organizations that are very high-quality, didn’t achieve savings. Our focus has always been about improving outcomes while also saving money. We’re very focused on the innovation, and look at it as a learning ground, in terms of how we might expand our success in the MSSP, into work with all our payers? We’re looking to expand that. But I think early innovation—we’ve been doing it a long time—and an intentional focus on invest- ing in our people and our technology. Our scale helps us, because we can do this across a large volume of patients and a large geography.

And part of the success is because we’re on a common electronic health record now, including throughout our employed medical group; that’s Epic. We’ve used that data to support care management teams, through Epic’s Healthy Planet. That’s a powerful care management tool, available to team members across the continuum of care. So we’ve invested in that technology, but also, in our integrated care management program. So we’ve invested in people; and there’s a cost to that. But following patients once they’ve left the hospital. And COVID gave us a little push. We’re using Care Companion, Vital Tech, and Emmi [the Emmi AI patient engagement solution from Wolters Kluwer] that we’re using to reaching out to our patients, to monitor them, in order to prevent unnecessary rehospitalizations and ED visits. And our seniors want to be at home, and want to be cared for at home. If we can give them that, it’s a big satisfier for the patient and the family, and improve outcomes and save money. Integrated care management team uses those tools to reach out to those patients. Emmi leverages phone calls, and also provides educational videos.

Some have compared this work to trying to turn a ship around in mid-ocean. On the one hand, larger, integrated health systems have far more resources than smaller organizations or standalone hospitals. But the politics and bureaucracy can be challenging, correct? I do think it depends on the organization. But our CEO, Jim Skogsbergh, is serious about improving outcomes and lowering costs for purchasers, payers, and patients. And the fact that we’ve spent millions in technology and on people—we have a proven track record. We’re serious

about it. And though it might lower our revenues in the short term, it’s the right thing to do for our patients, payers, and taxpayers. And when you’re looking at things like bundled payments and the MSSP, there’s a learning curve, and it requires an unwavering commitment over time. And another example of that is that we’ve grown the program. Within the context of our care management program, we’ve touched 10 percent of our MSSP patients in Illinois and 13 percent of our MSSP patients in Wisconsin.

Can you speak to the ongoing challenges in the U.S. healthcare system of changing the physician culture and evolving it forward? It’s physicians who control most healthcare spending, and who need to buy into any systemic changes. It’s a wonderful question. And you’re right: there’s no question our healthcare spending is out of control, and Medicare funding is in trouble. And the Commonwealth Fund report showing the U.S. ranking eleventh of eleven in quality; it’s embarrassing. The problem is clear and it’s out there. To answer the question, we feel we’re tearing down some of the silos. And we’re aligning finan- cial incentives for physicians. You know, it’s not just doing more, it’s doing the right care in the right place. We’re intentional about reducing duplicative services. And we have programs where we talk with the physicians about state of the art and best practices; and sometimes, it takes a long time to incentivize different behaviors. But doctors feel satisfac- tion in reducing expenses while delivering improved care, actually.

What have been the biggest challenges in changing the physician culture, and how have you and your colleagues overcome them? For all of us, we’re still living in two worlds—the fee-for-service world, and the world in which we’re taking on increasing risk under value-based care. You still have some push and pull, and some folks are still anxious about living in both worlds. So it’s education, it’s realigning incentives, and it’s also budgeting with eyes around value-based care.

So many leaders have referred to the one-foot-in-the-boat, one-foot-on-the-shore question; what does that feel like for you on a day-to-day basis? Well, it’s uncomfortable, but as we con- tinue to see success, in improving out- comes while reducing unnecessary care and costs—with our proven track record, we’ll be a trusted partner for patients’ healthcare.

What does the next couple of years look like for you and for Advocate Aurora Health? We’ve had our challenges with COVID, and we’re challenged with the surge, with the Delta variant, and with staffing. So there are other challenges that are pres- suring all healthcare systems across the country; I see us continuing to expand our care management. We see how effec- tive that is. We’ve done a pretty good job of starting to take care of these chronic conditions, and we need to continue to do a good job of giving optimal care in the right setting. HI


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