Collaboration between Ortho Rhode Island, UnitedHealthcare aims to boost value-based care

Mary Ellen Ashe is executive director at Ortho Rhode Island, which is working in collaboration with UnitedHealthcare to provide patients value-based care relationships. / COURTESY ROBIN IVY
Mary Ellen Ashe is executive director at Ortho Rhode Island, which is working in collaboration with UnitedHealthcare to provide patients value-based care relationships. / COURTESY ROBIN IVY

PROVIDENCE – Ortho Rhode Island has collaborated with UnitedHealthcare to dedicate more resources to care coordination among Ortho RI’s providers and primary care physicians.
The Ortho RI partnership of Blackstone Orthopedics & Sports Medicine, Foundry Orthopedics & Sports Medicine and South County Orthopedics (and West Bay Orthopaedics & Neurosurgery, which will join later this year), was created in December 2016. It came about when physicians from those competing practices met and talked about their shared desire to fulfill the “triple aim” of health care – improved patient care, improved patient health and reduced cost – and add fun to the equation, Mary Ellen Ashe, Ortho RI executive director, told Providence Business News.

“We had a clear vision that we wanted to bring value to the system; we wanted to partner with payers … accountable care organizations and primary care doctors,” said Ashe. Specialty care physicians, measuring triple aim outcomes can be difficult, yet the partnership understood that patient engagement was important to both UnitedHealthcare and Ortho RI, she said. To that end, in June of this year, Ortho RI began sending all its patients with one of two different surveys – the Consumer Assessment of Healthcare Providers and Systems survey (administered by the Centers for Medicaid & Medicare Services) and, more frequently, Survey Vitals surveys, which allow the practice, benchmarked against other orthopedic practices nationally, to receive immediate results and feedback. By getting feedback and responding accordingly, the practice will be better able to fulfill the elements of a value-based care relationship, which emphasizes quality, patient outcomes and full information sharing among all care providers, with the goal of getting all patients the right care in the right setting.

Although the practice needs 90 days of patient feedback to have meaningful data, Ashe reported that the feedback submitted to date has been very helpful. Anonymous survey responses indicate positive views about the medical providers and other staff members, she said, while patients want shorter wait times – in getting an appointment and in the waiting room. With an algorithm determining which patient receives which survey, there’s been a 30 percent response rate, said Ashe. The practice uses texts, emails and voicemail for survey communications.

Another patient-centric initiative is being developed as a result of patients’ requests to recover at home after joint surgery. By using a validated tool before surgery, the practice will help engage patients in pre-surgical comprehensive discussions about post-surgical discharge planning and where they expect to recuperate. “It’s a predictive and planning tool to evaluate both their clinical and social supports at home and their needs [after surgery],” said Ashe. “Using that information, we are working on a program to coordinate care … so that we can improve the percentage of patients discharged to home care.” While less costly than continued hospitalization or inpatient rehabilitation, that approach demands a great deal of care coordination and data exchange, which is where UnitedHealthcare plays a key role.

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For these initiatives, UnitedHealthcare will provide clear, actionable data on individual patients’ health needs, potential care gaps and proactively identify high-risk patients, a statement from the two entities reported. UnitedHealthcare and Ortho Rhode Island are working together to help patients receive more personalized and better connected care in order to significantly enhance their return to a more active, more pain-free lifestyle and help them live healthier lives,” Stephen Farrell, chief executive officer of UnitedHealthcare of New England, said in the statement. When asked for more specifics about its role, UnitedHealthcare reported that it considers confidential certain details of its July 15, 2016, agreement with Ortho RI.

This year is Ortho RI’s baseline data gathering year, and in 2017, it will start measuring outcomes. More than 140,000 people enrolled in UnitedHealthcare’s employer-sponsored health plans are eligible to benefit from this collaboration with Ortho Rhode Island.

As for the physicians’ desire for fun, Ashe reported that making the workday enjoyable or fun comes with promoting a collaborative culture and knowing fellow employees and patients. There is a Fun Facts quiz where the doctors submit a personal factoid about themselves for an internal newsletter and staff members try to match the factoid with the specific physician; those who guess correctly receive small prizes. “You will learn which physician was a professional soccer player … a fighter pilot or kicked the winning field goal,” said Ashe, who added that the practice’s quarterly physician meetings always build in time for camaraderie, one of the practice’s values.

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