Investing in Heart Health

In our March Intelligence Report, more than half of leaders expect their cardiovascular service line investments to include population health efforts. HealthLeaders Media Council members discuss how a population health strategy aligns with their cardiovascular service line, and where they are making CV investments.

This article first appeared in the September 2014 issue of HealthLeaders magazine.

Jeff Samz
Chief Operating Officer
Huntsville (AL) Hospital Health System

Our biggest focus has been around heart failure. It is nurse practitioner–driven, with physician leadership that manages any heart failure patient in our community who we can get to come to the center. We have nurses and nurse practitioners there who have developed a relationship with the patients to not only manage them clinically but also from a social standpoint to keep them from being readmitted and to keep them compliant. We have had that for years, and we have enhanced the aggressiveness of trying to get people into that program to get ready for population health.

We have done a lot of things with trying to improve our discharge teachings as patients leave here, educating them about their medications and what they need to do with follow-up care. We are starting a program to make sure that patients leave here with their appointment to see their physicians. We started a program to deliver medicine at patients' bedsides before they get discharged to improve medication compliance. We started a program this year to call patients postdischarge. We have a nurse navigator grant that we won this year to case manage the highest-risk cardiac patients in-house and get them into these resources to make sure they get good follow-up care.

Robin E. Flint
Former Director of the Cardiovascular Service Line
Ellis Medicine
Schenectady, NY

I saw the light some time ago and said we really need to start driving these efforts at the outset with behavioral modification as it relates to nutrition, health, and exercise. The real opportunity here is to begin to drive those efforts back out into the community from an education standpoint, but the issue that we are dealing with is we don't get paid for those things. Fortunately in CV services we still have a positive bottom line, but if you look over the past three years we have seen about a 40% reduction in that margin for the CV service line. It is still positive, but it continues to go down.

We have partnered with two private payers in this community to develop a bundled payment initiative for patients undergoing CABG surgery. We get an up-front bundled payment and we are responsible for those patients 90 days postdischarge. We've talked about doing it with the same payers as it relates to heart failure and atrial fibrillation. This facility is actually going to be working to develop an ACO with other local providers for an insurance product as well. We are seeing some of the efforts begin to pay off. But we've got a long road ahead of us.

Ruth Krystopolski
Executive Vice President of Care
Innovation for Sanford Health
President of Sanford Health Plan
Sioux Falls, SD

We've had a fully integrated health plan at Sanford for 17 years, so we've constantly managed the population in that health plan. There are nearly 100,000 people in it. We are rather diverse from a geographic standpoint, and support centralized enterprisewide structures around population health. That applies to our cardiac service line, our cardiovascular services. In the Sioux Falls market in particular, we have a freestanding heart hospital facility that integrates the full spectrum of care that a patient would need from a cardiac standpoint.

We have really been focused on how we help the populations we serve deal with their cardiovascular disease and impact positively their overall health. We have been doing it for a number of years and now are formalizing the structure to support not only cardiovascular services but all of the service lines that Sanford provides.

Sanford uses a single electronic medical record platform across the entire enterprise—inpatient, outpatient, and for every specialty and ancillary service and for our health plan. So we are 100% fully integrated from the data standpoint, and that is going to allow us to more timely engage individuals whose healthcare we might be able to help improve and hopefully improve outcomes and provide value to them.

Joseph Butz
Senior Divisional Vice President for Cardiac
and Transplant Services
Sentara Healthcare
Norfolk, VA

A population health strategy fits for the cardiovascular service line for us. It's demonstrated by where we are making the investments, and that is in the physician and ambulatory footprint. We have five key drivers for us in the cardiac service line.

No. 1 is wellness. That is dealing with cultural and social issues and driving compliance and engaging more of a holistic approach to the care.

The second area is data: patient registries and databases. You see that with the EMRs collecting the data and creating enterprise data warehousing. We are systemizing all of that to be on the same platform and do things in the same way, reducing disparities in the operations, which in turn generates data to deal with the population.

The third area is risk management. We have to have a larger ambulatory footprint, so that means investing in physicians, physician practices, and alliances and networks.

The fourth area is innovative disease management. For example, how do we develop boutique chest pain centers to manage those patients? How do we manage them to keep them out of the hospital and to get them out of the EDs?

The last thing is the heart care team approach, where you bring in a cardiologist, cardiac surgeons, and an anesthesiologist together to manage patients. You are looking at using population management in a whole new way in an acute care setting to manage these patients.