Unity Health Network: Leading with a Value-Based Care Approach
As the nation’s healthcare system continuously moves toward recognizing quality, Unity Health Network has concurrently focused its efforts on comprehensive care initiatives that have yielded extremely positive results in achieving improved outcomes and lowered costs of care.
Our value-based care model encourages an all-inclusive team approach, with coordination and communication between our physicians across all specialties and settings.
Much time and many resources have been invested by our physicians and staff over the past five years to ensure we designed and implemented programs that led to improved quality, access and satisfaction for our patients.
At Unity, we believe what is vital in a value-based care organization is to understand that there isn’t one “magic bullet” activity that will allow healthcare providers to move toward a quality approach in a swift and effective manner. Rather, it requires a careful and comprehensive method of first understanding the true goals of value over fee-for-service, followed by a plan of action to achieve these objectives, a plan firmly supported by all stakeholders involved.
Our multi-pronged plan of action includes such activities as a performance programs for providers and staff, a high-risk care management team, a focus on data analytics, and, a purposeful alignment with hospitals, skilled nursing facilities and home health agencies. Through these deliberate actions, we have been able to lower hospital admissions, reduce readmissions, improve diabetic scores, and improve cancer screening rates, in addition to a number of other gains.
Details about some of our programs, as well as some of the results of our work, can be found on this page. We recognized early that value-based care was the future of healthcare and have positioned our organization to grow and thrive as we continue to provide improved health for our communities. We believe our loyal patients will agree.
Value-based care programs
Details about some of our programs.
Call Unity First
“Call Unity First” is a program created by Unity Health Network’s Quality Improvement Committee (QI) with the goal to improve the appropriateness of care settings and access for patients.
To help ensure patients’ care was being delivered in a manner that was best-suited to their clinical need, a campaign was started to promote that the first call a patient should make – in a non-life threatening or serious medical situation – is to their primary care office.
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Whether during office hours or after-hours, patient calls are directed to a nurse triage team that assesses the patient condition. The triage team, in conjunction with a physician when necessary, helps direct the patient to the appropriate setting – an office visit, urgent care or emergency room. Patients with conditions treatable in the primary care setting are quickly scheduled with their attributed physician or, in an open appointment with another Unity Health Network primary care physician.
This program has not only allowed for a decrease in avoidable emergency room admissions, urgent care visits and hospital readmissions (all of which reduce costs), but the approach also maintains a higher degree of continuity of care for our patients as they are able to stay within our network of providers.
The “Call Unity First” initiative has met with extremely positive results. As an example, between 2017 and 2018, avoidable emergency room visits were reduced by 18% following implementation and promotion of the program to Unity Health Network patients. Additionally, in 2018, an average of 263 patients per month were able to see Unity Health Network providers as they were found open appointment times either in extended hour settings or in primary care offices other than their attributed physician.
“Call Unity First” has been promoted in a number of ways to expose patients to this important program. Exam room “door-backers” advertise the initiative, taking advantage of the “captive” audience waiting to see a physician. Refrigerator magnets were passed to patients with their discharge reports, flyers were included with billing and all office staff received talking points and instruction to remind patients about the program while interacting with them during an appointment.
Improving access so patients could see a Unity Health Network provider during an urgent clinical need, while reducing costs and increasing satisfaction and quality are the key benefits of “Call Unity First,” and its just one of the many ways Unity Health Network has been successfully moving toward a value-based organization.
Nurse Triage Program
Unity Health Network’s proprietary triage service provides continuity and consistency for the patient, a high degree of call relief for the doctor, and enhanced levels of quality and satisfaction for the patient.
Currently, nationwide the majority of physicians use traditional non-medical answering services to provide nights and weekend patient call support. However, these services do little more than postpone physician callback. The burden of responding to each call still rests with the physician. Unity Health Network’s proprietary triage service provides continuity and consistency for the patient, a high degree of call relief for the doctor, and enhanced levels of quality and satisfaction for the patient.
Our clinical team of trained Registered Nurses are the front line for all of our patients with off-hours needs and questions. After a complete telephonic assessment, a nurse recommends the most appropriate course of action, following industry-established and proprietary guidelines to ensure patients get the right level of care at the right time.
This approach has many benefits, including:
- Avoidance of costly, unneeded visits to the ER
- Connect Unity Health Network patients to a nurse in under 60 seconds
- Helps patients get to the right care at the right time at the right place
- Helps patients make informed healthcare decisions
- Promotes wise use of healthcare resources and benefits
Post Acute Care Network
Unity Health Network has taken a progressive approach to create and execute an effective Post Acute Care strategy.
Doing so provides our organization with three main benefits: to ensure our patients have access to the post-acute care capacity needed; to ensure successful participation with value-based payment models; and to keep post-acute care patients who do need readmission, within our continuum of care.
The first step was to develop a network of partnerships with preferred post-acute care providers. These providers offer a continuum of post-acute care services (skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, hospice care) that ensure appropriate geographic coverage, high-quality care and strong patient experience, and efficient use of resources.
Partners are selected based on evaluation against carefully developed criteria, with a heavy emphasis on quality performance and cost management, as well as willingness to accept hospital/system input into post-acute care standards and protocols. STAR ratings and LOS in post-acute settings, as well as readmission rates to acute care, are also among criteria commonly considered.
Once selected, Unity Health Network’s Quality Improvement committee reevaluates the preferred post-acute partners’ quality and outcomes data on a quarterly basis to ensure the organization is still within the parameters of the preferred network status.
With 30-plus home health agencies, skilled nursing facilities, and other post-acute care organizations in the Unity Health Network market area, some of the objective quality measures, such as Star ratings, do not always reflect true quality or value. We also take into consideration data around actual patient outcomes in as real time as possible, as one of the biggest challenges with reviewing claims data is the difficulty of talking about events that happened 10 to 18 months ago. Partnerships are also assessed by reputational insight and interpersonal/staff collaborative support.
We are always looking to align with facilities and home health agencies that do a good job of managing patients with certain diagnoses while improving quality, reducing length of stay, reducing readmissions, and enhancing patient experience.
High Risk Care Management
As Unity Health Network continues its move toward becoming a fully value-based care organization, company leaders realized one of their key actions must be to assume greater care management responsibilities to better control the clinical and financial risk associated with high-risk patients.
Patients with complicated health (and often accompanying social) conditions are at risk for poor health outcomes, inadequate quality of care, and increased costs.
Unity Health Network designed and initiated a process of managing the care of high-risk patients, using a number of tools that could be deployed in a supportive one-on-one environment to assist the organization in achieving three goals: delivery of the right care at the right time and at the right place.
The first step was to identify high-risk patients, and better understand the number and complexity of this patient pool. Using data analytics and selection criteria tied to chronic conditions and quality targets, Unity Health Network discovered that approximately 3-5% of its primary care physician’s patient lives could be identified as high-risk.
Concurrently, while the organization was getting their hands around the data, it began structuring a team of care providers and a process that would best serve the patients in need. The High Risk Care Management team includes a physician, Dr. Brennan David Kruszewski, who provides oversight to the work of RNs, medical assistants and a clinical nurse specialist specifically working with the program.
After the team was put in place and patients were identified as high risk, the High Risk Care Management program began to enroll patients through a number of paths. First, going back to the data, a patient is identified as possessing the characteristics needed for participation. That information is then vetted by the program’s nursing staff to ensure the patient is indeed a good candidate. Once the team feels comfortable with enrolling the patient, a letter is sent introducing and explaining the program, followed by a phone call to hopefully encourage the patient to enroll.
A second way to be enrolled is by a direct referral from the patient’s primary care provider. Unity Health Network’s primary care team are the closest to the patient population and can quickly determine if a patient not only fits the criteria but also has the personality to be a successful participant.
A third and final way patients may become enrolled in the High Risk Care Management program is while as an inpatient at a regional hospital. Both Dr. Kruszewski and the program’s CNP round at two hospitals in the Akron, Ohio area, and have the opportunity to identify those patients that may benefit from participating in the High Risk Care Management program.
Once a patient has agreed to participate, a home visit is scheduled and fulfilled by one of the program’s nurses. At this meeting, the nurse does a total health and home assessment, closely detailing the patient’s health history, current conditions, goals, lifestyle factors and environment. The patient is also provided a comprehensive description of the program, Unity Health Network’s goals with the patient, initiatives and activities to expect and a preliminary schedule of follow-up visits and calls. The care plan is specific to each patient’s individual needs, and that is where the power of the High Risk Care Management program comes to bear. A values-based approach does not allow for “cookie-cutter” care – it must look for the gaps that have led to or are exacerbating current conditions, and work to provide care to stop or reverse the negative effects. By doing this, Unity Health Network has begun its earnest commitment to a quality-based care approach.
Though care plans are individualized, all rely on an educational focus that builds the patient’s self-management skills. Ensuring patients understand the necessity of self-management between appointments, and using tools and technology (such as text reminders and emails) to reinforce this activity, Unity health Network has been able to reduce the risk of patient escalation and avoidable acute care utilization. The organization has also implemented newer technologies to promote more technology based care such as Bluetooth enabled devices that interact with our EHR system sending information directly to providers.
Additionally, Unity Health Network has begun to explore utilization of broader community resources to help patients adhere to the goals of the program. Transportation, physical activity and behavioral health needs can be supported through partnerships with other healthcare providers and civic and non-profit organizations in our region. Unity Health Network looks forward to growing the adherence to the program with these resources.
Patients are able to graduate out of the program, which is a very positive experience for them and the care team. Not only has their quality of life improved, but they are also experiencing reduced costs and increased satisfaction with their healthcare. Organizationally, the High Risk Care Management program is becoming more successful than planned, and it has had an overwhelmingly positive impact on reducing healthcare costs and readmissions to hospitals as well as improving provider satisfaction. Caring for complex high risk patients can be overwhelming in a busy office setting when providers have minimal time and resources; however, Unity Health Network is proud to have developed a High Risk Care Management approach to help not only its patients but also its providers and staff.
Read about the success of the High Risk Care Management program in Cleveland Magazine here.