Future of health care focuses on a comprehensive approach

Moore, originally of York, came to Saint Elizabeth Regional Medical Center 35 years ago as a registered nurse. She spent years in critical care and later as chief nurse before becoming hospital president 2½ years ago.

Woodrich, born in Omaha, got his first job at Omaha’s St. Joseph Hospital restocking medical supply carts and sterilized surgical supplies in operation rooms. After earning business degrees and climbing the ladder with Sisters of Mercy hospitals in Michigan, Virginia and Missouri, Woodrich became president of Bryan Medical Center four years ago.

The leaders of two of Lincoln’s largest employers, the caregiver and the businessman approach health care from different perspectives but share a passion for people and good health. Both bring that commitment to Lincoln’s hospitals, vowing to provide the best health care in an increasingly complex and changing world of medicine.

We sat down with Moore and Woodrich to talk about the future.

Q: How is health care changing the role of hospitals?

The focus is wellness -- preventing illness and disease before they become chronic, debilitating and costly, the two said.

“Health care is so complex. It is not just about illness care,” said Moore.

The best approach is comprehensive and individual. Both hospitals use a team approach to helping patients -- uniting hospital staff, physicians, insurers and even employers in an alliance of prevention and healthy living. And, in the case of illness, these teams work together to provide seamless transitions as patients move from hospital to care center and then home -- ensuring success through accountability, compliance and coaching.

The hope: healthier patients, lower hospital readmission rates, fewer medical crises and lower health care costs.

“With more preventive care you catch things earlier,” Woodrich said. “You get people into healthier lifestyles.”

Once upon a time, the hospital was the hub of health care in a community.

“Now it is more specialized,” said Moore, with hospitals doing far more than providing traditional inpatient care.

“Today, 40 percent of our business is outpatient. It is a totally different environment,” Woodrich said.

“Now we are changing from an outpatient (focus) to proactive health approach. You can never learn too much about a healthy lifestyle.”

That will play a huge role financially and medically as baby boomers continue to age.

“It is no secret that a lot of health care dollars are spent in our later years,” Woodrich said. “We hope that if we jump on something as easy as educating the patient, maybe there will be more savings.”

Key to that healthy knowledge is an integrated approach to medicine -- a continuum-of-care network, Moore said, using today’s health care buzzword. In basic terms, it means a nurse navigator or someone similar tracks a patient's progress through one-on-one communication from hospital to nursing home to home. The hope is that a medically trained professional can spot and address problems before they become medical crises.

“The goal is that we don’t have gaps in transition, and that patients don’t fall through the cracks anymore,” she said. “We try to simplify things for the patient, and ultimately prevent them from readmission to the hospital."

For the patient, continuum of care may mean a nurse navigator or nurse practitioner checking in on initial days, weeks and months following hospital discharge, making sure they are taking their medicine, following doctor’s orders and keeping follow-up appointments. If the patient is not going home right away, the hospital and physician work in tandem to ensure staff at the care center or rehab hospital know exactly what the patient needs to get better.

“It is really exciting,” Moore said. “I feel like we are doing things to keep people healthy.”

That strikes a chord with her.

“When I was a critical care nurse, I saw people at their worst. Now we do everything we can to keep patients out of the hospital.”

People who do end up there are usually the sickest patients, but even then they do not stay as long as they used to. The average hospital stay is 4.8 days according to the U.S. Centers for Disease Control. Patients are quickly transitioned to the next level of appropriate care, be it long-term acute care, rehabilitation, nursing home or home with outpatient services.

Today, the hospital means a lot of different things to communities and patients.

“And we all need to work together,” Moore said.

Q: What challenges do hospitals face under the Affordable Care Act?

“We are moving from a fee-for-service to a fee-for-value system,” said Moore.

Right now providers are paid for the services rendered, but ACA forces providers to invest in managing the health of the population, she said.

When Saint Elizabeth opened 125 years ago, it had a billing ledger -- one line for each patient, Moore said.

Today, medical reimbursements are so complicated it requires an entire infrastructure to support and regulate it.

With the start of the new year, Saint Elizabeth began offering a “bundle payment program,” Moore said. Patterned after similar bundle packages offered by cable television and telephone providers, Saint Elizabeth worked with 14 orthopedic surgeons to set specific prices for the entire care package -- meaning the onus falls on providers to ensure each patient has a positive outcome, thereby reducing the incidence of hospital re-admissions, infections and costs.

“It’s not easy and sometimes it feels counterintuitive because we are not paid for it,” Moore said, noting that hospitals cannot bill for services provided by nurse navigators and nurse coaches.

“The whole idea is to improve the transition of care … care continuity,” she said. “Not only does it cost less, but we achieve quality outcomes.”

Put simply, the idea is this: Do the right thing -- good clinical care, good financial care -- and be more cost effective, Moore said.

The Affordable Care Act forces health care providers to take the waste out of the process and streamline it, said Woodrich.

For example, Bryan Health implemented a new purchasing plan for medical supplies.

“We can get down to the root of the process and take out variations, resulting in significant savings and effectiveness which can be passed on to the consumer,” he said.

It’s not a one-size-fits-all approach, but rather allows hospitals to work with distributors to find the best cost for medical supplies.

The ACA also has a built-in quality matrix.

"I love that is it is outcome based,” Woodrich said. “In the past people used billing data and turned it into information about quality. Billing data is not in terms of best practices of care and best outcomes.”

Health care reform forces providers to use a coordinated approach to patient care.

“It’s not just what happens within the (hospital) walls, but promoting health for a lifetime,” Woodrich said. “It is a more comprehensive approach.”

Both he and Moore use the congestive heart failure patient to illustrate the point. People who have congestive heart failure have some of the highest hospital readmission rates in the nation.

Now, within 24 hours of discharge, hospital staff call the patient, go over doctor’s instructions, answer questions and reiterate the importance of compliance. Then, they call back a few days later to check in and schedule follow-up appointments with the patient's primary care physician.

“It helps with patients who may need a little more accountability completing the work,” Woodrich said. “It is now part of the package.”

That part cannot be directly charged to a patient or insurance company, so it is built into the existing health care approach, both Moore and Woodrich said.

“Affordable Care Act changes the role of hospitals. They have a more active role of managing that individual’s health,” Woodrich said. “There is no magic formula for accountability of the patient to get them motivated enough to take care of their health.”

But both say providing wellness coordinators and health coaches to their own employees signals that health is a priority.

“If we do it as an institution we have a nice product to show -- a healthier, happier workforce is there to provide care,” Woodrich said.

Q: What do you want people to know about your hospital?

"Everybody knows we are a faith-based Catholic organization that’s been around for 125 years," said Moore. "A little bit of a secret is the support we provide in the community.”

That support includes working with St. Gianna Women’s Home, Catholic Social Services’ transitional housing for women and children escaping domestic violence; Lincoln Health Hub, a program that helps arrange primary care for people who are uninsured or who do not know what they qualify for; and Lincoln ED Connections, a collaborative emergency department case-managed program between Saint Elizabeth and Bryan Health with the goal of decreasing 911 calls by 50 percent and nonemergency visits by 70 percent.

"We are here to serve the community," said Woodrich. "Our goal is taking care of our community, as well as areas outside of Lincoln, serving Nebraska, Kansas, Missouri and Iowa. We want to be a premier medical center and feel we can do it with collaboration and our relationships in the pursuit of excellence."