A Publication of WTVP

The NGACO model is among the initiatives driving healthcare providers to find innovative ways to deliver services.

With 2016 in full swing, what you are hearing about healthcare may sound familiar… but with greater emphasis. Healthcare providers must continue to find innovative ways to deliver the services communities want and need.

For OSF Saint Francis Medical Center, there are some key areas we are focusing on: access to care, continuing to improve clinical outcomes, and developing partnerships. We have to offer the care someone needs—how and when they need it—and sometimes that has nothing to do with the walls of a building.

OSF OnCall is one example. OSF OnCall is 24/7 online access to medical care for patients throughout Illinois via smartphone, tablet or computer with Internet access. They are connected directly to a medical professional who is able to see them using the camera on their device, allowing for a face-to-face consultation and assessment. This gives the patient control over when and how they get the care they need. It improves access and reduces wait times—at a better cost. This expanded use of telemedicine has proven beneficial for patients and providers, and it has reduced the burden on emergency departments.

The use of telemedicine will continue to grow as part of OSF HealthCare’s selection as a Next Generation Accountable Care Organization (NGACO) by the Centers for Medicare & Medicaid Services (CMS). Through the Next Generation ACO model, we will partner with CMS and 20 other ACOs experienced in coordinating care for populations of patients with multiple complex medical problems. The NGACO model is part of the Department of Health and Human Services’ efforts to create opportunities for providers to move an increasing percentage of Medicare payments into models paying providers based on the quality rather than the quantity of care provided.

We will be able to expand the use of telemedicine for the upwards of 45,000 lives we are responsible for within our NGACO. This could mean providing assessments in a person’s home, at a nursing home or even in a retail setting, with the goal of keeping people out of the hospital. We will be able to more easily expand services to where we see the need.

Two other components are part of NGACO opportunities: post-discharge assessments and evaluations, and a waiver that will allow OSF Saint Francis—if it is deemed medically appropriate for the patient—to transfer from the emergency department to a skilled nursing facility without having to first hold them as an inpatient. New rules are expanding this option under Medicare, and we see this as a positive opportunity.

Along with expanded opportunities come added risks: we are bearing more of the risk for improving patient outcomes and keeping them out of our inpatient facilities. This comes down to leadership as a healthcare system. OSF HealthCare had to be willing to take the risk and be prepared to handle the variety of issues these patients often bring with them. Having been selected as a Pioneer ACO in 2011, we will use that experience and the lessons learned moving forward.

Partnership development will play a key role in how we transform care for greater population health. Collaboration will be vital moving forward—whether it’s looking to expand the services we offer, or working with any number of social service agencies to get the services someone needs to stay healthier and at home. And none of this even begins to scratch the surface of the innovative work taking place at the Jump Trading Simulation and Education Center, which holds so much exciting promise on how we can continue to improve on the care we provide. We look forward to what lies ahead. iBi

Dr. Mike Cruz is President of OSF Saint Francis Medical Center.