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Reducing health inequity for value-based care

August 19, 2022
From the August 2022 issue of HealthCare Business News magazine

A patient coming to a safety-net hospital is often experiencing chronic health conditions such as high blood pressure, diabetes, or obesity that are not well-controlled and managed. This high-risk population, which typically seeks hospital care through the Emergency Department, comprises only 5–10% of all patients treated, yet consumes 60–70% of hospital resources.

Which leads to the question: How can a safety-net hospital effectively manage healthcare for a high-risk patient population and still meet the recommended quality standards and requirements for funding?

An unexpected pandemic outcome
The recent Covid-19 pandemic required healthcare to develop new approaches to managing patient health but had a minimal financial impact on value-based systems, in which reimbursements are tied to patients’ health outcomes regardless of the number of visits and treatments. Instead, it highlighted the need for value-based care. Six in 10 employers are considering or already engaged in value-based design approaches.

The pandemic also revealed those healthcare systems that were not effectively managing resources, and turned a spotlight on those better managing resources, including Nashville General Hospital (NGH), which grew in terms of patient volume, referrals to specialists, and other improvement metrics. Given the available
research, this is quite an achievement. When asked how this was accomplished, I am quick to point to evidence-based care delivery models that dovetail with the goals of most value-based care programs.

At Nashville General, we focus on underlying issues that create health disparities, including health literacy and social determinants of health (SDOH). For example, Nashville General has put programs in place such as CHEN (Congregational Health and Education Network) and our Food Pharmacy, addressing health literacy through a trusted resource and food scarcity, especially for those who cannot afford healthier options that directly impact their chronic conditions, such as diabetes and heart disease. Through our efforts and a population focus, where we intervene with our frequent flyers through aggressive case management, we have been able to “live within our means” while still addressing root causes for issues that patients have in being compliant or seeking care appropriately. As a result, we have attracted patients with commercial insurance, transforming our patient mix from 60% uninsured/40% insurance to 60% insured/40% uninsured---in spite of the pandemic.

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