Even as U.S. hospitals, medical groups, and health systems work forward to implement robust population health management programs, some patient care organizations are working with more abundant resources than others. One patient care organization that is doing more with less is Mennonite Health System in Cayey, Puerto Rico. Mennonite Health System encompasses three medical/surgical hospitals, one psychiatric hospital, five ambulatory care centers, as well as home healthcare and hospice subsidiaries, and its own health plan, which serves just under a half-million plan members, and has been in existence for nearly 30 years. Located in the east-central region of Puerto Rico, the system’s anchor facility is the 116-bed Mennonite General Hospital in Cayey.
Leaders at Mennonite in Cayey have been partnering with the San Francisco-based Acupera in their population health development work. Helping to lead change in the organization is Eric Grafals, director for care management in the health system; he is also in charge of the organization’s mental health organization. Grafalas has been in his current position for over two years. He spoke recently with HCI Editor-in-Chief Mark Hagland. Below are excerpts from that interview.
Where are you and your colleagues on your population health journey right now?
Corporately, we started our high-level discussions about three years ago. We started to look into the different models and things that were being done at different levels. In Puerto Rico, population health has been very limited. We’re the only major provider developing population health management right now, though many are talking about it. We started simple. We have our own health plan, so we said, why don’t we start by working with our own lives?
So the idea was to try to understand the concept of population health management, through working with our own covered population. Because pop health management means many things—care management, analytics, the provision of different types of services. And in our particular case, we wanted to start monitoring and following up with the highest-risk patients in the health plan. We started by monitoring patients at home. So we hired a local company that provided the equipment, and we developed our own call center. So that is an analytics vendor. They’re helping us to stratify our population for us by risk, using Milliman data in a program called MARA. So we’ve been gathering the data for three years. We did the analysis and stratified our health plan population. And we came up with four conditions: CHF, hypertension, diabetes, and asthma.
Those patients were selected and contacted. We started with only 80 patients at first, as we were new to this population. So we monitored those patients for a year and used our case managers. And the patients were very compliant, they were happy that we were taking care of them.
Where have some of the cost savings come from?
We’ve been saving the most costs with CHF [congestive heart failure] patients, and then diabetes and hypertension. With CHF, we’re saving up to 70 percent of costs for CHF patients; they had not been compliant, had not been making it to their appointments, had not been watching their weight or eating accordingly. In diabetes and asthma, the savings were probably about 15-20 percent through care management.
So we’ve continued to learn more about population health, and have educated ourselves and our board of directors. We’ve explained to them the differences between volume-based and value-based care.
And then we decided to go bigger. We decided to take all our employees and their dependents, who are ensured by our health plan. That’s 6,000 out of our total of 15,000 covered lives. And we needed to develop our platform to help us get better into the population health concept. So we went out and we considered proposals from different companies in the U.S. providing population health management solutions. We liked the Acupera solution very much. The system is developed from a provider perspective. The president of Acupera is a cardiologist; so they know what we as providers are looking for. We have been working with Acupera since last October.
What have your biggest lessons learned been so far?
It’s very important that any population health management vendor you select knows how to interface with your clinical information systems. Meditech is our EHR [electronic health record], for example. So you need a population health management vendor that can really provide the interfacing or interoperability. Without that capability, you’ll waste a lot of time and resources.
So it’s about a combination of the leveraging of technology, but also process management and change management, as well, correct?
Yes. We’ve hired social workers, nutritionists, and care managers to help us in this work. But we needed to work through processes to get anywhere. One of our challenges was that initially we lacked a project manager, a person with background in process management and care delivery coordination. We hired a project manager just to deal with the project management aspect.
So it’s important to design activities and actions around workflow, correct?
Yes. One of the good things about Acupera is that it’s easy and simple. Most of the solutions we had seen demo’ed were designed for payers, and most were very compartmentalized. The solution we’re working with is very simple: it moves us through the natural care delivery workflow, and which is easy to use, so our care managers and physicians don’t spend most of their time in front of the computer, but rather, with the patient. And that’s an aspect of the system we really like. And if we need to make changes, my staff members can call the vendor and easily make the changes.
Do you have any thoughts you’d like to share with CIOs and other healthcare IT leaders in particular, about your learnings from this work to date?
Yes. For the CIOs, you need to make sure that the system you select can enter into an interfacing process with your existing information systems. If the CIO doesn’t work closely with the vendor in this particular area, it can cause problems. For example, data from our lab needed to go through a process to be usable. Remember, the lab produces the information one way, and our vendor provides it very simply to us. So there has to be a transition during which the information passes through, in order to make it usable. So the communication between the systems very important; after that, everything else is easy.