The COVID-19 pandemic caused a lot of financial challenges for health systems. As a result, executives had to find new ways to connect with patients, which led to the creation of innovative care models and a heavier reliance on community partnerships. Some organizations, like Appleton, Wis.-based ThedaCare, are seeking to integrate those changes into their organizations for the long haul. Modern Healthcare’s population health reporter Steven Ross Johnson spoke with Dr. Imran Andrabi, president and CEO of the health system, about how the pandemic impacted its approach to population health management. The following is an edited transcript.
MH: What is your current situation in terms of capacity, staffing and care delivery challenges?
Andrabi: We developed an incident command system back in January of 2020 to stay a step ahead of the game in terms of where this virus was going. That broke us up into different teams that were looking at inpatient capacity and what would happen with respect to admissions, hospitalizations, intensive-care units, nursing capacity and all the things that we needed to be ready for. And then what we needed to do in terms of developing respiratory hubs, creating systems for people to be able to access information accurately and in a quick way be able to get their symptoms looked at and the testing that was needed.
We’ve gone through a lot of modulation early on with having to stop elective surgical procedures. That happened across the entire country. Then reopening (and) seeing a surge in northeast Wisconsin. We were in the top three states in the country in terms of the number of cases. And since the end of the year, we’ve seen a steady decline in cases coming into our hospitals. Having said that, there is an emergence of the variants across the country, and that potentially creates a challenge for another surge that could come our way. So we are prepared and preparing for that both internally and as we work with our partners in the community.
MH: How did some of ThedaCare’s previous work on population health prepare you for the challenges you’re facing now with the pandemic?
Andrabi: Over the last two years or so, we’ve been on this journey with the support of our board. We went in front of them and said, “We want to pivot from being a traditional healthcare provider organization to a population health organization.”
Not to complicate the conversation, but what it really means to us is making sure that we are providing the highest quality of care every time; that we are providing the best access to the people in our community; that they are having a tremendous experience with us every time they interface with us; and that we are ultimately creating affordability for the people in our community.
The other thing that we know and have learned is the fact that we cannot be masters of everything that we do, and that we have to partner significantly not only within healthcare, but outside of healthcare to be able to bring folks together, to create solutions. As a result of that, over the last two years we’ve done a tremendous amount of work both internally with our physicians, our other clinicians, our administrative folks, and externally in the community with respect to going upstream and trying to look at social determinants of health. What are the other things that impact health and well-being?
During this pandemic, the work that we had done in cultivating those relationships and partnerships has been critical. There would have been a lot of things that we would not have been able to solve for. For example, child care for our nurses, feeding people in the community that were not able to get out of their homes and how to get groceries to them, how to get pharmacy products out to those folks so they could continue to take care of themselves and be well.
We also partnered with a whole host of healthcare technology companies. The one that I would showcase is a company called b.well Connected Health. We took their product as a platform we had been working on before the pandemic, and actually accelerated the implementation … to help our own team members so that … if (they) checked in for a symptom that was positive, we could quickly get to them. We did the same thing for the people in the community and made that particular platform, which we call Ripple, available so they could access COVID resources, they could access us, they knew where testing sites were, they knew where to go in terms of a respiratory hub if they needed it and how to access ThedaCare much better.
MH: Logistically, how has the pandemic affected your ability to address social determinants? And what have you learned from this experience that will influence how you address social determinants in the future?
Andrabi: We always knew that social determinants were a big part of population health in terms of that journey. The pandemic has really focused light on the fact that you have to address social determinants, and that you cannot do this on your own. You need a lot of partners who are not necessarily within the walls of the healthcare systems. So we partnered with the United Way, the Boys and Girls Club, the YMCA, Feeding America and 85 other partners in the community to really look at social determinants, figure out how to prioritize them and then figure out solutions together.
They were community-based solutions to the social determinants that impacted health both from a COVID perspective and also for those who did not have COVID. I think those learnings and those relationships and connections that we’ve made are going to be things that we are going to take forward even post-COVID, because that’ll help us accelerate our work in the community.
We truly believe that 80% of healthcare is not only delivered but determined outside of the four walls of health systems. This learning opportunity that we’ve had over the last year will really accelerate that process. It’s also been an “aha” moment in some ways to say, “Wow, it truly takes a village to take care of a village.” And we are very fortunate to be part of the village that is so determined and committed to making sure that we do this work well.
And another example … we’ve had multiple community leader forums, almost one to two a month where we brought community leaders together. We had a conversation in a very transparent way about what the reality was, where things were going, showed them the modeling that we were doing, getting them prepared to be partners with us in the community, and spreading the word. And in many areas where we provide care, getting that community together made a tremendous difference in terms of our COVID volumes in the hospitals and the spread in the community as well.
One other example is working with our school systems. Every week we meet with every school superintendent in our region along with public health (officials), the health systems, all coming together, listening to each other, understanding what’s going on, what’s not going on, and creating solutions. One of the solutions we created with our school systems is mobile testing. As we were developing testing capability in the community, it was difficult for schools to send their kids or the teachers to fixed testing sites. So we created a mobile testing site that we now take out to these schools. We can test hundreds of people in a day and get that taken care of for them.
MH: Last summer, your system announced that it was undergoing a financial recovery plan that involves you taking a 50% pay cut and your executive leadership also taking substantial pay cuts. Will the economic strain caused by the pandemic impact your efforts to employ population management strategies in the future?
Andrabi: Our fundamental principle (was) to not lay off anybody, not to furlough anyone, and to make personal sacrifices, not only from a leadership perspective, but our physicians took a pay cut as well to take care of the front-line staff.
I’m happy to say that we have been able to not only retain a tremendous number of people because we didn’t let anybody go, but we’ve been able to recruit a tremendous number of people.
I think we are at a point now looking into 2021 that we will continue to go down a solid path with our team members who I am extremely proud of, and continue to invest in population health the way we expected to back in 2019. It may have slowed us down a little bit, but I think we’ve also gained a lot of insights and learnings during this process.
MH: What kind of role do you think your population management strategies will have in terms of helping you further stabilize finances?
Andrabi: We’re constantly looking at how can we not only live in with one foot in each canoe, but try to take our feet off the one canoe and move more toward the other canoe. That’s a tricky transition.
So a couple of things that we are constantly thinking about are: What does that next business model need to look like? Who are the right partners that can develop that business model for us? How do we continue to move in a non-regrettable way down a path where there are certain things we can do that work for us in fee-for-service, and also work for us in the value world? We may find ourselves partnering with folks that traditionally we would have thought there is no way you could partner with, but that’s what it would require for us to think about how to develop that new business model from a population health perspective.