By Erica Noonan, MA, and Lucy Berrington, MS
Population-based health care is morphing from a theoretical policy goal (a nice-to-have) to a real-life practice requirement (a must-have). As hospitals and practices work to implement the key concepts, systems such as Reliant Medical Group (RMG), which have been doing it for decades, are ascendant. State data show Reliant’s lead on key topical measures. Tarek Elsawy, MD, FACP, RMG’s president and CEO, has held up the group as a potential national model. And since Reliant was purchased in April by OptumCare, expectations have only grown.
“OptumCare’s vision is to become the biggest ambulatory, value-based health care system in the country,” says Dr. Elsawy. “We now have a platform — all the medical groups across the country that are part of the OptumCare family — not just for us to model care delivery but to continue to learn from others that are doing this.”
The deal with OptumCare, a for-profit system owned by United Health Group Inc., speaks to the attractiveness of Reliant’s model to companies investing in efficiently managed care. “We fit in very well with Optum’s overall vision,” he says. “We have a symbiotic and empowering relationship.”
Building (for) the Team
The $250 million OptumCare deal included $186 million for infrastructure investments including new clinics. Following the merger, RMG has undertaken a major workflow initiative, re-designing many of its physical spaces. “Health care is a team-based sport,” says Dr. Elsawy. “When we asked ourselves, ‘How do we better deliver team-based care?’ the answer became ‘Design the building around the teams, not the team around the building.’”
Facilities at nine new locations (due to be completed by May 2019) were designed for practitioners working alongside each other. Reliant will continued to employ salaried physicians, emphasize value-based care, and contract with local hospitals. The plan is for RMG to continually refine its model while incorporating new OptumCare assets, such as data analytics and pharmacy systems. “We are always looking for novel partnerships and that will never stop,” says Dr. Elsawy. “Nobody can solve [health care delivery] problems alone.”
Keeping Costs in Check
Tarek Elsawy, MD, FACP
The RMG method has long prioritized population-based care principles that are key to health care redesign: providing evidence-based prevention and treatment, delivering collaborative care, empowering patients, avoiding unnecessary interventions, and connecting patients with community resources. Now, the value of such an approach is being measured like never before. Reports in 2018 from the Center for Health Information and Analysis and the Health Policy Commission showed Reliant holding down costs more effectively than comparable medical groups in the Commonwealth, including spending per patient per year and avoidable ER and hospital visits (both reports used data from 2015 to 2016). The data show physician-led groups consistently delivering care at lower cost.
That cost containment has not undermined the quality of care, says Dr. Elsawy. “We are in approximately the 90th percentile on 90 percent [of the HEDIS [Healthcare Effectiveness Data and Information Set] quality measures.” These outcomes speak to a culture of risk-based modeling since the 1970s. “We have been doing [population-based care] for so long, we are truly vested in it.”
Success in care efficiency is cumulative. “To use a baseball metaphor, it really is not a bunch of home runs; it is a bunch of singles,” says Dr. Elsawy. “It’s your pharmacy spend, your population health, and preventive efforts, and on and on. All of those things on their own aren’t glamorous, but that is how you win.” The transition to risk management takes time, especially for the pioneers. “It takes a lot of years of growth, innovation, mistakes.”
Innovation and Challenge
RMG, founded in 1929 as the Fallon Clinic, lays claim to a history of innovation; it was among the first closed health models in Massachusetts, for example. The group currently has 2,600 employees, including nearly 500 providers, at 31 locations in and around Worcester. That this venerable and innovative health care system sits closer to the middle of the state, not the Longwood medical area, is a point of pride.
Population-based care continues to face challenges, such as the growing use of high-cost specialty drugs. “These new medications are exorbitantly expensive, adding in a new variable, and how do we manage that?” asks Dr. Elsawy. Physician burnout is another ongoing, multifaceted issue. “I think team-based care and meaningful work is part of the solution. But there are so many other systemic things that need to be addressed and every day we are battling new parts of it.”
