Gov. Pat McCrory came to Wilmington Wednesday to learn the prescription for improving effectiveness and efficiency of health care services.
McCrory and N.C. Department of Health and Human Services secretary Aldana Wos spent the afternoon touring Wilmington Health headquarters. It is one stop on a statewide tour of Accountable Care Organizations (ACOs) to see how they have reduced costs while improving service delivery and outcomes for Medicare patients. McCrory and DHHS officials hope that a similar approach could be applied to Medicaid patients. The state is looking for ways to reduce the cost of its Medicaid services.
Wilmington Health, through developing its own ACO model, has made great progress in all three areas: cost, quality and patient satisfaction, notably with state employees and state retiree patients as well as Medicare patients, said Wilmington Health CEO Jeff James. Comprehensive data mining software has allowed the organization to track its performance – including the performance of each of its 147 physicians- and has posted the data in hallways for staff and patients to see. The data and conclusions are also shared with physicians in an effort to become as transparent as possible, he said.
Each doctor can see how he or she ranks in each performance indicator, said clinical outcomes analyst Holli White, who works with the data collection and interpretation.
“We’ve been able to achieve these results with less resources than other ACOs in the state,” James said. While several viable ACO models exist, he explained, the success of any model depends on having physician buy-in and leadership.
“Once doctors understand and trust the data, they will do the right thing,” James told his visitors.
James also shared his ACO's difficulties in effecting change, and suggested ways in which performance could be improved more quickly.
"If the system as a whole were more transparent, it would drive change much quicker," he explained, citing as examples the states of Minnesota and Wisconsin, which have high levels of transparency statewide in their health care networks.
"They have the highest level of quality at below-average cost," he said.
In an unrelated comment, Wos said that changes in how health care delivery organizations operate cannot be legislated, but rather, must happen through cultural changes within each organization.
Following the tour, which was led by James, White, Kelly Schaudt, COO of Wilmington Health’s ACO, and Chasity Chace, Wilmington Health CFO, McCrory and Wos sat down for a round-table discussion of issues with several of the organization’s physicians.
Philip Brown MD, of Wilmington Health's Vascular Surgery, facilitated that discussion. He said that all ACOs have "one commonality. We're all trying to get at a triple aim: demonstration of quality at reduced cost in a patient-friendly environment."
Brown later said that he and his colleagues had an "outstanding" discussion with McCrory and Wos. He noted the recent passage, by the NC House, of a Medicaid reform measure that aligns with the ACO approach that Wilmington Health officials advocate.
"We have proven through our Medicare work that it can be done: to increase quality of care at lower cost," he said. "Over time, you learn and you get better and better. It's high time that we have better-performing practices and do what needs to be done for Medicaid."
Despite the reform measure's passage in the House, Brown said there does not seem to be "a lot of appetite" to bring the same bill to a vote in the NC Senate.
"North Carolina deserves a decision on this issue," he said. "We want to try and facilitate that, and we're pushing to have a vote in the Senate."
