Advances in patient care delivery are being made on a continuous basis these days at Cedars-Sinai Health System, an integrated delivery system that encompasses an 886-bed Cedars-Sinai Medical Center on the Westside of Los Angeles, as well as a medical staff of more than 2,000 physicians, a staff of over 10,000, and many ambulatory clinics in the Los Angeles area.
Among those helping to spearhead change is Scott Weingarten, M.D., senior vice president and chief clinical transformation officer for Cedars-Sinai Health System. Weingarten, who practiced medicine as an internal medicine physician for many years, worked for some years at Cedars-Sinai Medical Center as an administrator, co-founded Zynx Health, and then returned to Cedars-Sinai in January 2013, has been helping to lead numerous teams in clinical transformation efforts in the organization. He spoke to HCI Editor-in-Chief Mark Hagland in Los Angeles just before the opening of the annual AMDIS Physician-Computer Connection Symposium, being held June 24-26 in Ojai, California. Below are excerpts from that interview.
What are you and your colleagues up to at Cedars-Sinai Health System these days?
A whole bunch of different things. With the transition from fee-for-volume to fee-for-value, we’re really focusing on initiatives to demonstrate outstanding quality of care at more affordable cost, while improving the patient experience across the entire health system—inpatient and outpatient. So we’re enabling Cedars-Sinai Health System to succeed in the new world of value-based healthcare.
So I’m focusing on initiatives related to clinical quality, efficiency, the patient experience, and patient engagement.
Scott Weingarten, M.D.
Can you provide a few examples?
We have a population health initiative. We have commercially insured patients; two Medicare Advantage contracts; three accountable care organizations; we have Vivity—it’s a commercial HMO. We’re a one-eighth owner; Anthem is a one-eighth owner; as is UCLA; as are five other organizations. We’re focused on a geographically distributed network delivering high-quality, affordable care to the community.
How many members are in that HMO?
It’s substantial and growing. It started January 1 of this year. But it’s had substantial growth.
Tell me a bit about the ACOs that Cedars-Sinai is involved in?
Two are private-insurer; and one is the Medicare Shared Savings Program. And the two contracts with private insurers are with Anthem and Aetna.
How many enrollees are in the three ACOs?
In total, all the patients under population health care delivery number about 70,000, encompassing all those programs.
How have these programs been changing care delivery, and especially how physicians work?
We have a lot of programs, including work to reduce avoidable readmissions; intensive care management to identify fragile patients; and we have physician and nurse practitioner house calls. We communicate with our patients very regularly. And we’ve seen a substantial reduction in avoidable readmissions. And every single population health admission is reviewed by multiple physicians. So every admission is seen as a possible opportunity to improve ambulatory and team-based care. And we find many opportunities. And in the last 18 months, we’ve seen a 30-percent reduction overall in both primary admissions in the population health group. And then we have a readmissions program across selected patients who go to skilled nursing facilities; and we’ve seen a 25-percent readmissions reduction among those patients.
And we benchmark ourselves on our admissions rate, and we look at Milliman benchmarks, and we’re among the best in the country along that dimension.
What are the key elements in leveraging tools to help the physicians better examine the care they’re giving?
We provide real-time feedback and decision support in the EHR. And we’ve hardwired over 200 “Choosing Wisely” recommendations into the electronic health record. And they fire in both the ambulatory and hospital setting, 200-300 times a day. And in August, it will have been two years that we’ve hardwired them into the EHR. I still think we’re the only hospital organization in the country to have done that in that scale so far.
What is it that turns the key for most practicing physicians as you make this shift?