Home is where the health is

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Vassar Brothers Medical Center.
Vassar Brothers Medical Center.

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You’ve heard it for years. You may have even said it yourself: If you’re faced with a major medical issue, head south to New York City or north to Albany for treatment, the implication being that local hospitals lag behind their big-city counterparts in quality.

For decades, Hudson Valley residents seeking special care in fields like cardiology, oncology and orthopedics felt they had travel to New York City or Albany for treatment. But in recent years that trend has begun to diminish, with patients sticking closer to home. That’s no accident.

HealthAlliance of the Hudson Valley is an integrated healthcare system with campus locations in Kingston, Margaretville and New Paltz. Josh Ratner, chief strategy officer for HealthAlliance, said that one of the first goals when consolidation came in 2009 was determining why patients left the area for treatment and what might be done to prevent that from happening.

“We heard about the out-migration to other areas, both north and south,” Ratner said. “It was a priority to understand the environment we were serving so that we could better serve the community. Not only did we look at the data from the state, but also we undertook a community perception survey to go out and quantitatively speak to what the public’s perceptions were at that time so we could better understand how to make some of those changes. It helped us solidify factually why some folks were going outside the community. That became one of the pillars of our strategic plan.”

That plan resulted in a concept that was also pursued by Health Quest, formed through the affiliation of hospitals in Rhinebeck, Poughkeepsie and Carmel. According to Health Quest senior vice-president for strategic planning and business development David Ping, a first step was working with respected physicians in a concerted effort to address the perception of healthcare in the Hudson Valley.

“It started with one program, really,” Ping said. “It started with the desire to make Vassar be a regional referral center for cardiac services. We were able to attract Dr. [Mohan] Sarabu and his team here, and we made sure they had the tools that they needed, the equipment they needed to enable them to practice medicine the way they wanted to practice medicine. Once Dr. Sarabu was established, we moved on to the next thing we wanted to work on, which were oncology services. That was our approach, to take it one program at a time, recruit the best people we could recruit for those programs, have them build the team and then once that’s done start attracting the patients. It was a commitment on the part of Health Quest and Vassar Brothers medical board and the vision of the administrative team to make that happen.”

Change agents

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Fifteen people sat at a large conference table in a windowless room of a large office building in Fishkill later last Wednesday afternoon. The conferees, mainly doctors, health administrators and researchers, constituted the board of directors and staff of Thinc, the Taconic Health Information Network and Community. The Thinc board meets monthly to share information and research about the fast-paced changes in the healthcare industry, one-sixth of the gross national product.

“Welcome to Thinc,” says the organization’s website. “Thinc is the neutral, non-profit organization that convenes the community and articulates a collaborative vision for improving the quality, safety and efficiency of health care in the Hudson Valley. Thinc starts with the foundation of health information technology, then builds on that base for quality improvement that benefits the entire community.”

It was a geographically diverse group. Two of the participants, HealthAlliance Chief Financial Officer David Scarpino and Saugerties primary-care physician Dr. Eugene Heslin, are Ulster County residents. At least two more, St. Francis Hospital chief executive Bob Savage and information technologist and physician leader Dr. John Blair III, are from Dutchess.

A committee of the respected Institute of Medicine, a national doctors’ group, recently delivered the latest broadside emphasizing the urgent need for reform. “The costs of the system’s current inefficiency underscore the urgent need for a systemwide transformation,” it said. “The committee calculated that about 30 percent of health spending in 2009 — roughly $750 billion — was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best-performing state.”

Like any group used to handling specialized information, the people sitting in the chairs around the table in Fishkill tossed around jargon with which they all seem familiar, employing acronyms and other shorthand terminology in abundance.

Some of the arcane terminology they employed was medical, but most was bureaucratic: standards, programs, funding sources, government linkages. For a reporter attempting to absorb what they were saying, the experience might be likened to listening to a group of people who are constantly lapsing into a foreign language in order to express themselves.

The people around this table were cognizant that they were the de-facto coordinators in the Hudson Valley region of what is arguably the most ambitious effort at major social and economic change in American history. When it comes to leading the efforts for regional organizational development of health care, they’ve been doing the job that needs doing.

Health records are key

Five years ago, Thinc, working with MedAllies as its implementation agent, began a project to implement meaningful use of electronic health records (EHRs) at a thousand doctors’ offices in the Hudson Valley. Funded and incentivized by a $5 million state grant, the initiative has achieved its goal. The EHR adoption rate in the Hudson Valley is estimated to be 80 percent now, with Thinc’s initiative being directly responsible for about a third of those implementations.

Recently, 75 primary-care practices in the region were chosen for the next four-year effort at implementing the next phase of transformation. These practices will start delivering enhanced healthcare services this fall.

This federal program is part of a broader effort to find a new national model for the purchase and delivery of comprehensive primary care that will improve health and reduce costs throughout the country. Building on the foundation of what is called the patient-centered medical home concept, this initiative encourages multi-payer collaboration, aligning payment reform with practice transformation. Participating payers will reimburse participating practices for providing comprehensive primary care. The federal Center for Medicaid and Medicare Innovation will pay each participating practice $20 per month per fee-per-service beneficiary the first two years of the program, $15 per month the third and fourth years.

The selected primary practices will engage in systematic data-sharing and collaborative learning experiences. They will also have an opportunity to share savings achieved (at the market level). Such a collaborative effort, also involving a group of payers, has the potential to transform primary-care practices.

Tools for transformation

At the same time, the rules for meaningful use of information technology have this past month been raised to require increased technical interoperability among record systems and greater patient engagement. Medical practices and hospitals will need to be able to exchange records with each other. The government will be using its considerable market clout to push vendors toward standardization and unification of existing regional health records exchanges. Building on regional health information organizations such as Thinc, a statewide network of secure medical records is not quite around the corner. But it’s on the horizon, the Thinc participants said, and getting closer all the time.

You’d suppose that the community would want to know more about what we are doing, one board member at the table in Fishkill ventured. Other heads at the table nodded in agreement. So far, that supposition hasn’t often been translated into reality. Public involvement in this phase of health reform has been a rare commodity.

The Hudson Valley is now ready for the next phase in the long process of transformation of health information technology. A recent blogger, David Whitlinger of the New York eHealth Collaborative (NYeC), described the change succinctly as “moving from countless tons of paper files, containing life-saving data, which is trapped in file rooms across the state, toward a secure, Internet-enabled health information network that responsibly allows information to be shared across the care continuum to improve care.”