Steward's ACO focuses patient engagement efforts on 4 percent of covered lives

By Aditi Pai
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Steward Hospitals Mark GirardSteward Health Care System's President Dr. Mark Girard, who spoke at the Digital Healthcare Innovation Summit in Boston this week, discussed how Steward's facilities use digital health tools to manage their patient populations.

According to Girard, there are two fundamental processes in healthcare, information flows and people flows. The ideal, he said, is for both processes to be happening at the right time in the right place.

"We have to earn patient engagement," he said. "We have to drive good outcomes, we have to drive quality. [Patients] don’t really care about the overall [total medical expenses]. They might care about some of their deductibles and copays, but what they want is convenience. They want access, they want quality, they want good outcomes, they want integration. They want to know that when they’ve seen one doc and then they get an appointment for another doc, that the information is arriving there at the same time."

At Steward, Girard said that about 4 to 5 percent of the company's covered lives generate about 50 percent of the total medical expenditure, while 20 percent of the patients account for about 80 percent of the spend and the remaining 80 percent of patients account for about 20 percent. Girard said that this means the entire economic viability of his program right now is managing 4 percent of the patients. 

This small population of patients is what he calls high risk patients. The group of patients, he explained, typically sees eight different types of doctors per year. As a result, Steward developed a population health program with ambulatory nurse case managers where patients are assigned a nurse case manager who they can communicate with.

"I’ll give you an example: congestive heart failure," Girard said. "You have a patient with congestive heart failure, all you have to do is know how much they weigh every day and if they gain two pounds, you better give them a water pill or they’re going to be in the emergency room very soon. We’ve got scales and each one of our congestive heart failure patients — they weigh themselves every day. We get the data through telemedicine, and we just keep an eye on it. The nurse case manager says, 'Look you’re up four pounds, let me have your doctor get you a dosage for your water pill.' So I think using technology as a way to engage patients particularly early on in that top 4 or 5 percent can really help drive up your model."

Steward Hospitals, Girard said, also offers another service, a tele-ICU.

"We have a bunker down in Westwood," he said. "Each one of our ICU beds is hardwired to that bunker in Westwood. We have an intensivist on call 24-7 in there and they monitor our ICU patients throughout the night. What we’ve noticed is mortality has gone down, length of stay has gone down, and patient satisfaction has gone up. And we are not paying for  a doctor to be on call every night."