Issue link: https://beckershealthcare.uberflip.com/i/644565
16 federally qualified health center. We work with the FQHC on the Safe Home Meds program, which was first funded by a Cardinal Health grant. Inpatient and outpatient case managers lead the program and work with patients postdischarge to ensure medication compliance. We are also working on a new specialty care program with the FQHC. Maine did not participate in Medicaid expansion; we have many low-income patients who are underinsured or uninsured. is pro- gram aims to qualify these patients for free care or financial assistance." Maryland Paul Rothman, MD, Dean of the Medical Fac- ulty, CEO, Johns Hopkins Medicine (Baltimore) "I think of three core concerns in our market. e first: Getting the correct diagnosis. e second is getting rapid, effective and person- alized treatment. e third is returning to a productive life. ere are a lot of components to rapid and ef- fective treatment. We and other major hospi- tals are overwhelmed with patients and the need for increased access to healthcare. We are trying to become more efficient. We set up an operations center to try to get patients effectively moving through our hospital. In regard to personalized medicine, precision medicine resonates with us. We have a major precision medicine initiative that utilizes big data to define subsets of patients and precisely treat them for their specific disease. Lastly, patients want to return to a full and productive life. We are really focused on population health. We are trying to prevent disease and get people out of the hospital and back to the health. We understand our care does not end with discharge." Massachusetts Howard Grant, MD, President and CEO, Lahey Health (Burlington) "Despite the work we have done in Massachu- setts, the cost of healthcare remains higher here than in any other state in the nation, and it im- pacts not only patients, but the entire common- wealth. e cost of healthcare in Massachusetts is 36 percent higher than the national average. Far more hospital care in Massachusetts is pro- vided in more costly teaching hospitals than in other parts of the country. Excessive healthcare costs mean less funding for education, infrastructure, transportation and public safety. At Lahey Health, we are focused on delivering care in the most ap- propriate and cost-effective setting without compromising quality. Our model of care is not just aspirational — we are already redirect- ing less complex care back to lower-cost community settings when- ever appropriate. In addition, we work tirelessly to better educate providers, employers and the public on the benefits of choosing high quality, high value settings for medical care. ese efforts will help reverse the trend of patients automatically choosing the most expen- sive option available to them." Michigan William Conway, MD, CEO, Henry Ford Medi- cal Group, Executive Vice President, Henry Ford Health System (Detroit) "e biggest challenge we face is how to sup- port our patients in managing their own health behaviors. We must form a partnership with them, providing the guidance and support that will work given very individual and diverse needs. Henry Ford has made great strides in this arena by developing a range of tools as part of our population health management program. We believe these will have a significant impact on improving the quality and efficiency of patient care. Examples include embedded case managers who are located in all Henry Ford Medical Group patient-centered medical homes, and the managers connect with all health plans that participate in the Mich- igan Primary Care Transformation Project. We have an ambulatory intensive care unit, an advanced care center to respond to the sickest 3 percent of the population, especially among the dual eligibles. And there's panel managers, who proactively review patients identified by health plans as having 'gaps in care' and conduct ongoing outreach by phone, mail and EMR reminders. e panel managers have delegat- ed authority to make appointments, order and schedule preventive services tests for aligned patients. Other tools include disease management for diabetes and heart fail- ure patients; health risk appraisal outreach, which provides one-hour appointments to patients who have not been seen in the past year; and the Choosing Wisely Campaign, which manages patients more efficiently by implementing recommendations within specialty de- partments and incorporating prompts into Epic that remind physi- cians of the best options for certain conditions; advanced medication therapy management; and a Referring Wisely Initiative to decrease unnecessary specialty referrals." Minnesota Kari Bunkers, MD, Medical Director, Office of Population Health Management, Mayo Clinic (Rochester) "e biggest concern facing Minnesotans about healthcare is the cost. We are starting to see the shi toward patients being responsible for more and more of the cost for their own care, whether it be through high deductible plans or lack of insurance. Because Minnesota lags behind many other states in providers taking on risk, the deliv- ery models have not kept up with the need to reduce the total cost of care, and our patients are paying the price. We are starting to see the emergence of lower cost convenience care options, but until health systems begin to shi from a fee–for-service model toward thinking about the total cost of care, our patients are going to continue to be caught in the middle. e Office of Population Health Management at Mayo Clinic is re- sponsible for transforming our community practices to a value-based model in alignment with the Institute of Medicine's triple aim, which includes lowering the overall cost to our patients."