Northeast Georgia Health System is a four-hospital nonprofit community-based health system based in Gainesville, Ga. Antonio Rios, M.D., chief of population health, recently spoke with Healthcare Innovation about the organization’s population health efforts.
Healthcare Innovation: How long have you been chief of population health there, and can you describe the role?
Rios: I am the first chief of population health and officially started Oct. 1, 2021. Prior to that, I had been the chief physician executive for the employed physician group for the past 13 years. We had our initiation in population health with strategies like Patient-Centered Medical Home. All of our primary care clinics are certified as level one NCQA PCMHs. Also, for the past three years we have been part of a Medicare Shared Savings Program ACO track one.
HCI: Could you talk about how you got started and the importance of data quality to help reach those goals?
Rios: The health system had been hearing the buzz around the country with population health. We started in 2018 to really find out more about population health, and our CEO met the CEO of Lumeris at a conference and the conversation started. And after due diligence, in late 2018 or early 2019, we started working with Lumeris, but then COVID hit and that threw a wrench into the whole speed of how things were moving. Nevertheless, we restarted the initiative and the opportunity to sign on to the CMS Direct Contracting program, came about. We decided that we were ready to take some more risk as an organization, as we have performed well in the ACO program. We started Jan. 1 of this year into Direct Contracting, and that really accelerated all the work that that I'm doing, and in conjunction with our partner, Lumeris.
[Note: Lumeris is an operating partner for health systems in Direct Contracting /ACO REACH by providing end-to-end services and technology to help them be successful in managing this downside risk program.]
HCI: Direct Contracting is morphing into the ACO REACH program next year, right? Are you looking at the requirements for that?
Rios: Yes....it is at that level where all these new conditions apply, and they slowly cascade down to the participants, so we are one of a couple of participants. Definitely we're looking at that. I think that our organization has already been doing a significant amount of work in partnering with the community, and offering a great deal in uncompensated care a year, and also has a very, very strong charity care program. We are trying to ensure that we're providing care to the whole community. Not only that, but partnering with other agencies in the community, like United Way, Meals on Wheels, etc., to try to extend beyond the health system to solve for the issues, and include school systems, industry, etc. I think that if something good came out of COVID, it was the tightening of those relationships with the community in a big way.
HCI: Are there some things you’ve done about increasing and tracking preventive screenings around cancer or diabetes, or other care models that you put in place?
Rios: Yes. I think one of the key things for the clinicians is to provide them accurate and actionable data, and to really empower the team to be able to assist and work at the top of their licenses. We created standing orders, so that when we see that patients had not had their mammograms or their colonoscopy, based on those standing orders, the staff can actually just put in the order, under our guidance and supervision, so I think that has really helped to increase the numbers of screening and preventive care. In our electronic health record, we're also trying to put it right in front of the clinicians: hey, this person needs x, y, z, and we are trying to make it easy to fill those care gaps. Between the team and technology, we are really trying to facilitate the completion of those screenings. Even for the patients we are not seeing in front of us, we have a team of nurse care managers who are usng the analytics that our partner Lumeris has given us to look at those folks and say, ‘How can we help them to complete these care gaps?’ Our offices are also given lists of patients who have not been seen in the office and we need to try to get them in. So I think that that's the power of the team and the analytics.
HCI: Besides the MSSP ACO and the Direct Contracting you described, is there a recognition on the part of commercial payers that this kind of work is valuable? Is there a way to get partnerships with a Blue Cross or some other kind of regional payers on similar types of programs?
Rios: Absolutely. I think that that's our goal — to eventually create value-based contracts with all of our payers. We are slowly getting into that space with Medicare Advantage, but the plan is to have these conversations with groups like United Healthcare, and to start to really get into that space with all the people that are covered under them.
HCI: When we interview people in your position, we hear a lot of people say they have this sense of having one foot on the dock and one in the boat, because they're thinking in a fee-for-service mindset half the time and then trying to have this value-based care mindset half the time.
Rios: Fee for service is not going to go away completely. There has to be an element of volume. However, I do think that we have significant opportunities to improve what we do with value-based care. It really is pushing us to achieve what now is that quintuple aim, right? Instead of the triple aim, we're now going to the five legs of a stool. And that includes the well-being of the clinicians and equity — reaching out to those folks who are disadvantaged in some way, shape or form.
HCI: Do you get the sense that leadership in your organization understands the impact you are having from a clinical point of view?
Rios: We're early in our journey, so we don’t have the clinical outcomes to show yet, but we are confident that we'll get there. But we are making a difference with the work that we're doing. And when we share those examples of stories that the care management team is doing in preventing readmissions or catastrophic complications, it really energizes the teams and the clinicians. The clinicians have been for the longest time used to fee for service — a hamster wheel, and we're trying to slowly change the mindset to incorporate the top-of-mind quality metrics and what's best for the patient. That is probably the work that requires a lot more of my energy — to be able to connect and engage the clinicians in this different way of learning to look at the data, how they're coding the information that they're seeing from their patients, their diagnosis, to ensure that they're very specific with the condition that the patient presents to accurately reflect how sick the patient is.
HCI: Anything else you look forward to working on?
Rios: I think that as we start really expanding this work outside of the payer space into the community and in some way intersecting with public health, I think that's probably the most mature model that you can attain. That is going to take some more time, but that's probably the end goal.