MERRILLVILLE — When Mary Parnell was admitted to the hospital with congestive heart failure last year, Lyndsay Simpson came to see her.
Simpson is a nurse navigator for Methodist Hospitals. She educates patients on how to prevent health problems in the future. She helps coordinate their care to ensure they follow through with it.
She talked to Parnell, a 59-year-old from Gary, about limiting her salt intake. She later called Parnell at home to see if she needed transportation to her follow-up appointments. She offered to set up home health care.
Simpson is part of an increasing trend in health care in Northwest Indiana. Hospital systems are proactively reaching out to patients and coordinating their health care to keep them from being readmitted to the hospital.
Many medical institutions now use data analysis, usually as part of their electronic medical record systems, to manage the health of all their patients. The goal is to bend the cost curve, at a time when health care accounts for nearly 20 percent of the nation's gross domestic product. Private insurers and the federal government are starting to reimburse providers on quality rather than quantity of care.
"Population health management is caring for an entire community as opposed to caring for the sick within that community," said Matt Doyle, chief financial officer for Methodist Hospitals.
"It's designed to promote health through wellness and prevention, and also treating the sick when the sick need to be treated. Better outcomes and better health are the end goals."
Obamacare advanced true health
To reduce costs, the health care industry is "moving from what's considered emergency medicine to true health medicine," Doyle said. Emergency room visits and hospitalizations are expensive — and, with regular checkups and screenings, often preventable. Methodist also has expanded its outpatient care, Doyle said, to get "the hospital beyond the four walls."
Methodist utilizes its electronic medical record system to automatically notify patients of upcoming appointments that need to be scheduled or tests they may need. Data analysis helps the hospital system identify high-risk patients in need of care. Providers go over a checklist with the patients on items like diet, exercise and lab work.
These changes started before the 2010 Affordable Care Act, also known as Obamacare, but the law included provisions to advance them. For instance, the law penalizes hospitals if patients are readmitted within 30 days of being in the hospital. Even if President Donald Trump and congressional Republicans follow through on their promise to repeal Obamacare, Doyle doesn't expect population health management to go away.
"At the end of the day, I think cost is the name of the game," he said. "So if there's a repeal, or repeal-and-replace, I can't imagine there will be a change from this side. It's too important from a cost perspective."
Quality care priceless
The LaPorte and Porter physician groups have nurse navigators who reach out to patients to help them close care gaps or transition from the hospital to home or a skilled nursing facility. The nurses contact patients to remind them that they missed, say, a cancer screening. The navigators also identify and contact people who are at high risk for readmission.
"It has been said that population health is providing the right care for the right patient at the right time in the right setting," said Dr. Stacey Leva, vice president of population health management and quality for the LaPorte and Porter physician groups.
The focus on population health management has helped increase the mammogram and colonoscopy rates in LaPorte and Porter counties, she said.
"If there is an abnormality that's caught, it's priceless to the patient and their care team," she said. "It means a lot to us to know that by doing this work we are helping to improve the health of our patients and the communities we serve."
Best care at right cost
Community Healthcare System has improved its population health technology over the past couple of years, increasing automation and better filtering information to providers. The system's data analysis can determine, for instance, which medications work best for which patients, depending on what strain of a disease they have.
"With the analytics, we're using ... we can start identifying patients before their first admission to prevent that admission in the first place," said Dr. Alan Kumar, the hospital system's chief medical officer. "The sophistication of the analytics is there."
Community has population health agreements with Cigna and HMO Illinois, where the system is paid a monthly fee to care for patients, and is in negotiations with other insurers and employers on similar arrangements.
"Health care systems are not just competing to say we're the biggest, but to say we're the best," Kumar said. "We aim to provide the best value of care at the right cost. Employers, payers and patients appreciate this."
Franciscan Health has an accountable care organization, where it provides free care coordination to its Medicare beneficiaries. Under the arrangement, part of Obamacare, the federal government rewards Franciscan Health for lowering costs and improving quality.
"Our medical providers are using population health analytics tools to identify high-risk patients with chronic illnesses, who we assign to our team of care coordinators," said Joe Riffle, administrative director of the Franciscan Accountable Care Organization.
"The care coordinator's role is to assist these patients with obtaining the right health care services in the right place at the right time to help eliminate avoidable emergency or hospital admissions, reduce unnecessary duplication of care, and promote high-quality care by ensuring that age-appropriate screenings and disease management protocols are being followed."
Hospitals focus on prevention
On a January day at the Methodist Heart Failure Clinic in Merrillville, nurse practitioner Fran Clark looked at a computer and asked questions of Parnell, the Gary resident who was hospitalized last year with a heart condition.
"Shortness of breath?" Clark asked.
"It was a little worse today because I had to walk from the bus," Parnell responded.
"Have you quit smoking?"
"I use a vapor pen once in a while, two or three times a day."
"Your blood pressure was good."
Parnell discussed what she learned from the nurse navigator about a heart-healthy diet.
"Yesterday, I got ready to fix pasta. I got ready to eat," she said. "I said, 'I can't eat this.' "
"It's not that you can't eat it," Clark said. "You have to be aware of what a serving is."
With the help of her care team at Methodist, Parnell has avoided having a heart attack. Clark told her that her condition had stabilized.
"We want to help patients be able to better manage their condition," said Connie Adams, clinical and quality director of the Methodist Hospitals Heart and Vascular Institute. "This really is a team sport."