A healthy community is the foundation of a thriving healthcare delivery system and western Massachusetts is no exception. At Baystate Health we are proud of our leaders, who are constantly asking questions, innovating and engaging to fully meet the needs of our patients in our ever more diverse and dynamic communities.
We sat down with Dr. Elizabeth Boyle and Dr. PJ Helmuth to talk about their respective roles in primary care and Baystate population health. It was an enlightening and thought-provoking conversation. We hope you enjoy.
Where We Are Today
What is your title and what role do you play in Primary Care?
“I’m Elizabeth Boyle, I’m a Med Peds Physician and I’m the Vice President of Primary Care and Clinical Integration for the Primary Care Service Line here at Baystate. We have 100 plus providers, over 15 sites in the Pioneer Valley and Western Massachusetts and I practice Primary Care and Med Peds in Springfield. Our sites serve adults and children in Western Massachusetts.”
“My role at Baystate is the Medical Director for Quality and Population Health and I also am Med Peds trained. I am in a private practice as well two days a week and then I’m here at Baystate in this role three days a week.”
Can you tell us about the patient population that you serve?
“We have a diverse population that we serve in western Massachusetts. We have some rural areas to the north of Springfield in the Greenfield area, and to the east in Ware and Monson. Then we have our more suburban practices outside the main city of Springfield. Given that broad geographical spread, we have patients from all different walks of life. Some are very old and some are very young. We have a wide range of patients from various parts of western Massachusetts.
The diversity of the population is usually a plus. Our providers like that they have a lot of choice as to type of population and where they’d like to practice - suburban, urban or rural.”
Another thing to mention is that we have a number of strong affiliations with private groups that have opportunities that we are jointly promoting. Patients can have that small practice, private practice feel, and yet have the security of being backed by a large health system like Baystate Health. This combination also appeals to providers who may be interested in working in a small practice with all the advantages that being employed by a larger organization has to offer.
“I definitely agree with that. I would say is that this diversity presents both an appeal to providers and a challenge, in that we must try to adjust to the needs of this diverse population. That’s something we are starting to think about and work on more. We must think about how you work with a population in a rural area that has different challenges than an urban area, which has different demographics and different social determinants. It’s a place we are really focused on when we approach population health.
What is the biggest challenge you face when working in the community setting?
“I think doing primary care is a very rewarding job because it is based on long term relationships with patients over their lifespan.
What is a challenge, for all of primary care in our community, is to help people access all of the resources available around health education, health coaching and health promotion. I think that some of the resources needed to keep patients well, in their communities, can be a challenge to coordinate at times.
Baystate has been very forward-thinking in its approach to population health and risk-based contracts. We really look at quality, value and health prevention - value over volume.”
“I agree. In addition to Dr. Boyle’s point about addressing our patients’ diverse needs, we are also focused on communication and coordination of care. We have specialists who are associated with the hospital, but also specialists in the community. Primary care is always working to coordinate our patients’ care among inpatient care, specialty care, skilled nursing facilities and home health care.
How are you making strides in bridging the socioeconomic gap in a population health model?
“At Baystate there is a Medicaid ACO that we’ve embarked on this year. A lot of the work within that space is focused on social determinants of health and healthcare disparities. A lot of the ACO work is around linking with community-based agencies that are already doing the work.
For example around food insecurity, healthy eating, and transportation - there are elder service support groups. There are a number of community-based organizations that are doing great work. Having a coalition with them is one of the things the ACO is doing to reduce healthcare disparities and drivers of health.”
“I would agree with that. I would also note that the Medicaid ACO is really active in the urban health centers in our health system here, but it still falls in the same sort general approach of the health system and the physician hospital organization. We see an opportunity for us to learn best practices from this smaller, health center population with significant socioeconomic challenges. That is to say: If we find that deploying care managers or community health workers for a specific population looking at certain social determinants of health is effective for improving the health of the population or decreasing hospitalizations or utilization, then we would definitely be looking to implement that across practices in the health system as we learn more about best practices. We have an advantage here -- as a larger community -- to learn from each other, to trial some things and see which make a positive impact.”
When talking about population health management you often hear that providers and organizations have to think differently about the approach to delivering patient care. Do you agree with that? What are your thoughts on how to improve the process?
“We’re looking at ways to do alternative visits as a population health approach. Not all patients need or want to come in for face to face visits. We are looking at televisits with emerging technology, in collaboration with Techspring, Baystate’s technology innovation center here in downtown Springfield. We’re also looking at telephone visits and we have a patient portal. We’re finding other ways of meeting the patient needs while meeting them where they are as opposed to the traditional face-to-face visit.”
“I would also note that our community is somewhat unique in that we are a bit further down the road with value-based care than some other health systems or communities. We’ve been involved in quality contracts with commercial insurers and with Medicare for some time, and now indeed Medicaid as well just in this year, so that includes quite a bit of our population. As such I think that the practitioners and staff in our area have embraced the idea that we are responsible for the care of all of our patients, whether they show up at the door or not.
For example, we need to identify which of our female patients from age 40 - 75 haven’t had a mammogram and how we can reach out to them so that they get the care that they need. Our responsibility is to their care.
It’s always an ongoing challenge to identify your patient population and to identify the gaps in care and to find the most effective ways to engage those patients to make changes. I do feel like the culture of Baystate at large has begun to embrace this as our new role, moving away from traditional fee-for-service and into a value-based system.”
What do you think needs to be done to move population health management forward and improve outcomes?
“I think having more incentives for systems and independent provider groups to provide population health services such as care management would be helpful. Part of that might be to look at the payment model that is currently in place. We need to look at payment models to encourage value not volume. It’s important to think about the reimbursement structure as we look at population health.”
“I agree with that and think that it is going to continue to require thoughtful change to benefit design so that the incentives align for patients and providers toward these goals. Some of that is happening now. But sometimes we’re asking patients to do things that will help them, but they may have significant coinsurance or other barriers to adhering to the treatments that we are asking them to do. I do think there are a lot of policy changes that could make this easier.
Obviously payment reform is a big one for us as well, and then the coordination of care across the different specialty sites of care and more robust use of analytics to help us identify who our patients are, what their gaps in care are, what’s the most efficient way to communicate with them - all of which we have a basic understanding. But the various interlocking factors could evolve to be much more efficient in the future."
What Sets Us Apart
How does Baystate Health improve the health of the community?
“Baystate Health is a great community resource that is dedicated to improving the health of our community and our providers and staff take great pride in our connectedness and being the provider of choice to our communities.”
“I think that the senior leadership of the health system have really focused on the four compass points that they’ve identified which are: quality, safety, value and experience. Previously they had said patient experience, but it has been expanded to include the experience of the providers as well, which I think is important. Those four compass points are reiterated in multiple ways for us as we think about the things that we’re measuring and setting our goals upon, both from a larger organizational goals to the goals that we set for small practices and providers. That has helped us maintain a clear vision of how the health system is trying to really improve the health of the community and continue to be the most important resource for primary, specialty and tertiary care in the valley.
We really are working on delivering high quality care with best practices and clinical models for both individuals and populations. And from the value proposition we are really focused on improved population health and affordable care.”
How is your team structured to best accomplish this goal you set forth to improve the health and wellness of the patient community that you serve?
“As we’ve looked at this, we have added resources such as care coordinators and case managers. For some segment of our population that’s going to help.
A big win was having added integrated behavioral health to all of our sites, which is certainly very helpful in looking at the whole patient and their mental health needs and even around health behaviors like tobacco or weight issues. I think in an ideal world we would have more care coordination, more case management. We would also have health coaches as well for some of our patients with chronic conditions like diabetes and high blood pressure.”
“I think the one important thing to think about with Baystate is that we are positioned in our community as the biggest medical provider, but we are also part of a larger community. Our physician hospital organization known as Baycare is also part of our strategy, not only in contracting and coming up with the financial aspects and risk- and value-based contracts that we enter into, but also helping us to work together as a community on these population health goals.
What’s become clear is that population health is a team sport and that we really need to be working not only as Baystate health group, but also in the larger community in a collaborative way to work on this. That means figuring out how we share data with each other, how we do analytics on the data that we are able to collect and communicating about gaps in care so that we’re being not only effective in improving the health of the community, but also in an efficient way across the multiple providers in our community.”
One Last Question. In your opinion, what is at the intersection or primary care and population health?
“Population health helps primary care to know all the patients, not just the ones who are in the office in a given day. It gives us a broader view of how people are doing and allows us to keep track of them as they move through the different elements of the health care system to best coordinate care. Population Health helps us to provide great access to high quality Primary Care with a highly engaged, highly functioning team to promote wellness in our communities.”
“I agree with all of those things and I would note also that I think the role of Primary Care in population health has been fairly obvious. It has come to the Primary Care doctors to work on the goals of population health including managing costs, quality, metrics and things like that. One of our challenges is to move beyond asking the Primary Care doctors to take responsibility for population health management. They know that that’s what they need to do, and at this point we are far enough into our journey over the last decade to instill a sense of ownership for population health management.
I think our next phase is to really establish that this is truly, as I said previously a team sport and that we need to continue to engage specialty care, hospital medicine, skilled nursing and home health care to all be aligned with us on the goals we set for population health management. It’s a different health care model. A small example is maybe a Primary Care doctor needs to have the cardiologist review the testing that has already been done and to give advice about management, which is not necessarily reimbursable in the present models. So I do think we need to think about how payment reform may help us in this regard, but also the way we are interacting across specialties to move toward our population goals and supporting Primary Care doctors.”
“Baystate has been forward-thinking in collaborating with our hospitals, our physician hospital organization, our Primary Care and specialty providers, as well as the skilled nursing facilities in the community. Everyone plays a role in these value-based contracts. Because really, anywhere that the patient is interacting with our system, we should all be giving the same message. It’s all hands on deck for population health.”
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