September 2019Letter from the President Dear colleagues: The hottest topic in medicine is Social Determinates of Health (SDoH). Your zip code appears to be more important to your health status than your genetic code. SDoH are defined as the structural determinates and conditions in which people are born, grow, live, work and age. They include such factors as socioeconomic status, education, the physical environment, employment and social support networks, as well as access to healthcare. A recent meta-analysis of nearly 50 studies suggested that social factors accounted for a third of the deaths in the United States. The US Department of Health and Human Services reported to congress in 2016 that both patients and providers are impacted negatively by SDoH. While it is easy to see how these issues can affect an indigent population, SDoH are just as important in all populations we care for. We are being moved to a value-based payment system to help improve the care and outcomes for our patients. We will not be successful in an outcome- based reimbursement world if our patients’ healthcare results are mostly influenced by SDoH.
These facts create a real Catch 22 for providers. They set up situations where doctors might avoid certain groups of patients for fear they won’t have good outcomes due to SDoH. Unfortunately, these are the people who need us the most. If patients can’t get a ride to the office, can’t buy food, can’t afford co-pays and deductibles and have no one to help them at home, the health outcomes are poor no matter how hard we work or whether or not they have insurance. We have all seen it.
What can we do?
We have seen the importance of SDoH in our Community Care Coordination (5/50) program. If we can address and improve the SDoH for our patients, they are happier, healthier, more engaged and productive. Robust and aggressive care coordination is the key to understanding and meeting the needs of our patients across all groups. We have seen the difference these efforts make. Fewer ER visits, fewer readmits, fewer hospital stays and an improved, healthier life. This requires partnerships with health systems and provider groups across the community. Addressing food deserts, transportation, housing deficits and access to care are essential for quality care delivery. Oklahoma is poorly ranked in health statistics and in SDoH. We must think differently and be willing to change what has not worked in the past. We put 12% of our healthcare spend toward SDoH and 88% on care delivery. It is not working.
I was recently at a healthcare conference in Chicago, and SDoH was the most discussed topic, not networks, high deductibles, smoking and new clinics. Investors and private equity firms were there making the case that spending on housing, transportation, nutrition and better living conditions are the keys. That this type of investment improves health more efficiently than new hospitals and clinics is a very compelling argument. The policy makers, health executives and physician leaders in attendance agreed with the concept. Maybe attacking the SDoH is a more efficient way to improve the health of our communities and a better use of resources. The consensus of those in the know was that fee-for service isn’t dead, but it will be greatly diminished over the next few years.
We used to be more connected to our patients and understood how they lived and what their needs were. The machine of medicine with its RVU’s and EMR’s have changed those relationships. The social history discussion has been lost in a check-in kiosk or half-filled out checklist. Do you know your patients’ SDoH? Are they always late because they want to irritate you, or is it because they use our inadequate bus services? Have you or your staff ever asked? Do they eat fast food all the time because it is cheap, or is it the only thing UberEATS delivers, and they have no car or nearby grocery store? We should know and try to help them.
I hope you see the quandary we are in. If you don’t, you better figure it out. We will soon be paid for outcomes and quality, not quantity. We will be compelled to take risk on patient populations with not just upside but also downside risk. These populations might have SDoH that impacts are ability to succeed. President Trump’s Director of Health and Human Services, Seema Verna, recently stated the administration ”is doing everything we can to accelerate the implementation of financial incentives to drive costs down and improve quality.” The alternative in her view is “Medicare – for – all “. Status quo isn’t affordable. There is a lot to be done to achieve success in the coming healthcare environment. More on that next month.
Sincerely, Carl Raczkowski, M.D. INTEGRIS, Blue Cross and Blue Shield sign agreement – Blue Advantage now in network! You may have heard the recent news that INTEGRIS and Blue Cross and Blue Shield of Oklahoma (BCBSO) signed a longer-term agreement. An exciting component of the unprecedented five-year contract is that for the first time, INTEGRIS providers and facilities are included in the Blue Advantage PPO as of Sept. 1, 2019. Find more information here. 2019 Metrics and Metrics Completion Lists Available Please review the 2019 clinical and operational metrics, available for you to view anytime at https://integrisok.com/ihp/2019-metrics.
Unsure of your 2019 metrics completion status? Check here. 2019 INTEGRIS Health Partners – Last 2019 Summit October 1 Attendance at one INTEGRIS Health Partners Summit is required for all network physicians to participate in shared savings. If you missed the March or June Summit, there is one more summit on the calendar:
Tue. Oct. 1, 5:30p, in the Baptist Medical Center auditorium with livestream options to other INTEGRIS facilities. Dr. Raczkowski will provide an IHP update, including an exciting announcement about 2018 Shared Savings.
Human Factor Training will also be offered with CME starting at 6:30p. Human Factor Training for providers is required to receive and maintain INTEGRIS credentials. Note: Providers who have completed Human Factor Training or who are already registered for a different training session may leave after the summit and before Human Factor Training starts.
Register online here. 2019 Education Metric – Videos now available INTEGRIS Health Partners presents three online education videos for physicians:
Viewing any IHP education video by Dec. 31, 2019 will meet the education metric for 2019, which is required to participate in shared savings. https://integrisok.com/ihp/annual-education INTEGRIS Golf Classic benefiting Southwest Medical Center Community Care Coordination Program The INTEGRIS Health Foundation will host the 2019 INTEGRIS Golf Classic on Oct. 22, 2019 at Jimmie Austin Golf Club in Norman. Care coordination brings compassionate care to indigent patients fighting chronic diseases. Your support will fund the equipment and resources needed to serve patients in-need. Donate to this worthy cause by playing in the golf classic, becoming a sponsor or you can “chip in” if you can’t play. Interested in a single player spot? Contact Breann Hager directly at breann.hager@integrisok.com to secure your spot for early registration when single registration opens. Thank you for your recognition and support in making a true difference in the lives of our neighbors. Upcoming INTEGRIS CME Events Please mark your calendars for these upcoming educational events. Questions? Contact INTEGRISCME@integrisok.com
October 4 INTEGRIS Pediatric Emergency Services Symposium IBMC Auditorium Register: www.integrisok.com/ESS
November 1 INTEGRIS 31st Annual Fall Symposium IBMC Auditorium INTEGRIS Connect Welcome Matthew Draelos MD, Jamie Crain APRN and Brock Vorwald PA at Draelos Metabolic Center are the latest independent provider to implement INTEGRIS Connect, the Epic product for community providers. Dr. Draelos and his staff members can now access information for their shared patients throughout the Epic system. Congratulations! To learn more about INTEGRIS Connect, visit www.integrisok.com/connect. Submit an inquiry to schedule an informational meeting. New Physicians and Advanced Practice Providers
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