North Texas is home to wide gaps between the haves and have-nots by nearly every measure, and healthcare is no different. Life expectancy, chronic disease, and COVID-19 all reveal the stark divides in our community, often between northern and southern Dallas.
Accountable Care Organizations were designed to manage care for Medicare patients, reduce overall healthcare spending, and allow well-run organizations to benefit from the money they save for keeping patients out of the hospital and away from other expensive treatments. Because Medicare kicks in for citizens at age 65, ACOs have an incentive to address disparities in high-need populations to prevent downstream costsExperts disagree on whether ACOs are working as a whole, but local ACO Southwestern Health Resources (run by UT Southwestern and Texas Health Resources) has experienced significant savings and has been a top-ranked ACO nationwide for several years.
In order to learn more about what ACOs are doing and can do to reduce those gaps in care and outcomes, D CEO Healthcare spoke with SWHR’s Chief Medical Officer Dr. Jason Fish, who is also a practicing internal medicine doctor. Many of the issues need to be addressed from a policy standpoint (expanding Medicare would help), but specific measures are already making an impact.
In a word, the goal is teamwork, Fish says. “We put it all together to give a 360-degree view of what’s happening to patients driving optimal health,” Fish says. “It lets me as the provider focus on what I know best, which is clinical medicine and preventive medicine. Then, the team works collectively to ensure that we remove as many of the barriers as possible so that the patient can be empowered to be a true partner with me in those decisions.”
- Define Health Disparity Correctly
Traditionally, most people think about health disparity in terms of economics, which is still the most critical factor. But only looking at economic factors will miss other indicators. One’s neighborhood can positively or negatively impact health outcomes depending on the availability of healthy food, safe streets for exercise, nearby pharmacies, doctor offices, and several other factors.
If a [atient lives in a neighborhood without these resources, their health outcomes may suffer even if they are more economically stable compared to their neighbors. In addition, education and race, regardless of the economic situation, are also factors. One only needs to look as far as the troubling maternal death statistics in Texas to see that health disparity can impact Black women independent of their economic status.
A more comprehensive idea of how disparities form can help address the problem more efficiently. “If you take one approach and look at SES only, you are likely missing other areas that aren’t based on income that drives health equity or health disparities,” FIsh says.
- 2. Let Analytics See What Physicians Can’t
With electronic medical records and artificial intelligence infiltrating the healthcare industry, there is no shortage of data for providers to access. This data can often reveal patterns and trends that aren’t immediately obvious to physicians and other caregivers. Providers don’t need much help identifying high-risk or healthy patients and managing existing diseases, but identifying those trending one way or the other can be more difficult.
If a patient has a rising risk of heart disease because of genetic or social factors, an ACO can leverage the data it collects on its patients to create a care plan to address the rising risk that might not have manifested in the patient. Most ACOs use a multidisciplinary approach to accumulate data on the patient that may not come up (or maybe intentionally withheld) during a primary care visit. For example, patients are more likely to tell a pharmacist about their problems affording medication than their physician.
Using a team to care for patients can mine data to help predict rising risk, but they can also address those issues as necessary. “Collectively, we’re going to solve the problem,” Fish says. “Physicians get caught up with the high risk, and we think rising risk patients are better than they are. We don’t have good predictive models in our brains and the analytics help.”
- 3. Address Problems Upstream
When caregivers identify deficits in a patient’s social determinants of health, they often look for partnerships to address these needs. That may be partnering with local nonprofits or churches to make sure people can get to their appointments and have access to healthy food or offering vouchers for rides to the pharmacy. Texas Health partnered with the City of Fort Worth on the Blue Zones Project, a multidisciplinary effort to improve healthy eating and increase movement to enhance longevity. UTSW is part of the newly established RedBird development, bringing primary and specialty care to traditionally underserved southern Dallas.
Addressing social determinants of health can help stop problems before they start, reducing downstream costs and improving outcomes. A hospital system can’t transform a neighborhood’s infrastructure overnight, but it can educate a patient on available resources and partner with organizations that can provide healthy food and transportation.
“You can do a lot of education, but in terms of transportation and access to food, you try to tackle those at the individual levels,” Fish says. “We have to make sure that if we have an individual coming out of the hospital with chronic diseases where nutrition matters to their health outcomes, we have to bring that to them.”
- 4. Engage, Engage, Engage
Understanding the need to address health issues upstream and identifying trends with data analytics aren’t new concepts. The main hurdle is to operationalize the theory and implement the plans developed by care management organizations. Engaging the patients and getting buy-in from caregivers is a significant part of making that happen.
Insurance companies have an incentive to reduce healthcare spending and often make efforts to engage patients and make sure they have what they need to maximize their health outcomes, but insurer engagement rates remain low as well. ACOs can directly partner with a patient’s primary care physician, who is more likely to convince the patient to follow their care plan.
That added engagement takes on many forms but focuses on the physician’s office. SWHR team members meet with the patient at their appointment (getting patients to answer the phone, especially during an election year, is often impossible) to ensure patients have what they need. Utilizing telehealth options can make the doctor more accessible, and moving care into a patient’s home can make the process more comfortable and get meaningful insight into obstacles to care.
“Establishing your relationship is what’s most important,” Fish says. “It all starts with the PCP and the patient, and we are seen as a member of the PCPs team. For us, that seems to be a more effective way, and we’re seeing a lot more uptick in that engagement from our patients.”