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Interprofessional Teams Drive Evolution of Healthcare

Issue

The U.S. healthcare system has been criticized as fragmented, inefficient and costly. But Eric Beck, DO, MPH, president and CEO of Evolution Health in Dallas, and his staff are proving it doesn’t have to be. They’re building new models of team-based delivery and processes that offer patients and providers a better experience. And they’re making healthcare more efficient and effective.

What Is Evolution Health?

Evolution Health, a subsidiary of Envision Healthcare, is an integrated medical practice that specializes in managing and caring for patients with complex medical problems in their homes or other alternative settings. Beck oversees 2,400 team members who provide just over 2 million patient touches annually.

“Evolution Health is really focused on population health, post-acute care in the mobile environment, in-home care, and virtual and telehealth strategies for delivering care,” says Beck. “We work with health plans, health systems, hospitals, providers and ACOs that are trying to improve clinical and quality outcomes.”

Evolution currently offers hands-on healthcare in 10 states and extends its reach through virtual practices and telehealth into a total of 42 states. Its work is directed by a commitment to improving value, collaboration and better outcomes, rather than a singular care model.

“As a provider organization, we can offer a complete delivery system solution. In some places, that’s what we do,” says Beck. “But in other places we’re collaborating to fill certain gaps in the system.”

In Dallas, for example, Evolution Health provides primary care using a team of advanced practice nurses, physician assistants, physicians, nurses, therapists and paramedics. They deliver mobile diagnostics, labs and imaging in the patient’s home, often to patients with 10 or more chronic conditions. As a result, “We have been able to optimize outcomes for chronically ill patients, see top-box scores on patient experience and achieve incredibly low utilization of acute care,” says Beck. “This translates into significant savings for payers.”

One of the ways the team achieves these outcomes is by leveraging a medical command center, which is a logistical hub for different types of expertise and resources. Home care teams can call the command center to consult with pharmacists, for example. “Those pharmacists can help advise on medication, provide decision support, and consider specific safety and quality measures, helping translate evidence-based guidelines into practice,” Beck says.

In other markets, Evolution Health’s work may be more focused on home care, home hospice or another gap in the care delivery system. “In some locations, there’s already a robust system from the hospital or the health system and they’ve asked us to help care for a particularly challenging population,” says Beck. “We do a fair amount of telehealth intervention work such as telemonitoring, telephonic coaching and support.”

An Interprofessional Leader

Beck’s team and approach at Evolution Health reflect his career trajectory. He started his clinical career while he was in high school, training at night to become a paramedic. He went on to train in nursing, work as a firefighter and then complete medical school, residency and a master’s degree in public health focused on outcomes and performance management.

Eventually, he joined the faculty of the University of Chicago as an EMS physician and assistant residency director. He also served as the medical director of the Chicago Fire Department, where he started working on interprofessional collaborative care models. “We did some fantastic work around integrating home care and mobile integrated care using existing services, EMS teams, and our hospital internal medicine and cardiology teams,” says Beck.

When the offer to join Evolution Health came, “I really saw it as a chance to make a broader commitment to this work, developing innovative systems of care all over the country,” he says. “It was the ultimate opportunity to leverage some of my historical experiences and be a part of a new forward-looking model.”

Building Interprofessional Teams

One of the ways he’s doing that is by crafting new configurations of healthcare teams. “We believe very strongly in the interprofessional collaborative practice model, which is really redefining what healthcare teams look like for the future,” says Beck. “We have paramedics working with hospitalists and pharmacists, for example. We have nurses working with technologies that weren’t historically part of their home-care delivery strategy. We have clinicians who traditionally practice in the hospital now in the mobile environment. We have interesting combinations of therapists and emergency physicians interacting. It’s a pretty powerful interplay.”

Beck believes an interprofessional model that encourages all team members to practice at the top of their licenses is key to creating a more effective delivery system. And, in Evolution Health models, the experience of all stakeholders in care is as important as the patient’s. “When people come to work every day and they’re happy to show up, it translates into improved patient outcomes and better family caregiver experiences,” says Beck. “We aim to empower all members of a care team to work intelligently, equipped and prepared to deliver what the patient needs, when and where they need it. Our clinical programs are intentionally designed to influence outcomes, and their architecture supports a more enjoyable clinical practice environment.”

Technology Provides a Critical Link

One of the keys to building new care models and connecting care teams in new ways is technology. “The IT, the informatics, the data, the information-sharing is absolutely essential to integrated delivery—from logistics to the interprofessional collaborative practice model to measuring outcomes and the impact of those outcomes,” says Beck.
“Leveraging the technology from EMS, from home care, from hospice, from the hospital and acute care, and bringing all that together with telemedicine and telehealth, is an ongoing journey. But it’s hard to overstate the value of the technology in terms of supporting the clinical workflows and information sharing among the teams and other stakeholders of the delivery system.”
Beck’s focus on building interprofessional teams and giving them the right tools and preparation is part of an overall vision for improving healthcare on three important measures: experience, effectiveness and efficiency. “When you are able to link team members together much more systematically and leverage technology, you’re able to realize efficiencies,” says Beck. “The proof is measured by the outcomes—improved productivity, improved clinical outcomes, reduced waste and cost, among others.”

Susanna J. Smith is a content strategist and freelance writer who focuses on the future of healthcare and how new technologies and care models are reshaping the healthcare industry. Follow her work at @SusannaJSmith and susannajsmith.com.

The Evolution Health Team on How It’s Changing Care Delivery

Like the caregiving teams it delivers to patients’ homes and other locations, the leadership team at Evolution Health demonstrates the benefits of interprofessional collaboration. IHE spoke with members of the team about how each of their areas fits into the Evolution Health approach.

What is the role of home healthcare?

“Historically, home care has been underutilized and underappreciated but should be at the center of the integrated care delivery system in the post-acute setting. With an increased focus on providing the most cost-efficient and effective care possible while improving patient satisfaction, it makes sense to provide care in the home, which is where the patient wants to be. By leveraging technology and home health’s multidisciplinary approach, we are driving down costs and improving outcomes and satisfaction.”

– Cindy Heit-Welch, RN, President of Home Care Strategies

How is Evolution Health collecting and using data to drive better healthcare?

“We are using data at the population-based level as well as an individual level to add transparency so we can publicly report on quality and drive improvement. We’re putting in place a very robust clinical management strategy, not based just on claims-based data, but clinical data. We’re seeing significant improvement in outcomes that matter to payers as well as patients.”

– Daniel Castillo, MD, MBA, Chief Strategy Officer, Chief Quality Officer & Vice President of Population Health & System Effectiveness

How does Evolution Health train its interprofessional teams?

“We train teams—which include physicians, advanced practice nurses, physician assistants, clinical pharmacists, nurses, and paramedics—to work collaboratively. The focus of our clinical training is all about keeping the needs of the patient central and creating a culture where each member of the team is empowered to work at the top of their license for the benefit of the patient.”

– Sean Cannone, DO, CMD, Vice President & Executive Medical Director

What has surprised you about current trends toward more integrated care?

“I think the biggest surprise is the variability in understanding of the Affordable Care Act among providers. There are some providers who have investigated it and understand how it’s going to affect their practice. There are others who just have a very peripheral understanding. I think over the next 24 to 36 months, there’s going to be fairly dramatic change in the way things are paid for. For example, starting in January of next year, hospitalists could have a 2% to 4% increase or decrease in all of the fee-for-service revenue based on how patients do the three days before they were admitted as well as the 30 days after. I think some people think, ‘well, I’m not going to do the bundle payment initiative.’ These aren’t elective things. This is a change in policy.”

– Brent Myers, MD, MPH, Chief Medical Officer, Executive Vice President of Medical Operations



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