Host Dr. Wayne Tuckson welcomed Dr. Jody Prather, MD, chief strategy and marketing officer at Baptist Health to discuss the growing use of health care networks as a model for care in the U.S. system. Here are key takeaways from the episode.
Consolidation of Services Equals Better Treatment
In days past, many physicians’ offices operated as individual businesses or as part of small, local groups. But those practices are declining, replaced by physician groups that are incorporated within a larger regional network. Baptist Health in Kentucky is one example of a hospital system that has, in recent years, expanded its reach to cover much of the commonwealth and provide an ever-growing variety of medical services.
“When I came out (of medical school), in my generation, I got a line of credit, and set up shop with a couple of partners,” Prather says. “You don’t see that as much (today).”
More and more, Prather sees new doctors come out of residency with the goal of becoming part of a larger health care network. He reasons that many of them are seeking more financial security in a hospital network that has already established a reputation for care rather than taking the risk of starting a new individual practice.
But there are other benefits offered by a health care network too, for both provider and patient.
“You’re part of a group that is focused on a continuum of care,” Prather says. The health care network can help a physician by providing electronic medical records and staff, by navigating regulations, and by situating the physician’s services within a framework that also includes specialists and the hospital’s services.
“You really get a global view of the patient, which is really a significant advantage,” Prather explains. “There are trade-offs to any model, but to be a part of a truly integrated health system for a physician – ready referrals, ready colleagues, transfer of information, making sure your patient is being managed along the transition of care with less dropped balls – I think is a big win,” he says.
Prather says that doctors and staff who are part of a larger integrated health system are able to establish a more normal routine of practice, knowing when they’ll be working and can take time off since they have colleagues to support them. This is especially true for those practicing in urban areas such as Louisville or Lexington, but Prather says that Baptist also strives to help physicians in rural areas through its network.
For example, he explains that Baptist offers certain patient services in rural markets such as Madisonville even if they are not in high demand, in order to support their physicians but also serve the community. They can do so because of the scale of their operation, and the same is true for other large health systems in Kentucky.
“You’ve either got to say that you’ll cover that person somewhere else, and by being a bigger network you have that option, or the other side of it is, we’re going to provide this service to the community and it’s not financially the best move,” Prather says.
How the Integrated System Works
Building a successful integrated health systems model requires a lot of expertise, planning, and teamwork, Prather says. He uses breast cancer care as an example: the system incorporates primary care physicians, nurse navigators, radiologists, oncologists, surgeons and other professionals existing throughout the system to engage patients starting when they visit for their routine checkup. Once the patient is encouraged to get a mammogram and receives a concerning result, she will be on a path to coordinated, comprehensive care for the duration of her medical issue – all the way through biopsy, consultation, and then surgery or ongoing therapy if required.
If a patient with breast cancer lives in a rural area, she will get her first exams at her regional hospital, but eventually proceed to more complex surgery and/or treatment, if required, at a larger flagship hospital in Louisville or Lexington, Prather says. The integrated health system facilitates this process, with coordinated care at every step.
“Is it perfect? Your viewers will have had situations where it hasn’t worked,” Prather says. “But it’s what we’re working towards, and I think the advantage the patients are going to see over time within integrated health systems, as we get better at it, we’re going to see more streamlined care.”
As for medical costs, Prather says that the Baptist Health model and other integrated health systems in Kentucky are moving more and more toward what he calls, “pay for performance, a movement toward value.” Having an integrated system can help achieve this, Prather believes, through establishing uniform, high quality standards for procedures that are practiced throughout the network.
“In all of our discussions with providers, our goal – and we have a set goal within the next four or five years – is being in the bottom third of costs in the country, while not affecting quality, because that’s how we think we’re going to serve patients best,” Prather says.
One of the most concerning aspects of modern health care from a patient standpoint is surprise billing. While providing services through a network doesn’t eliminate surprise billing, Prather says that the network model does help to reduce it, since all contracts within Baptist Health, Norton Healthcare, or other Kentucky systems are negotiated internally.
“When you go to an integrated health system, you’re able to provide more of those services, and you know that they’re all aligned,” he says. “So there’s not going to be this separate physician group with a separate contract. That’s the goal. Nobody can completely eliminate it, but certainly an integrated health system helps.”
Even though keeping services within an integrated health care network can lower costs, Prather affirms that the needs of any individual patient always come first. If they need a service that is not offered within the network, Baptist Health works to connect them to an outside provider.
“We tell our physicians and caregivers, do the right thing for the patient – that’s rule number one,” he says. “Beyond that, if it’s a tie (in terms of quality of service), we like to keep them in the system because of transition of care.”