Accountable Care Organizations (ACOs) are a model of care delivery that is gaining traction in the healthcare industry. These organizations aim to improve the overall quality of care while reducing costs by incentivizing providers to work collaboratively and efficiently. But, with the focus on cost reduction and quality improvement, how can ACOs ensure that the optimal patient experience is delivered?
Join Todd Liu, VP of Accountable Care and General Counsel at Griffin Health, and host Alan Tam as they discuss how ACOs have adapted to continual changes, the importance of aligning goals with clinical leadership, and how technology, data, and quality metrics contribute to their organization’s success.
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VP of Accountable Care and General Counsel
Chief Marketing Officer
Speaker 1 (00:03):
Consumer demands, disruptive technologies and AI are shaping healthcare for years to come on. On Hello Healthcare, we dive deep on these issues with leaders who are driving change. We hope that these stories will inspire you to create and demand a better future in healthcare. Please welcome your Alan Tam, Chief Marketing Officer at Actium Health.
Deb Pappas (00:25):
Hello Healthcare. I’m Deb Pappas, Chief Marketing and Communications Officer at Connecticut Children’s. I’m inviting you to join the Healthcare Marketing & Physician Strategies Summit, taking place this April in Austin, Texas. I’ll be speaking at this year’s HMPS on integrating DEI into your organizational culture.
One of the highlights of HMPS are the thought-provoking and insightful discussions that address so many of our shared challenges and opportunities. To learn more, visit healthcarestrategy.com/summit. I hope to see you there.
Alan Tam (00:55):
Hello Healthcare. As the healthcare industry continues to transition and migrate to value-based care, accountable care organizations have been at the forefront leading the charge in driving change, from internal processes and structure to externally reading, managing and adapting to the ever-changing expectations of healthcare consumers. ACOs are faced with a plethora of challenges, as is. Toss in a couple years of a pandemic, and I cannot even begin to imagine the chaos that has since ensued into the present day.
So, joining me today on Hello Healthcare, I have the pleasure and delight of speaking with Todd Liu, VP of Accountable Care and General Counsel at Griffin Health. Griffin Hospital is an acute care community hospital serving the lower Naugatuck Valley region. They also serve as the flagship hospital for Planetree, who is an international leader in patient-centric care.
Healthcare organizations from around the world send visitors to Griffin Hospital’s facilities every single year. They’ve also received numerous quality and clinical excellence awards, and have been recognized for providing exceptional patient experience. Todd, welcome to Hello Healthcare, and thank you for taking the time today.
Todd Liu (02:03):
Thanks, Alan. It’s a pleasure to be with you.
Alan Tam (02:05):
Let’s start with your role at Griffin. I believe you’re one of the first healthcare leaders that I’ve spoken with who oversees both accountable care and general counsel. How did you happen to manage that?
Todd Liu (02:17):
I guess I couldn’t decide what I was going to be when I grew up, so it just kind of evolved that way organically. I had a legal background, and when I came to Griffin almost 20 years ago, we had another gentleman that was our vice president for legal affairs and general counsel for the hospital. So, I really started my career at Griffin in a number of other administrative and operating roles, and over time, continued to take on more.
Griffin got into accountable care in 2013, with the Medicare Shared Savings Program. That was kind of our first foray into it, and then our general council retired in 2015, and like all hospitals, we’re trying to keep our costs as thin as possible. So, we have a pattern at Griffin of having people take more responsibility on when people move on or people retire so we can reduce expenses.
And that’s kind of what happened with me. So I took his role, and just kept the other things I had been doing, around accountable care up to that point, as part of my responsibilities.
Alan Tam (03:19):
That’s awesome. Sounds like a real startup environment at Griffin, and I’m sure your plate is amazingly full. But thank you so much for doing what you do. I think the focus that you guys are doing is paving ways for a lot of accountable care organizations.
So, a lot has happened in healthcare in the past few years. I’d love to get your thoughts on how the ACO landscape has changed and adapted to these changes, but more specifically, the expectations and behaviors of healthcare consumerism.
Todd Liu (03:51):
It’s been a long road, I mean, we’ve been at this now for about 10 years. We were an early adopter in Connecticut, but other parts of the country have been doing value-based care even longer than we have. So, Kaiser out in California and some of those other healthcare systems, they’re old pros at this, and I think other parts of the country, like Connecticut, we’re just trying to play catch up and kind of do some of the things that they started doing years ago.
But I think in terms of our experience, some things have moved a lot quicker than I would’ve expected, and some things we’ve made some progress, but there’s still a lot more that we can do. I think in terms of consumers, if you said “accountable care” to the average consumer and asked them what that is, most people would have no idea what you were talking about. And I’m not sure they need to know what accountable care is. But the question really is, do they see and do they feel that difference of what it means to be in an ACO, or what it means to be part of a value-based care arrangement?
I think that for the consumers that are part of our ACOs, the answer to that is yes. So, they know that there are certain things that are different than maybe what they looked like or felt like before they were part of our ACO. They know they’re getting a lot more, kind of high-touch services. They know that if they have chronic conditions, that they have nurses that are calling them and trying to work with them. They know that if they have social needs, we have community health workers that are trying to work with them to connect them with services in the community. Those are just a couple of examples.
Again, I don’t think that they would tell you that they’re part of an an ACO; they probably haven’t made that connection. But certainly from our perspective, we know what those things are that we’re doing to try to help them. And I think that if you ask them, they would acknowledge that things are different than maybe what they were five years ago, before they became part of one of these arrangements.
Alan Tam (05:42):
Right. You did mention, one point I want to kind of tease out a little bit more and have a better understanding is some advancements that you guys have undergone, through the past couple of years. Can you share what are some of the neat things that you guys have done to help improve the patient experience and kind of their expectations?
Todd Liu (06:02):
Yeah. I mean, I think when you look at the future and what we need to do to be really successful as ACOs, a big piece of that is getting patients engaged. And I also kind of hate using that term because it’s somewhat overused, right? I mean, every consulting company out there talks about patient engagement and, “We’re experts at engaging patients in their care.”
But if you think about what does that really mean and what does it mean for us, as an ACO, to be successful, what it really means is we need to get people interested in taking care of themselves. And maybe more important, we have to talk to them about that in a way that’s kind of inspiring, or motivating, and wants them to make those changes.
But I really do believe that everybody wants to live their best life. So, as healthcare providers, we have this tendency sometimes to label people as noncompliant, or we start to think that they’re very content not being that healthy. But I don’t believe that’s true. I really do believe that people want to live their best life, they want to feel good, they want to be healthy, there’s goals they have in life. And so for us, the question is, how do we figure out what those things are, and how do we work with them so they can live their best life? And there’s a number of ways that we’ve tried doing that.
One is, we try to really understand who they are as people and what those goals are that they have for themselves. On the patient-centered care side, we started this concept of patient-centered care here at Griffin Hospital back in the 1980s. It was actually 1987 when Griffin first started down this journey in our birthing center. And then, we adopted that patient-centered philosophy, called Planetree, back in the early 1990s. We’ve thought a lot about what it means to be person-centered in an inpatient setting, and now it’s taking some of those same lessons that we learned and trying to apply them to outpatient care.
And so, that really is getting to the core of who people are, what motivates them, what is it that matters to them, how can you form relationships with them in a way that’s going to tap into who they are and inspire them to want to make lifestyle changes. And everybody is different. So, we have to meet folks where they are. And some people are ready to make change and other people want to make change, but they’re not quite ready yet.
So, we have to figure out what all those different factors are, and we have to figure out how to connect with people, again, so that they want to make these changes. Which, again, I do believe that people want to make, deep down, but sometimes it’s easier said than it is actually done.
Alan Tam (08:32):
Yeah. That sounds like a Herculean effort, quite honestly, trying to tackle all these different things. If you had to distill it down to the most critical items, say, the top two or three things to focus on for the next couple of years, what would those be?
Todd Liu (08:48):
Well, I think one of the really, really big ones is kind of identifying some of the social and environmental barriers that people have to getting care. So, there’s some pretty well-published literature out there that tells us that 60% of people’s health is actually not driven by the medical care that we provide as doctors and hospitals, and 60% of overall health is actually driven by behavioral, environmental and social factors that people have to come in contact with every single day.
So, if you’re food-insecure, if you don’t have a safe place to live, if you’re concerned about paying your utility bills, you’re probably not going to care all that much about whether or not you’re going to see your PCP for an annual checkup. You’re concerned more about the immediate living needs that you have to meet. That for a lot of people is a really big barrier, and I know in our community, we have two of the towns that we serve as part of our primary service area where 50% of the people we’re serving in these two towns don’t make enough money to meet their basic living needs.
So, we’ve got to grapple with that, and we have to kind of acknowledge the fact that those are serious barriers to people achieving really good health. That’s a huge part, and we can talk as part of this conversation about some of the things that we’re doing, first to identify what those social needs are that people have, and second, what are we then doing once we find these needs that folks need to be connected to services? So, that’s huge. That’s something we’ve got to kind of figure out, and that’s something that is hard for us, because we’re an acute care hospital. We are not experts at how to meet people’s food-insecurity needs and people’s housing needs, but we’re having to kind of figure that out, and we’re having to work with other partners in the community that have been working with folks to meet these needs for a very long time.
We’re lucky because Griffin actually has longstanding relationships with other nonprofits in the community that go really deep and reach pretty far back. So, I think from that perspective, we have kind of a innate advantage over some other ACOs where they don’t have that longstanding, trusted relationship, and they’re now trying to form them so that they can meet some of the social needs that people have. Those are huge.
And the other thing, too, which I would just point out quickly that we’ve got to figure out is how to take care of people as they get older. We know people are living longer, we know that they have more and more chronic diseases that they’re living with. And those chronic diseases over time really cost the Medicare program and the Medicare Advantage program a lot of money.
There’s some statistics out there that 80% of all healthcare spending is actually spent on only 20% of the population. So, 80% of people are healthier. What we’re spending on that 80% is a lot lower than the 20% that are really sick. So, if we’re going to figure out how to get the most bang for our buck, we also have to really focus on those people that are sick; they’re older, they have multiple chronic conditions. That’s, from an ACO perspective, where we’re concerned about quality, and concerned about cost, as a high priority.
Alan Tam (11:57):
Absolutely. And I think, obviously quality performance and metrics play a tremendous role for ACOs. How does quality, though, impact your programs? And you talked about some of the challenges already from the healthcare consumer side and what the providers face. With respect to quality performance, how does that drive the programs that you’re implementing for your population?
Todd Liu (12:23):
So, every ACO program that we are engaged in right now has quality measures that we’re accountable for. One of our challenges is we are probably in eight or nine different ACO arrangements, and every payer that we have an ACO arrangement with has its own unique set of quality metrics. And sometimes, even if some of those quality measures overlap from one payer to another, the thresholds and the targets that we have to meet can differ. So, it can make you a little bit schizophrenic trying to keep up with the different quality measures that we’re trying to keep track of.
And you can imagine that if it’s hard for me to keep track of this, and I’m thinking about this and talking about it every single day, imagine our poor PCPs that are in the office taking care of patients. If you tell them, “Oh, this is an Anthem patient, and this Anthem patient has this quality measure. But this quality measure, we have to achieve 90% instead of 86%. So, please make sure that we take extra-special care, so we can reach the 90% threshold for this payer program, instead of the 86% that I talked to you about yesterday.”
I mean, you can imagine that to doctors hearing that, that is just complete and total nonsense. So, I see part of my job is helping to make it easier for physicians and for nurses and other caregivers that are involved in this work, to just focus on the things that they want to focus on, and the things that matter to them.
And then, folks like me have to kind of run around behind the scenes and figure out how to sort out all of this madness when it comes to different quality measures and different thresholds and cutoffs that we have to achieve. That’s one of the things that’s kind of a challenge for us, just in terms of what I see happening with quality measures and with quality programs, things are changing.
When I look back three years at the kinds of quality measures that the payers used to hold us accountable for, it was things like, “Hey, did you bring in this person who has diabetes this year to get their retinal eye exam done?” “Did you bring this person into the office this year to check their A1C?” So, it was more about doing something, right, to kind of help that person that might have something like diabetes.
But that’s changing. Now, payers are moving to quality measures that say, “Did you keep this person’s A1C under control?” Right? “Was their A1C actually below seven during the course of the year?” Or, “For this person that had high blood pressure, did you bring their high blood pressure under control during the year that we’re measuring?” So, it’s not so much about doing things, now it’s about actually achieving, control, or achieving some kind of health result for this patient that’s part of one of our ACOs.
That’s a good thing; I mean, we should be striving to help people achieve better health. And doing something for someone is helping that, but really we should be measured on whether we’ve actually been successful at controlling their high blood pressure or controlling their A1C. But again, it does bring its own unique set of challenges, while we’re accountable for the outcomes and not accountable for the process that might get you to that outcome.
And that kind of takes us back to where we started when we were talking about consumers. If we’re going to be successful in the future, how do we do that? Well, if you can’t get people interested in their health and you can’t figure out how to engage them in ways that is meaningful, how can you expect that someone’s going to adjust their diet and their lifestyle and take their medication so they can control their high blood pressure? I think that all the things that we knew we had to do, it’s just becoming more and more clear that that’s how we’re going to be successful in the future.
Ahava Leibtag (15:58):
Hello Healthcare. My name is Ahava Leibtag and I lead AHA Media Group. I cannot wait to see you at Healthcare Marketing & Physician Strategies Summit, one of my favorite conferences of the year.
One of my favorite things about HMPS is the networking, the conversations, the seeing friends and colleagues so that I can grab those water cooler conversations in the hallway about the problems and challenges that we’re all facing. You can learn more about HMPS by visiting healthcarestrategy.com/summit. See you there.
Alan Tam (16:34):
What are some things that Griffin is doing specifically to tackle some of these challenges and initiatives that you’ve mentioned?
Todd Liu (16:41):
Yeah, I told you before about how part of what we’re trying to do is put the information into the hands of doctors and the other caregivers that are taking care of patients in the office. One of the strategies that we’ve used to try to do that is a pre-visit planning form.
So, again, we spend a lot of time trying to keep track of the things that we want to say to patients when patients come in to see their PCP, and as you probably know, people come in to see their PCP, they don’t spend an hour with their PCP. A lot of times, they only have five to 10 minutes of face time with their physician and then their physician is off to the next patient. So, we have to really prioritize what we want to say to that patient in the five or 10 minutes that we have their attention.
And so, we’re trying to make sure that we can queue that up for the providers so the providers know, what are the things that are really important that we want you to make sure that you’re talking to your patient about when you go in to see them, in addition to what might have brought them there that day, if they’re there for a sick visit or if they’ve come in for an annual well exam. Sure, there’s other things that the patient is going to want to talk to their physician about, but again, we have our own things that we’re trying to make sure that physicians are talking to patients about, that connect back to some of the outcomes we have to achieve in these ACO arrangements.
So, the pre-visit planning form actually takes information from all different sources. We have payer information that’s coming through claims, we have information coming out of our clinical EMRs. We have information that is coming from some of the nurses and the care managers and the community health workers that are talking to these patients, in between their encounters with their primary care physicians.
And we’re trying to distill all that information into a one or two-page summary that’s giving the physician a quick snapshot of what’s going on with that person, so that when they see them and when they talk to them, they can see very quickly what’s happening in their life; what are some of the things that we’re talking to that patient about, what are some goals that we’ve talked to that patient about setting for himself or for herself? And hey, if you have a few minutes, physician would really like you to focus on these things because they’re going to help us be successful in the ACO arrangement that we’re in.
So, I’m making that sound very simple, but there was a lot of work that went into taking all of those different data sources and connecting them and making that pretty seamless. And even now, we continue to try to iterate so it’s even better. I don’t think that we’re ever going to reach perfection with the pre-visit planning form, but it is something that’s come a really long way.
Alan Tam (19:19):
Absolutely, and I applaud you for doing so. I think one of the biggest challenges that healthcare organizations face today is being able to make sense of all that data and all the different data silos that they have. There’s also tremendous focus, I think internally, of the patient experiences within a clinical facility is for the most part, top-notch. I think that’s where a lot of organizations are focusing.
What about improving patient engagement and access? So, you’ve built this center of excellence. You guys are a poster child, for the most part, for delivering one of the best patient experiences while the patient is there. What are healthcare organizations doing today to continue to improve patient engagement and access?
Todd Liu (20:03):
That’s a great question, and there’s a number of things that different providers would probably tell you that they are trying to do.
When you think about this from a consumer’s perspective, and you used the word “patient access”, maybe a good question that we can start talking about is, what does that mean to somebody? What does it mean when you say, “Hey, is it easy for you to access healthcare?” Does that mean they can get in quickly to see their doctor? Does that mean that it’s easy for them to use online tools to schedule? Does it mean it’s easy for them to change appointments online, or picking up the phone and calling somebody?
Interestingly, I actually just saw some survey results that were published by Experian that talked to consumers, and also talked to providers about patient access, what things matter and how are we doing? And providers think that we’re doing better than patients think we’re doing when it comes to patient access.
And if you look back at how people’s perceptions have changed over the past three years, since the start of the pandemic, patients reported that access actually improved at the beginning of the pandemic, but lately, it’s kind of stagnated. So, patients are still having a hard time getting in to see their doctors as quickly as they would like to. Patients still don’t feel like they get clear estimates of what it’s going to cost for the care that they’re coming in to receive. They don’t find the tools that we’re providing around patient portals, or around online scheduling, they don’t always find them all that easy to use.
So, I mean, clearly, that survey told us that there’s still a lot of work to do. But you can imagine that, if you can make it easy for people to use healthcare, that’s going to help with this relationship-building that we were talking about, that providers need to establish with their patients.
Alan Tam (21:48):
What are your thoughts about why it has stagnated? I know that there’s some obvious things in there, but would love to get your sense, why has it slowed down? I mean, tremendous progress was made at the onset of the pandemic. From personal experience, things were amazingly better. And I think you’re absolutely right in terms of, well, it’s kind of all stopped now. Why is that?
Todd Liu (22:11):
Yeah, I think it’s a combination of maybe a couple things, at a high level, that are probably driving that. One is, and you’re right, there was a tremendous investment that was made in Telehealth and helping to open up access at the start of the pandemic, because many doctors’ offices were closed.
So, the only way that people could receive care was virtually. And so, there was a lot of companies that were jumping into the Telehealth space that, before, were kind of dipping their toes in that water. But once they saw that providers around the country were looking to find these solutions, suddenly there was this mass rush to be able to kind of help perfect some of these tools.So, there’s no doubt that, both for patients and for providers, they’ve embraced Telehealth more than they did before the pandemic. That’s a really good thing.
I think one of the big challenges that we have right now is around staffing. And that’s not just in the hospital, that’s in physician offices, and frankly it’s even physicians and kind of mid-level providers like PAs and nurse practitioners. We’ve seen a mass exodus of nurses since the pandemic hit. It was a really, really trying and stressful period. And so, a lot of people took a step back and they were deciding, “I’m not sure I want to do this”, or maybe reevaluating the kind of care that they were practicing.
So, that’s some of it. There is a staffing crisis in this country when it comes to nurses, when it comes to physicians. We knew before the pandemic that we weren’t training enough nurses and doctors to keep pace with all of the needs, folks that we’re getting older and folks that we’re going to need healthcare services. There’s still a structural shortcoming there that we have to figure out. But when you don’t have enough providers, it does make it difficult for people to get in to see the doctor they want to see as quickly as they would like to.
So, I’m trying to remain optimistic and think that, over time, that’s going to get better. But right now, it’s absolutely a challenge that we’re kind of grappling with.
Alan Tam (23:59):
One area that is a shining light, potentially, and can help, is technology. And there’s been rapid advancement of technology to help healthcare organizations continue to push forward in the areas of patient engagement, access, and meeting healthcare consumers where they are. How has technology and healthcare consumerism changed the way that ACOs utilize data?
Todd Liu (24:27):
I think that it’s challenged us, frankly, to be more resourceful with how we use the data that we have. Healthcare data is often pretty imperfect; a lot of times the data that we’re using is coming from claims, and so the claims data tell you something about that person, and they absolutely help to point you in the right direction of maybe what that person needs. But there’s a lot of things that the data in claims is not capturing.
Alan Tam (24:57):
Right. So, definitely a lot of challenges there. What’s going well in that arena? I mean, from a technology perspective and data perspective, what are some advancements that you see here, perhaps even specific examples that you can share with us at Griffin that have gone quite well with technology?
Todd Liu (25:15):
Yeah, I mentioned the PVP before, the pre-visit planning form, I think that that’s a big one. That’s been a real success for us, and our partners at Actium have been tremendous in helping us build that. They’ve been very patient, as we keep coming back to them, over and over about things that we need to change and how we need to tweak it. But that’s the kind of partner that you need. I think if you have a partner who is just going to do a one-and-done and think that then their job is done, there’s no way you’re going to get it to where it needs to be.
I think another success that I could point to is around some of the screening that we’re doing for social needs. So, I mentioned that before, and we’re working with another third party system called Unite Us to record, in the system, some of the needs that we identify from talking to patients. But more important than just capturing what those needs are, we’ve actually used that system to create a closed loop kind of environment with providers in our community.
So, for example, there’s an organization called TEAM, which is kind of the big anti-poverty agency in our community, and TEAM is a tremendous partner. They provide all kinds of services, like housing, like food, early childhood development, Meals on Wheels. I could keep going on with things that they’re doing, but they do tremendous work. So, they’re usually the first organization that we’re trying to reach out to when we find patients of ours that have food needs, or housing needs, or other things like that.
And what’s really great about Unite Us is it actually enables us to see what referrals we’ve made, it lets us see that those referrals have been received by, I’m using TEAM as an example, and then it lets us see what the outcome of that referral was. So, if TEAM was able then to connect that person that, say, had food insecurity, with a food pantry, and now they were able to get nutritious foods once a week and that was helping to supplement the food that was in the house, we’re able to see that.
Then that allows us to kind of go back to that patient, whether it’s one of our nurses, whether it’s the physician when the physician’s in the exam room with the patient, and have a conversation about that. So, it’s great transparency on both ends; again, lets us see what happened with those referrals that we send, and it lets the folks from TEAM know what’s happening with the patients that we’re sending over to them.
And again, that’s really, really critical. If we didn’t have a closed loop referral system and we were just making calls to TEAM and sending patients but not having any idea what happened with those referrals that we made, you can’t really say that we are active population health managers if we’re sending referrals, and for all we know, those referrals are going into a black hole.
Alan Tam (27:52):
Absolutely. So, let’s end on a high note with that. Love the progress that you guys are making there. I’m sure many in the audience are very interested in continuing the conversation. If they would like to reach out to you to learn more and have a conversation around accountable care organizations and how technology and healthcare consumerism all mesh together, what’s the best way for folks to reach you and get ahold of you?
Todd Liu (28:20):
They’re welcome to send me an email. My email address is email@example.com.
Alan Tam (28:29):
Fantastic. Todd, thank you so much, again, for your time today and sharing these amazing insights. Really love what you guys are doing at Griffin. And for all of you listening, until next time, Hello!
Speaker 1 (28:43):
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