The Path to a New Health Care Model: Innovation, Agility, and the Ability to Pivot Quickly

Posted by Dawn Marie Bailey 

Innovation, intelligent risking, sustainability, and visionary leadership are all concepts that appear in the Baldrige Health Care Criteria for Performance Excellence. And in today’s health care environment, a culture that embodies these concepts may be just what is needed for the health care organization of the future—both in conforming to the Affordable Care Act and in delivering the highest-quality patient-centered care.

In southeastern New Jersey, one health care system is looking at the difficult journey to that future and has been evolving its business model–with the Criteria as a framework for its success.

Recently, 2009 Baldrige Award recipient AtlantiCare, a nonprofit health system, the largest provider in its region, announced that it had signed a letter of intent to partner with Geisinger Health System, an integrated health system in rural Pennsylvania.

“Following a thorough year-long search process to find the right partner to continue our transformation of health care, we are pleased to move forward with a letter of intent with Geisinger Health System, a national model for innovation and value,” said AtlantiCare President and Chief Executive Officer David P. Tilton. “We believe that together, AtlantiCare and Geisinger can broaden innovation and improve the quality, experience, and value for our patients and the communities we serve.”

David P. Tilton by DONNA CONNORIn a conversation with Mr. Tilton, he elaborated on how AtlantiCare has been planning for this transformation of health care and the future.

What do you mean when you say “transformation of health care” and what does this letter of intent mean for AtlantiCare?

Over the last decade, we began developing new models of care aimed at providing more value to our community. Over the last 18 months, we have used Category 2 [the strategic planning category of the Criteria] to evaluate our readiness to be accountable for the health of populations in our region and to develop and implement our population health strategy. We looked at the needs of our community, the evolving roles of our care team, and the ever-changing national health care environment.

We made a strategic decision to focus on population health management and determined the need for a partner in order to succeed. We looked for a partner with a proven track record whose culture is compatible with AtlantiCare’s. Geisinger Health System proved to be the most likely candidate.

Population health management is a significant strategic shift in the health care model from fee-for-service, in which the greater the volume, the more the health care organization is paid. We believe that the fee-for-service model is becoming obsolete. Instead, we plan to create greater value for health care patients and other customers with a value-based business model, one in which the organization is compensated for services provided and outcomes achieved. The health care organization becomes accountable for services.

How is this move beneficial, especially in terms of innovation and value, for AtlantiCare and its patients, other customers, and stakeholders?

Consider that the health care field in America is like a strong running river, and we are trying to shift the river’s flow to a different direction. What customers and businesses are saying and the Affordable Care Act is signaling is that health care must move in a different direction. Across the nation, the challenge is that health care is not always affordable or producing the outcomes required. The overall population and business community demand a new approach. Episodic care is not producing major value.

AtlantiCare decided to take an intelligent risk to change our business model. It’s kind of strange because we are a very strong organization. We continue to perform solidly. All of our measures are solid. This was a big, thoughtful shift in how we deliver care.

Did AtlantiCare use the Baldrige Health Care Criteria during this opportunity? Does it still use the Criteria?

The Criteria still live strongly at AtlantiCare. We think about what our future Organizational Profile will be and that fuels our vision. The Criteria are not something we occasionally use; they are embedded in our culture, our work, in all we do.

We use the Criteria to determine our path to the future, as well as to design and evaluate our key services and daily operations. All of our work and planning are targeted toward our vision of building healthy communities well into the future, and all of our work is rooted in the Criteria. This is especially important because we believe that AtlantiCare and all health care organizations will experience some choppy waters with the transformation of the entire field of health care.

What has AtlantiCare learned and/or implemented during its Baldrige journey that led to improvements?

One of the things that came out of AtlantiCare’s Baldrige improvement journey was more effective strategic planning.That discipline is serving us well.

What we have also learned is the importance of real-time communication with our board, physicians and staff, and community so that they can all connect with the work we do and with our goals. We continue to enhance communication–even more so this past year. Be it internally or externally, with traditional or new media, face-to-face or other venues, we know we have to successfully communicate in many ways to reach the various communities we serve. We invite feedback, thoughts, and observations.

We have been studying this transformation in health care over the past four years and sharing information and what we’ve learned throughout AtlantiCare, so that all stakeholders can prepare for and participate in our future.  This communication is an important part of AtlantiCare’s incredible engagement work with staff, resulting in top-box employee engagement scores. How we relate to people is essential to our work in health care. Workforce engagement continues to be important in achieving goals, fostering innovation, and creating an outstanding patient experience.

Given the current health care climate, how do you think that the Criteria might help or be used by other organizations?

The Criteria are incredibly valuable. I think one of the things that has really helped us a great deal and could help other organizations is taking a look at writing an Organizational Profile and assessing your category one [leadership category of the Criteria] position. This helps you really think about who you are as an organization, how visionary your leaders are, where you want to be three-to-five years down the road, what relationship you want to have with your staff, customers, community, etc.

The future is not going to be an extension of the past. Difficult journeys require innovation, agility, and the ability to pivot quickly. Having the Baldrige framework surrounding and guiding you and using it as a way to improve performance, is extremely effective. The language and thinking that the Baldrige Criteria bring to you really can provide great overall benefit for any organization.

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