This edited article features Warren Smedley, UAB Health System Service Line Director and double-HSA alumnus (Executive MSHA and M.S. in Healthcare Quality and Safety), and looks at one of UAB’s most recent ventures, Guideway Care.
The economics of health care in the U.S. continue to move towards value-based care, which will better align the financial incentives to enhance the patient centered focus of care, reduce unnecessary utilization, and reward providers for improved efficiency. Multiple alternative payment models are being introduced that will reward providers for the value of care versus volume and support the now-foundational concept of the Triple Aim—improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care.
As the requirements for alternative payment models are rolled out, it has become clear that the ability to impact a patient’s total health, and not just their healthcare, will be crucial for success. A recent Kaiser Family Foundation¹ research paper noted that health care accounted for only 10% of the factors leading to premature death, while social and environmental factors combined with individual behaviors made up a total of 60%. Providers have struggled to find effective ways to address these types of non-clinical issues that have an overwhelming impact on patient health. Many have redirected expensive clinical resources, including nurses, towards tackling these non-clinical issues. Unfortunately, models that utilize clinical resources to address these non-clinical factors are not economically feasible long-term.
UAB Medicine has been a leader in developing innovative health care models to address whole-person health for many years. One of these models, Patient Care Connect, was an innovative program of lay patient navigation that spanned 12 hospitals across the southeast, funded by a grant from the Centers for Medicare and Medicaid Innovation (CMMI). The lay navigators played a crucial role in helping coordinate care for cancer patients receiving treatment at these facilities, helping connect them with vital resources and breaking down any barriers encountered by the patients. The program produced substantial improvements in patient satisfaction and reductions in unnecessary utilization and gave rise to one of UAB’s most recent ventures, Guideway Care.
“While the concept of patient care coordination using non-clinical patient navigators is not new, in the Patient Care Connect model, we championed a novel approach to supporting and empowering cancer patients to overcome health system barriers, addressing treatment complications earlier, and getting the information they need to make more informed choices about their care options,” said Warren Smedley, Health System Service Line Director at the University of Alabama at Birmingham (UAB) and co-author of the CMMI patient navigation grant. “We developed unique, individualized care pathways for navigating cancer patients, based on a proprietary model of continuous patient assessment, and then provided the navigators with extensive training in cancer care coordination and navigation. The result was extremely high patient satisfaction, a substantial reduction in unnecessary utilization, and a significant overall cost savings.”
UAB Medicine recently invested in Guideway Care, a for-profit entity which grew from the Patient Care Connect program, in order to spread the message and accelerate adoption of care team redesign. Care team redesign will be crucial to providers who wish to succeed under alternative payment models. Within the redesigned care team proven by Patient Care Connect (and now Guideway Care), physicians, advanced practitioners, nurses, and admin/clerical staff are joined by a care guide. Care guides provide patients with the non-clinical support they need, helping improve patient outcomes and experience while freeing clinical staff to focus on clinical issues. The care guidance program bridges gaps in care, creates patient behavioral change, and addresses the barriers to care hidden within social determinants of health. This type of redesigned care team is able to efficiently extend their reach and impact the non-clinical issues that impact patient health, supporting the Triple Aim of better patient experience and health, and lower costs. Ultimately, in order for healthcare organizations to meet the Triple Aim and succeed within alternative payment models, they must find a way to impact non-clinical determinants of health; we believe that a redesigned care team is the solution.