strategies — construction and expansion of existing facilities — because we live in communities where the population is growing a lot. We need more beds.
We’re seeing a large uptick in new customers. One of the challenges is how do you build out that 24/7, omni-channel services layer? Do we need more urgent care? How do we deepen and expand the schedule for virtual care? How do we perfect asynchronous interactions? What are other ambulatory services that we need? We know the demand is there. The old model was: If we build it, then they'll come. It’s not that way in this model.
What are your goals for Longitude Health?
You should expect Longitude to have more health systems involved.
We’re launching three business cases on specialty pharmacy, population health and revenue cycle management. By taking these pieces and pooling our expertise and capital, we can be more effective, more efficient and then also build equity for the systems.
