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Episode 42 - October 2022: Funding Innovation with Shared Savings

October 2022

MHACO Chief Medical Officer Rob Chamberlin, MD, announces the innovation projects that the ACO is funding this year through a special allocation of shared savings. Also, we meet Heather Ward, MD, BACON’s new co-host.

Mike: This is BACON, brief ACO news from the MaineHealth Accountable Care Organization, a deep-fried monthly podcast for health care providers. I'm Mike Clark.

Heather: And I'm Heather Ward. Mike and I are practicing physicians who participate in the MaineHealth ACO.

Mike: Heather, welcome to your first episode of BACON.

Heather: Thanks, Mike. It's great to be here.

Mike: Well, it is so good to have you. And later in this episode, I'm going to put Heather on the spot and ask her a few "get to know you" questions. But first, for our Meaty Topic, we'll hear about new innovation projects that the ACO is funding this year.

Heather:
Okay, let's get right to it.

Mike: You know, you don't have to dig too deep to find ACO participants working on exciting projects to help improve patient care. Recently, the ACO allocated $200,000 in shared savings to help fund some of the projects that align most closely to its goal of ensuring patients receive the right care at the right time and at the right place.

Heather:
Through a competitive application process, the ACO identified eight projects to receive funding. Here to tell us about them is our very own Rob Chamberlin, the ACO's Chief Medical Officer. Welcome, Rob.

Rob: Thanks, Heather. We're really pleased to be able to invest a significant portion of shared savings in projects like these that promise to increase care quality and reduce unnecessary spending.

Mike: And, although I don't want to beat the drum too hard, it's probably important to point out that this is funding that's going to participants above and beyond the usual shared savings distribution. Is that right, Rob?

Rob: Yeah, Mike, That's right. So, when we earn shared savings, the vast majority of that goes back to the medical groups or private practice PCPs at the hospitals. But these shared savings transformation funds are earmarked for special innovations that go to support those health care groups that are above and beyond what we distribute through the regular shared savings distribution model.

Heather: Excellent. Let's hear about those funded projects.

Rob: Sure. So I'm going to kind of group these projects together, and I'll start by saying someone framed this in a way that I feel helpful, which is, you know, across the ACO and across MaineHealth, there's a lot of top-down innovation, which is really exciting. New care models or things that come out of our executive leadership. But a lot of what we're finding here is bottom-up. So, a lot of people who kind of are on the ground doing the care for the patients, have an idea of how to make something better, and they're able to apply for some funds to support that. And we really think there's a lot of excitement that can come from that and a lot of new things that can be started with this and then spread across the whole system. So the first three are, really, projects that give new tools to primary care teams to provide enhanced care for their patients. So there's one project that we'll be giving funding to help with hypertension remote monitoring, to help our primary care teams be able to monitor patients' blood pressure at home and titrate medications based on that. There's a couple of projects out of St Mary's one to get dermatoscopes so that they can do dermoscopy in their primary care practices, and another for them to get some diagnostic continuous glucose monitoring within their primary care practices. So all three of those projects are really going to be new tools for primary care teams to provide better care for their patients from within their own offices. And then kind of moving from new tools to expanded teams again within primary care, we have Maine Behavioral Health, who will be partnering with the Westbrook practice from MaineHealth Medical Group to do a pilot of the collaborative care model. So that's really about expanding the behavioral health care part of the team. And then St Mary's, again, is going to be using some funding to support nurses to do self-management and prevention of chronic diseases. So really kind of expanding the role of the nurse. And then moving beyond primary care, we have the MaineHealth healthy aging team that's going to be looking to engage eight to 10 facilities in the Age-Friendly Health Systems Improvement Initiative. And, from Maine Medical Center, Dr. Chris Wellens is looking to invest in a technology that helps identify patients who can go home after their hospital stay instead of going to a skilled nursing facility, and identifying those patients early so we can key them up well for that in the hospital and that really saves them the second admission to a skilled nursing facility and allows them to go home. And then lastly, we were able to support a project from the Southern Maine Hospital emergency departments, and they are looking to put together some harm reduction kits for patients who are identified as high risk. These kids will have things like Narcan and condoms and other things to help reduce the risk of overdose or other things. And we know that that's really been a crisis that continues to plague our communities. So altogether, a bunch of projects that we really are excited to be able to support, and we're really grateful for the hard work of the care teams that help us earn the shared savings that we can then reinvest in initiatives like this.

Heather: Wow. Rob, those are such a diverse group of projects. Just remind me, can you tell me how they all come together and support the ACO's directive?

Rob:
It's a great question, Heather. And you know, the ACO, at the end of the day, the reason we are here is to provide support to our care teams, to provide high-value care. And, I'm sure you see this in your practice, but our care teams really just want the tools to provide good care to their patients. That's what it's all about. I mean, when you go out and you talk to folks, they're not, I don't hear people clamoring about "we need higher salaries." Kind of, what they want is, "I want to be able to provide great care to my patients in a system that's supporting me." So if you look at these projects, it's really about that. It's about new tools to help with management of chronic diseases. It's about expanded teams to provide that support to our patients. It's about responding to a community crisis of patients who are overdosing on opioids. So it really just inspires me so much because what I see when these applications come through is care teams who are saying, give us the tools we needed and we have great ways to take care of our patients, and that, when we do that well, that kind of realizes our goal of providing high-value care to our patients, which is what we're here for.

Mike: Wow. This is great stuff, Rob. You can really hear the commitment and the passion of the providers who put these projects together. And I so appreciate the support of and the vision of the ACO and making these things happen. So, Rob, thank you for being here and to share this positive news with us.

Rob: Hey, thanks for having me, Mike.

Mike:
So welcome to the sizzle. Our segment on ACO participants doing good things both inside and outside of work. This month, we're not going to wander very far from the studio because we wanted to take a few minutes to get to know my new co-host, Dr. Heather Ward. And this isn't the first time Heather has been on the podcast. If you recall, she was one of several physicians we spoke to back in January about practicing in this seemingly unending pandemic. You know, Heather, one thing you said back then really struck me. Even when patients disagree with us or make decisions regarding the pandemic or vaccines or other things that we don't agree with or we think is inadvisable, we have to remain compassionate. Do you remember that?

Heather: I do. I honestly am not positive I remember the exact wording that I said, but for me, that time of rediscovering compassion was really important and actually felt just a huge weight lifted off of me with all of the burden of pandemic care. And then the frustration, honestly, of having patients tell me that it's not real or that it's all made up or choosing not to get vaccinated because they were worried about it, even though I was recommending it and I had been taking care of them for 20 years. To be able to come to that, that place really of acceptance, I think, is probably what happened first and just say, yup, if I'm going to be angry about this, then COVID is beating me for sure, and I just cannot let that happen and survive. And, you know, we're all human. We all make bad decisions and have that extra cookie or do whatever we're doing. Don't go out for the walk in the morning because we're too tired. And I mean, we all make those decisions. And to put patients' decisions in that context just makes it real and human.

Mike:
That was so true and it was so powerful at the time for me. I found myself coming back to that thought of how grounding it is to be empathetic and compassionate in what we do. And it really is the heart of patient care. So, thank you for those words and bringing them back to us once again. So also, I know your journey as a physician has shifted a bit and evolved over the past few years. You like me, you were in private practice in primary care for a number of years, and then, recently transitioned to a more of employed status. So, your practices touched a lot of the experiences of some of our listeners. Tell me just a little bit about that journey and what it's been like for you.

Heather: Yeah, sure. Absolutely. So I joined a practice here in Belfast with Tom Maycock as soon as I left residency. Right, like I was looking for that private practice, do everything country doctor and really had it. This practice was thriving and continues to be, and was a really wonderful environment to practice in. But, as the requirements around medicine changed, so, patient-centered medical home, doing more quality reporting, electronic medical record, it became more and more burdensome for us just to providers to practice in the private practice model. And I mean, honestly, I think it was about not having the desire to focus on that. Rather, I really wanted to just take care of patients. And so, that was around the time that I met you and had lots of really important conversations about whether or not to continue with private practice or become an employed physician, and ultimately decided that becoming an employed physician would give our practice the support that we needed so that we could continue to engage with patient care the way we wanted to. And I wouldn't feel distracted by keeping the books and doing the practice management that, as you know, you end up doing in private practice.

Mike:
So, as you have made that pivot, what other opportunities have opened up for you? I understand there's some leadership opportunities that began to open up, and a chance to kind of take that heart that you always brought to patient care and to expand on that a little bit, maybe even with your colleagues. What's happened since?

Heather: Yeah. So, we joined the MaineHealth system. Well, it was before COVID, so probably about a year before COVID. And having that support with practice management then gave me more opportunity to be a voice for my fellow physicians and APPs. And I became involved in more discussions around the MaineHealth Medical Group coming together and moved into the role of med staff president and really looked at it as the opportunity to start having a voice in decisions that were being made rather than being frustrated with decisions that were being made for me. I'm really thankful to have that opportunity to be able to have a seat at the table at those discussions, and to be able to, hopefully, positively influence our practice environments and our practice cultures by at least saying what we feel like is important or what we want to be doing or have available to us. At least I'm able to say it. Whether or not it happens is a whole different situation, but at least I'm there talking about it.

Mike: Heather, I'm so grateful that your voice, that you've brought your voice to the table for, not only on behalf your patients, but for your colleagues, but to MaineHealth, to the Medical Group. And I'm so grateful that you're bringing your voice and your experience and your wholeheartedness to our podcast. So welcome and so glad you're here.

Heather: Thanks, Mike. This is going to be a fun journey, so I'm looking forward to it.

Mike:
Thanks for listening to BACON this month. You can find all our episodes on your podcast app and at our web page, MaineHealthACO.org/BACON. And if you have questions, comments or suggestions, we really would love to hear from you. Please email us at bacon@mainehealth.org. That's bacon@mainehealth.org.

Heather: BACON is produced by the MaineHealth Accountable Care Organization with help from MaineHealth Educational Services. Thanks for joining us. See you next time.

Mike: See you next time.