At the 11-hospital Presence Health, an integrated Catholic health system based in Chicago, Sam Bagchi, M.D. has several titles—and a lot of responsibility. Dr. Bagchi, who practiced internal medicine and hospitalist care for 10 years before moving into healthcare administration (he still practices limited telemedicine), is not only the health system’s chief medical officer and its chief quality officer; he currently is also interim president of Saint Francis Hospital, one of the larger hospitals in the system, while that facility, located in the Chicago suburb of Evanston, looks for a new facility CEO. What’s more, the corporate IT and informatics teams at Presence report to him.
As his current corporate bio notes, Dr. Bagchi “provides the vision and direction for a diverse list of system functions including: system quality/risk, care management, information services, telehealth, hospitalists, emergency medicine and clinical analytics. This broad area of focus has equipped Dr. Bagchi with uncommon insights into the challenges and opportunities facing today’s health systems as they move towards highly-reliable care delivery.”
Dr. Bagchi spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland about Presence Health Care’s journey into value-based and accountable care. Below are excerpts from that interview.
How would you frame your organization’s journey around population health?
It’s very much aligned with our mission, which is very much focused on the health of our communities and the patients we serve. So population health is a very nice fit for us, in terms of how we can take care of people outside the walls of the hospital. And because of our Catholic mission, we’ve focused on communities that potentially were not well-served, and also areas that other providers have abandoned or not focused on—behavioral healthcare, for example. In fact, we’re the largest inpatient behavioral health provider in the state. So from a pure clinical services point of view, we’ve been very interested in the full health and wellness of our communities, so it fits really nicely. In terms of our business, we’re still heavily dependent on fee-for-service revenues.
Sam Bagchi, M.D.
You’re involved in one of the Medicare ACO [accountable care organization] programs, correct?
Yes, we’re in a Medicare ACO; we’re in Track 1 of the Medicare Shared Savings Program. We’re in the third year of our participation in that program. In addition, we have some value-based contracts with a few commercial payers, with Blue Cross Blue Shield of Illinois, with Humana—small amounts of Medicare Advantage with Humana. And we have a clinically integrated network, Presence Health Partners, for our affiliated physicians, who number about 3,000. Most of the physicians in Presence Health Partners are not employed. About 20 percent of our physicians at the hospital level are employed, and 10 percent at the network level are employed. The Chicago market remains a little bit underdeveloped in terms of physicians, compared to some other major metropolitan areas.
What types of technology are you using in order to perform health risk assessment across your covered populations in your MSSP and commercial risk contracts?
We’re using Healthy Planet, the care management system from Epic [the Verona, Wis.-based Epic Systems Corporation]. We transitioned over from another solution. We were part of the Medicaid ACO—we were one of those providers, but we’ve transitioned those lives to a third-party payer. Pretty much all the provider-based plans in Illinois have done that. But we do take the patients we’ve done the risk assessments for, and are trying to develop the best care management programs for the highest-risk patients. One thing for your readers to think about, in terms of ACOs and value-based contracts, then, outside those contracts, is how to how to manage those patients.
Whether you’re at risk through an ACO contract or value-based contracts or via the DRGs for your physicians, you need to find ways to analyze their health status and act on what you find. In our case, we’ve incorporated a high-risk screening process for all of our patients, called the LACE tool—a pretty traditional inpatient methodology for identifying patients at high risk for readmission. “LACE” stands for length of stay + acuity + comorbidities + ED visits. Using that tool, you take those factors into consideration, and create a score, and can determine which patients—those with higher LACE scores—are at higher risk for admission or readmission. And for those patients who are at a threshold score or above, we do a series of things, including specialized discharge planning, care navigation, home care if appropriate, and post-discharge follow-up appointments for them. In terms of care navigation, we’re looking at a couple of touchpoints—making sure people are getting to their appointments, filling their prescriptions, have transportation to follow-up activities, and we’re really tracking patients more than we ever did.
The fact is that we already have a lot of the information we need. For example, the LACE tool is a pretty basic tool that gives us information we can get easily; and its part of our admission assessment when we admit patients. It can have a real impact on readmissions.
Have you been able to measure any results of interventions yet?
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