Breaking Down the Silos

For decades the healthcare system has operated in silos resulting in fragmented care that focused on episodic treatment of disease rather than managing the overall well-being of an individual. As a result, healthcare in the U.S. evolved into transactional medicine, with doctors and hospitals caring for one case, one disease at a time, as patients showed up in our ERs and sick-care clinics.

Texas Health Resources’ mission is to improve the health of the people in the communities we serve, and that goes beyond caring for people in our hospitals.  As one of the largest faith-based health systems in the country, we are committed to caring for the whole person – body, mind and spirit.  To fulfill our mission, Texas Health is transforming from a hospital system that treats people when they are sick or injured to a health system that improves the health and overall well-being of individuals and entire communities.

We are pursuing a path that might strike some people as an unusual business model.  We’re working toward the day when our customers do not come to our main business locations as often or stay as long.  In effect, we’re pursuing a strategy of “demand destruction” because we must transform from a sick-care model to a physician-directed population health model that focuses on improving well-being and keeping people healthier so that they do not need to be in the hospital.

Effective change cannot happen without close collaboration among physicians, health systems, employers, community leaders and payers.  For several years, we have been making internal changes to our hospitals across North Texas and forming partnerships to enable this transformation.  Now Texas Health is building on that foundation and aligning with key organizations that will travel with us on this journey.

Recently, Texas Health announced agreements to form accountable care organizations with Blue Cross & Blue Shield of Texas and with Aetna. Under these arrangements, tens of thousands of North Texans will benefit from a more coordinated health care experience that we believe will enhance outcomes, increase patient satisfaction and bend the cost curve away from its upward trajectory.

We are creating a physician-directed population health management approach that we believe will foster more accountability across the continuum of care, from the individual patient to the physician to every other caregiver on the team. Our ultimate goal is to help physicians manage the health of their patient populations and improve their health and overall well-being.

Texas Health is working with Healthways, one of the country’s largest independent providers of well-being improvement solutions, to help physicians manage the health of their patients across the continuum of care. Together we are also developing an infrastructure that directs individuals with chronic diseases to appropriate and timely interventions.

We selected two areas where we could immediately begin to make an impact – diabetes care coordination and transition care.  Both of these initiatives involve specific populations of patients who need help coordinating their overall care.  Both could have a significant positive impact on outcomes and the cost of care.

Diabetes Care Coordination

An estimated 26 million people have diabetes and another 79 million people have pre-diabetes, according to the American Diabetes Association. People with diabetes represent a tidal wave of patients who, if their treatment is not well managed, could quickly overwhelm the healthcare system in the coming years.

Diabetes is often not the primary reason a person enters the hospital, but it is a critical factor in determining the course of treatment and outcomes for the patient.

Texas Health is attacking this problem on several fronts, including community-based education, patient awareness, advanced treatment capabilities and improved coordination of care, both inside and outside the hospital.  Texas Health is implementing a consistent system-wide approach to optimize the care of in-patients with diabetes and improve coordination of care after the patient is discharged.

Critical elements of diabetes care coordination include identifying patients who have diabetes, and aligning in-hospital and post-hospital providers around the patient’s needs.  It also involves the patient’s primary care provider to facilitate ongoing monitoring and appropriate interventions.

Physicians, nurses and others on the care team are working together to launch this diabetes care coordination initiative at Texas Health hospitals in Dallas, Plano, Arlington, HEB and Fort Worth. Our ultimate goals are to improve health outcomes for patients with diabetes, reduce their frequency of readmission to our hospitals, and establish Texas Health as the preeminent place to go for diabetes care, education and support.

Transition Care

Our goal is to improve health before people end up in the hospital, coordinate care if they do enter a hospital, and enhance follow-up care after they leave the hospital. Effective coordination of care after the patient is discharged can improve quality and patient safety, lower cost, improve patient outcomes and help prevent costly readmissions.

The Transition Care program integrates health services and helps patients navigate through the complex environment of care.  Once caregivers identify patients who are most at-risk for readmissions, the program aligns inpatient and post-hospital care teams around the patient’s needs.  It also involves the patient’s primary care provider to facilitate monitoring and timely interventions.

This approach builds off successful initiatives at Texas Health Presbyterian Hospital Plano where specially focused nurses coordinate an in-depth admissions process that goes beyond the reason for the current hospital visit and takes a comprehensive look at the health care needs of the whole patient, including their post-discharge needs. Similarly at Texas Health Harris Methodist Hospital Fort Worth hospital pharmacists are now working in the Emergency Department to help reconcile medications as patients enter our facility.

Changing the way healthcare is delivered is a daunting undertaking involving many parties breaking down the old silos and working together for the good of the patient. The changes we are making will not happen overnight. But if employers, physicians, community leaders and health systems work together, we can drive meaningful, lasting changes that will improve the health and well-being of the people of North Texas.

Doug Hawthorne — CEO of Texas Health Resources

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