Partners plans for future with connected health

BOSTON—“Market pressures continues to intensify, requiring a system approach to compete successfully,” said Gary Gottlieb, MD, MBA, president and CEO of Partners HealthCare System in Boston, speaking at the 2014 Center for Connected Health Symposium.

For a long time, insurance served as a buffer from cost pressures and price sensitivity, he said, “essentially allowing almost endless elasticity in price. With the Affordable Care Act, increasing price transparency will make it very difficult not to be accountable in the long run.”

Partners has been preparing for the future by investing in long-term care, psychology, pediatrics, prenatal care, community health centers, rehab and more. The question now, he said, is how to transform them from a set of related silos to have a higher degree of coordination so they can be used seamlessly.

Since 2011, “we’ve done things to change the paradigm,” he said, including reopening existing commercial contracts, working toward bundled payments for referral populations and becoming a Pioneer accountable care organization. “We want to define the sweet spot between payer and provider in care management.”

Partners currently cover more than 500,000 lives under accountable care contracts. “That really requires transformation and redesigning of care,” Gottlieb said. Partners has addressed three main areas:

1. Primary care is where the majority of its contractual population is managed. “We’ve demonstrated that a new way of designing primary care for very sick people could, in fact, reduce their utilization, improve their health, reduce mortality and reduce costs.” Identifying those very high-risk people is important, he said, because fragmentation causes substantial costs and potential for catastrophic utilization.
2. Specialty care is where a large fraction of costs are incurred, especially in commercial and employee populations, Gottlieb said. So, Partners wants to involve patients in better self-management of their care. The organization also is creating better access to specialties virtually, in a connected way and directly. “We’re starting to look at episodes of care around the specialist and create bundled payments.
3. Primary prevention and wellness promotion are the third phase. “We need stable populations over time to do true wellness. We have to have the right incentives for people to manage their nutrition, exercise and so on.”

Connected health is at the core of these plans, he said, including a remote monitoring data repository, patient portal and EHR. A technology platform brings these tools together and promotes a higher level of interaction with one’s own health. “That allows us to start to create strategies that allow us to manage care.” For example, Gottlieb cited Partners’ connected cardiac program in which nurses can see through remotely-generated data when somebody is beyond a specific threshold and intervention is necessary. After four months, they saw a 50 percent drop in readmissions.

Partners also is working on establishing medical neighborhoods, Gottlieb said. “We’re taking venues where people are and making primary care providers, medical centers and hospitals seamless. A medical village is the center point with perfect customer experience to support the overall vision.”

Through Partners eCare, the organization will move from system fragmentation to one shared system, he said. “We’re developing and implementing an integrated health and administrative system across Partners by 2017. The goals are to provide greater value with better, safer, more efficient patient care; and support new ways of caring for individuals and entire populations. This will provide more and better information to support all aspects of our mission.”

Each patient will have a single record and a single team accounted for by the whole spectrum of services, he said. Partners also wants to make certain the tools they use translate to science, catalyze and improve it. “We want to bridge research, clinical and community missions that will help us move in a diagnostic way from pursuing negatives to pursuing true positives.”

Connected health, Gottlieb said, “will create the efficiencies necessary to transform from an illness care system to a wellness system, translate science in a relatively instant way, and manage populations in a way that has the greatest of ease that is totally patient-centered and improves the human condition.”