A New Era of Women's Health

To thrive in today's marketplace, healthcare organizations must offer female-specific medical expertise that meets women's expectations as consumers.

This article first appeared in the December 2016 issue of HealthLeaders magazine.

Less than a generation ago, medicine generally approached female patients as though they were simply smaller men, with the differences in reproductive organs and sex hormones representing somewhat of a "black box," says Dixie Horning, executive director, COE and associate chair, finance and administration, in the department of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco (UCSF) National Center of Excellence in Women's Health.

UCSF was designated with the National Centers of Excellence in Women's Health in 1996, sponsored by the Office on Women's Health in the U.S. Department of Health and Human Services. The center was tasked with promoting sex and gender research as essential for understanding women's (and men's) health and disease, encouraging the development of multidisciplinary clinical care organized around the needs and preferences of women and based upon the emerging evidence, and more.

While the science of women's health is better understood than it was 20 years ago, female-focused service lines must continue to evolve to meet women's unique lifelong health needs in an ever-shifting healthcare landscape.

Success key No. 1: Appreciate the power of female consumers
The top reason to make women's health a priority, experts agree, is because of the tremendous buying power women have as healthcare consumers and influencers. According to the U.S. Department of Labor, women make about 80% of healthcare decisions for their families.

"They're also the toughest critics," says Adrienne Kirby, PhD, FACHE, president and CEO of Cooper University Health Care, which includes Cooper University Hospital, an academic tertiary-care medical center, and more than 100 outpatient locations throughout New Jersey.

"We know that when you look at the distribution of patient experience scores, women between the ages of 40 and 60 tend to be the hardest raters," she says. "When you have a decision-maker who is also a discerning consumer, it makes sense to us that you would consolidate services into a wonderful environment where women can delight in what they experience so they will feel loyalty to your organization and select your organization when making decisions about other family members."

In 2007, Cooper University Health Care sought after that goal with the creation of The Ripa Center for Women's Health & Wellness, named for TV personality Kelly Ripa and her family, which has supported the Cooper system. The facility features internal medicine, obstetrics, gynecology, imaging, cardiology, pulmonology, neurology, endocrinology, gastroenterology, plastic and breast reconstruction surgery, behavioral health services, as well as various exercise and cooking classes.

Not only does the center offer "one-stop shopping" for women's health needs, but patients get assistance from a navigator to help coordinate their care. The organization's Half-day for Health program even offers women the opportunity to handle many of their health needs within one three-hour block.

While not all women's health service lines are centralized in one facility, executives agree that convenience matters.

"We found that having OB-GYN and primary care services less than a block from pediatric services is an important key because women are often taking their children or parents to appointments," says Horning. "So colocation or close proximity to other services a woman would want to access will improve her adherence to coming to her own appointment."

At the same time, women have high standards for clinical quality, says Scott Hayworth, MD, FACOG, president and CEO of CareMount Medical, an independent multispecialty medical group in New York State, with more than 400 physicians representing 42 specialties throughout eight major campuses.

"Women are sophisticated consumers," says Hayworth, an OB-GYN by training and former chair of the New York district and former treasurer of the American College of Obstetrics and Gynecology. "They will check out the credentials of doctors to make sure they are board-certified and that advance practice providers are well trained. They want to know the expertise of the individuals they're seeing before they make their first appointment."

Success key No. 2: Build a primary care foundation
And contrary to perceptions even within the healthcare industry, the medical expertise women need extends far beyond OB-GYN. "Women's health is not OB-GYN renamed," says Horning. "The concept that it's much more is a philosophical and cultural change."

After all, reproduction represents a relatively short period within women's life spans, but they have unique needs from birth to puberty and beyond child-bearing years as well. "OB-GYN is only a small portion of women's health proportionate to our longevity," she adds.

According to Horning, holistic women's health should begin with primary care, which lines up with today's reimbursement climate more than in the past. "The Affordable Care Act is pushing the very thing that women and our population need, which is preventive primary care," she says.

And with value-based and population-health incentives rewarding organizations to keep women well, UCSF primary care providers, which Horning oversees, are doing more to create medical homes and medical neighborhoods. These models help ensure women get all of the preventive services they need at the right times, such as mammograms, pap tests, and diabetes and blood pressure screenings.

"Primary care is the foundation on which we need to build evidence-based practices to keep people out of the hospital and needing expensive care."

Success key No. 3: Evaluate emerging opportunities
That said, women can benefit from gender-specific care in numerous specialties. "Women's health is not just focused on reproductive organs, but it's the heart, it's mental health, and more. Women have different needs than men, and we have to make sure we are gearing every part of our organization to take care of women as women," says Hayworth.

Even within a major life stage exclusive to women—menopause—current evidence no longer supports hormone replacement therapy (HRT) as a given, notes Horning. "Through newer studies we now know menopause does not need to be treated as an illness," she says, adding that UCSF research has verified other studies suggesting that HRT can increase women's risk of stroke and heart attack.

There are plenty more areas of opportunity in the women's health space, but few guarantees. "We started with the traditional group of services for women, and we grew it," says Kirby. "We added behavioral health because the doctors were referring patients for it, and it turned out to be quite successful."

Similarly, the center brought on specialists in cardiology and endocrinology based on seeing more patients with metabolic disorders. "It was based off of our experience but a little bit of a calculated risk," Kirby says. "And we continue to grow, which I think is the success of the program."

There are currently 19 physicians working at The Ripa Center, 17 of whom are women, who conducted a combined 17,000 visits in 2015.

The next venture for The Ripa Center, according to Kirby, will likely involve weight-loss management as well as an exercise and fitness program. "We're hearing a lot from our patients that they want to have a place that they feel is trustworthy, where they can go to have a comprehensive weight-loss management program," she says. "We do have a bariatric program that sees patients right on that campus, and we are developing with endocrinology and the bariatric team a metabolic service to offer medical management of weight loss."

And CareMount is looking to build on its existing OB-GYN expertise by offering in vitro fertilization services, says Hayworth, who also expects growth around genetic medicine and women's cancer screening and treatment.

The group already employs specialized women's pathologists who only do gynecologic pathology, he adds, and is able to offer patients access to clinical trials through its clinical affiliation with Massachusetts General Hospital.

"Even though we're miles away we're able to offer our patients state-of-the-art cancer care," he says. "It's very unique that we're able to offer these clinical trials in the private practice setting."

Meanwhile, Cooper University Health Care's partnership with the MD Anderson Cancer Center provides patients with oncology expertise as well. If patients seen at The Ripa Center are suspected to have or are diagnosed with a malignancy, they can receive care across the street at the MD Anderson Cooper Voorhees satellite campus, a Cooper entity. All of the center's affiliated physicians are duly credentialed as MD Anderson Cancer Center (Houston) and Cooper physicians.

But the key partnership that's vital to The Ripa Center is with the physicians, Kirby says. "They have embraced this and the physicians that work there are dedicated to making this a one-of-a-kind, top-in-class center. They come up with ideas and are constantly looking at ways to make it better."

Success key No. 4: Mind your metrics
As healthcare executives know, you can't improve what you don't measure.

For CareMount, clinical quality is priority No. 1. "Whatever we do, if we're not going to do it well, we're not going to do it," Hayworth says. "We're blessed that we have a relationship with both MGH and Mount Sinai in New York. And if it's something that we can't handle, even with our subspecialists, we have the ability to send our patients to some of the best hospitals in the country."

The organization also watches financial and outcomes measures closely, he says. And Press Ganey patient satisfaction ratings are of critical importance to make sure patients are happy with their experience.

Patient experience is paramount for The Ripa Center as well. "Our goal is giving women healthcare that they could probably get in a fragmented way in the community, but giving it to them in a very comprehensive manner in a really wonderful, women-focused environment," Kirby says.