Payment & Delivery Models

Creating value-based care takes time, perseverance and trust

Sara Berg, MS , News Editor

AMA News Wire

Creating value-based care takes time, perseverance and trust

Jun 17, 2024

More of Ochsner Health’s patients are taking advantage of preventive care offerings such as smoking cessation. Meanwhile, physicians and other health professionals at the Louisiana-based health system can easily access bioinformatics and other useful data with automation built into their EHR networks. This has led to improved patient outcomes and lower costs.

But it took time—and patience—for Ochsner Health to see a return on its investments in this type of value-based care effort.

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Ochsner Health is the largest integrated delivery system in the Gulf South and a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

About 10 years ago, Ochsner Health started a clinically integrated network with the intention of partnering with community doctors throughout Louisiana, Mississippi and Alabama to collaborate on problem-solving. Health system leaders began studying available data to find gaps in care.

“We basically divide our approach into three buckets: quality, documentation and utilization,” said Sidney “Beau” Raymond, MD, an internist and chief medical officer for Ochsner Health. “I believe quality needs come first, as a physician, because if we're not doing that, the rest doesn’t matter. It allows us to focus on where the opportunities are to do better.”

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To achieve better patient outcomes, Ochsner Health put a system into place to “marry” claims to clinical data in new ways and feed it to physician practices at the point of care.

Each physician practice has a quality coordinator, and all data comes from a shared EHR. For the last decade, the health system has integrated data from disease-focused registries on type 2 diabetes, hypertension, cancer and other conditions into the workflow of its physician offices. As soon as a physician opens a chart, they can see where the care gaps are and start closing those gaps.

For example, physicians at Ochsner Health were able to screen 95% of eligible patients at risk for diabetes in 2022 and saw a 14% reduction in total cost of care for patients in their programs. They are also ramping up fall risk and depression screenings.

But Ochsner Health’s approach goes beyond just offering more detailed data for their physicians to use. The health system is actively taking feedback from physicians to refine their systems.

“If you're not talking to people that are on the front line about what's happening, you're never going to be successful,” said Dr. Raymond. “They're the ones who know what's happening regularly with their patients and understand the impact that any changes will have on how they practice medicine.”

“What we don't want,” he added, “is to have a bunch of administrators or operators dictating how to take care of the patients who we serve. We started as a group practice that came together and said: Let's practice medicine differently by working together. Being physician-led is at our core, and that keeps patients front of mind.” 

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Institutions in this article have been honored by the Joy in Medicine™ Health System Recognition Program.

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Mississippi, Louisiana and Alabama rank among the lowest in the country on state public health assessments. But Ochsner Health is up for the challenge.

For example, Ochsner Health offers tobacco-cessation screenings and interventions, but for several years these were underused. IT staffers were able to implement entry points to the program within the EHR, making it easier for medical staff to flag patients who might be a good fit. The results were 94% of eligible patients who came through Ochsner Health locations were screened for tobacco-cessation in 2022.

“We didn’t want a 20-step program. We wanted it to be three steps,” said Dr. Raymond. “It’s proactive for the patient because it’s really more of an opt-out program than an opt-in. By doing that, you end up with a lot more people at least having that first phone call with the cessation group.”

Ochsner Health has also been able to leverage its EHR to help patients overcome access barriers, which could range from transportation needs to a variety of other socioeconomic or location-based circumstances. Dr. Raymond offered the example of a patient who kept visiting a nearby emergency department because she didn’t have a car, or someone who could give her rides to her physician office.

“She was walking to appointments along a highway and would get rides from strangers when she could,” said Dr. Raymond. “She got enrolled in our outpatient case-management program and a case manager found out the patient has transportation benefits within their plan.

“Our group got her plugged in and she can get to her appointments,” he added. “We as a health system can't address all those things, but there are lots of community resources out there that can help us.”

“It’s about creating something that makes it easier for the staff, and proactive for the patents,” said Dr. Raymond.

Automating alerts to physicians when patients might need specific screenings and testing has been crucial to getting the right interventions to people in need. However, Ochsner Health’s leaders took care not to overload physicians and other health professionals with alerts by making them organized and manageable. They also designed approaches in which patients and support staff can be notified.

“We have teams that will do outreach. We have campaigns that will send portal messages letting people know that they're due for something. We have self-scheduling available for a lot of things,” said Dr. Raymond. “So, you're actually taking things off of the physician's plate.”

The approach that Ochsner Health’s leaders took to create value-based care takes time, patience, perseverance and trust. Convincing a health system to make the necessary investments when they might not see immediate return on those investments is the biggest challenge, Dr. Raymond said.

“That really ends up being the biggest hurdle: Not getting the benefits right away. The reality of value-based care is that you’re trying to take care of patients in a more proactive fashion,” said Dr. Raymond. “You're trying to actually take care of them outside of your four walls. You're trying to do things differently to try to keep them healthier. We have a system that's great for people when they're sick. How about we try to keep people healthy?”

Learn with the AMA about ways to improve value-based care data sharing and advance value-based care with alternative payment models in Medicare.

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