Orlando Health Network Innovates as It Expands

Jan. 27, 2025
A Q&A with Orlando Health's Brandon Burket, vice president of value-based care and population health

Over the last several years, 26-hospital Orlando Health has built an impressive clinically integrated network of approximately 8,000 healthcare providers across 14 counties in Florida, 20 percent of whom are employed by the health system. With recent acquisitions, the network is now expanding into Alabama and Puerto Rico. Brandon Burket, Orlando Health’s vice president of value-based care and population health, recently spoke with Healthcare Innovation about several new initiatives the network launched in 2024. 

Healthcare Innovation: Before we talk about the new initiatives, could you first describe the governance structure of the network? 

Burket: From a governance standpoint, there is a physician-led board. There are non-physicians on the board, but the majority of the voting body are physicians. That has traditionally included both employee and community representation. We have even more engagement at the committee level. They focus on things like clinical pathways, evidence- based programs, and data sharing. Our system administrative leaders, including myself, sit on those committees as well for quality, operations and finance.

HCI: One of the things I read in the network’s annual report is that Orlando Health is one of the first health systems using the Value-Based Performance Management (VBPM) module in Epic. Could you talk about some of the reasons you decided to use that? Also, clinically integrated networks are usually dealing with dozens of different EHRs among the affiliated practices. Does that complicate things? 

Burket: We’ve decided to make strategic investments in Epic to expand its capabilities, and VBPM is a piece of that that. It will give us better analytic workflow and performance capabilities over time. Sometimes it feels like we're definitely doing a lot with a little. Right now we're managing 340,000 patients with roughly 100 folks on my team. The idea of population health is not to touch all 340,000 patients all the time. It's to focus on the patients who could most benefit from our services. VBPM helps to understand that a bit better — who are those patients with clinical and cost opportunities. How do we better report clinical outcomes and keep track of those to track and trend patient acuity and disease progression? How do we holistically manage expenditures? How do we engage patients through patient outreach capabilities? 

That's the patient side of it, and you alluded to the provider side. We have over 8,000, including 800 unique tax IDs or different entities, and of those, we have more than 80 different EMRs in our network. We don't think we're probably ever going to be able to integrate into all 80 of them, because there's just so much fragmentation there. It would probably be a fool's errand to try to go integrate, especially as upgrades are constantly made to these platforms, and some go by the wayside. But what we've done is integrated some point-of-care solutions that sit on top of those EMRs. So regardless of what EMR you have, we're able to provide you insights as a provider at the point of care, and Epic helps support some of that. We also have read-only capabilities for providers who want to know what's going on with their patients while they're in our hospitals or facilities. They can actually look into the Epic record in real time and see the care teams that are taking care of those patients, as well as any sort of clinical insights they'd be looking to glean from the medical record.

HCI: Let me ask about a couple of the new programs highlighted in the 2024 network report. There was some information about the Support Team for Aftercare and Resources (STAR) Outpatient Centers. I understand it has transitional care management and medication disease management programs. Could you describe how these work? And have they been in place long enough to tell whether they are having an impact? 

Burket: This is one of our favorite things that we've launched in the last year. I love to talk about this one. STAR’s aftercare piece is specifically speaking to making sure patients have a safe transition from hospital to home after an acute encounter, and then the resources piece really speaks to the fact that we do not just clinical services, but also non-clinical support. We have embedded care coordinators in these clinics who are helping patients with social determinants of health barriers — things like getting access to their medication, transportation, and food assistance programs. We know that clinical management is important to prevent readmissions, but a lot of times we find it's a lot of the simple logistical things like patients not having transportation to get their follow-up appointment that cause these issues to occur. 

The transitional care management side of the clinic is the major focus of STAR. It's meant to allow patients same-day or next-day access for post-hospitalization follow-up. And in those appointments, we include a multi-disciplinary team and extended visits. These encounters are typically 45 minutes, if not an hour, so it's much longer than your typical primary care office visit. These encounters include a physician, an APP, a pharmacist and also a care coordinator nurse. They're not all in the room at the same time. They're cycling through to make sure that they all address the different issues that the patient may have, ranging from clinical to non-clinical. 

What we've seen in that clinic in its first year is that it's producing a readmission rate that's about half that of our system average across all lines of business. So it really does speak to the fact that giving the additional time and having a multi-disciplinary approach that factors in the non-clinical aspects has been really impactful for our patients. 

The medication disease management side of the clinic is focused on a much more narrow scope of patients who are on high-cost, complex, difficult-to-administer polypharmacy. There are not many patients on drugs that cost $10,000 or $20,000 a month, but those who are on them probably need additional levels of hand-holding and support that they don't get in the traditional outpatient model that has always existed. 

We are deploying an integrated pharmacy model with a multidisciplinary team. Again, this involves hour-long encounters, typically, with patients who are bringing in laundry baskets full of orange pill bottles. We're sitting down with them, chatting with them about medication optimization, and they're really focused on the specialty pharmacy medications.

As you're probably aware, specialty pharmacy is the fastest-growing cost segment in all healthcare, and it's not just the GLP-1s. There are a lot of biologics and other sorts of medications that are quite expensive, and the dosage and the titration requirements have all these iatrogenic effects and cross-indications. They're all updated every single year because these drugs are so new. And there are more than 100 new specialty meds that hit the market every year. 

What we have seen nationally is that this type of program typically saves 10% to 15% right off the bat, just by medication optimization, and the clinical outcomes typically improve. Whereas the transitional side of the clinic is really meant to be more of a non-durable relationship, the medication disease management is actually quite the opposite. We want to build a relationship with this patient and have an ongoing review of their medications and their disease progression to make sure we're updating their meds frequently. You need to have a clinical eye on these, as opposed to just kind of set it and forget it. That's why we're seeing these integrated pharmacy models deliver the results that they've been able to produce. We've been able to save significant dollars for both the patients out of pocket as well as for the health plans, and most importantly, being able to get patients access to medications they wouldn't otherwise have access to, and to help them with their compliance and adherence as a result. 

HCI: I read that in the past year you also launched a joint venture with InnovAge through the national Program of All-Inclusive Care for the Elderly (PACE). What does that look like and what segment of your patient population is it addressing?

Burket: I would say one of the most underserved portions of our community has been the sick, frail, elderly population.This program is an opportunity that Orlando Health saw to partner with InnovAge, which is the largest PACE leader in the country, to bring a dedicated center into Orlando. The PACE program is designed for frail, vulnerable, elderly patients, and it essentially serves as their medical home, where they align to a primary care physician in the facility. 

The facility here is really quite impressive. We actually took over a large former department store, totally gutted it and refurbed it, and it’s almost like a spa. It's so nice when you walk inside. It has all the services built in. It's got dedicated physician offices, with 10 exam rooms for primary care. They have specialty care offices. They have a full dental suite,, a dietitian, a gym, a spiritual care center, behavioral health, kitchen areas, and activity rooms. It is basically a full living facility that allows patients to get bused in every single day from their homes at no cost to them to be able to get this care that they need. And it's a full-risk program with Medicare, so we're obligated to make sure that we're managing their health in a way that's as efficient as possible for them and gets them timely care and access. But it's also focusing on not just the medical but all of the social and behavioral aspects as well. So there is a camaraderie and community element to that, but we’re still giving them the autonomy to live independently in their own homes. There are a lot of patients who don't want to live in an assisted living or skilled nursing facility, and this gives them an alternative to that. 

HCI: I understand that you also have created a practice support specialist team for primary care practices. How many positions were created, and what kind of role are they playing?

Burket: The practice support specialist role is something we rolled out about a year ago, and at the time we brought on nine. We’ve since expanded that to 12, and their role is really pre-clinical encounter-focused. What they're doing is providing a concierge service, reaching out to patients prior to their scheduled appointments with our primary care physicians and going through questions and data input items that the physician would normally have to do in the encounter and have a lot of their time and drive a lot of clicks in Epic and screen time so they're looking at the computer instead of the patient. We're able to do this service where we call the patients in advance, make sure that they have transportation to their appointments and everything that they need to know. If they need to have labs performed before they show up, or any sort of studies, we can get those organized. We can get mammograms or colonoscopies ordered. They also going through a series of health assessment questions, things like depression and tobacco cessation screening, and we're getting it all documented in Epic prior to the encounter.

What we've seen is patient satisfaction has gone way up for these patients. They are getting more time with their clinicians during the encounter, partly because we're saving an average 99 clicks in the EMR per patient encounter. It's saving over 12 minutes per encounter on average across all the clinical staff. So it's actually improved our access as well, because we've been able to add almost two extra appointment slots per day for the physicians who have used the service. Today about 95% of our primary care docs are using this service,

HCI: Is that primary care docs who are both employed and and affiliated in the network?

Burket: We've only, deployed it to our employed Orlando Health physician associates as of now. Although we've talked about it for community docs, the biggest challenge, as you alluded to earlier, is that those providers are on different EMRs. So we would just have to figure out a way to pipe into those EMRs with our team, but it's something we're exploring, for sure, because we have seen better quality outcomes, better risk scores, better patient satisfaction, improved access, all all the things that we were hoping for, and honestly, they've exceeded our expectations by a long shot, so we've been very happy with that, and obviously the physicians and the patients have as well.

Sponsored Recommendations

Cloud Communications: Connecting Care at the Core

Cloud communications is the present, the recent past, and the future of collaborative healthcare.

The Ultimate HIPAA Security Guide for Cloud Communications

The healthcare industry is leading the charge in innovation, embracing cutting-edge technologies to enhance patient care and optimize operations. Forward-thinking organizations...

Improving Workplace Safety and Patient Care in Behavioral Health

In 2023, Vail Health enhanced safety in their behavioral health clinic, but the impact went beyond their expectations. Read their case study to see how prioritizing workplace ...

Transforming Hospital Capacity Through Smarter Patient Progression Strategies

Helping patients move seamlessly through every stage of their care, from admission to discharge, is critical to ensuring patient safety, improving outcomes, and optimizing capacity...