Hospitals prioritize women’s health

Major structural changes are under way in the delivery of women’s health care by Rhode Island’s two largest hospital systems, Care New England and Lifespan.
These changes, which hospital officials claim are primarily designed to put women’s health needs first, offer a lens into the new business models being adopted by the two hospital systems as they struggle with declining revenue.
In the brave new world of health care reform, hospitals and doctors are seeking to wean themselves from fee-for-service delivery systems to those organized around metrics that benchmark health outcomes and wellness, a change that will yield increased future payments and rewards.
Likewise, investments in outpatient medical centers as hospitals reinvent themselves into accountable-care organizations offer a more holistic approach to health and prevention – as well as a path toward improving the future rate of return for hospitals.
Women’s health services in Rhode Island have become a proving ground for the new approaches – and along with the changes come opportunities and risks for greater competition and collaboration, for both patients and providers.
In September 2011, Lifespan launched the Women’s Medicine Collaborative, an outpatient medical center with all its services under one roof, focused on personalized, comprehensive caring for women at all stages of life. Located near the main U.S. Post Office in Providence on West River Street in a newly rehabbed, former mill building, the collaborative’s trademarked brand of “For women. By women,” underscores that all care there is provided by women, across multiple disciplines and specialties, including behavioral health.
Dr. Karen Rosene Montella, who serves as Lifespan’s senior vice president for women’s care and clinical integration, is one of the medical center’s founders. Until February 2011, she had served as chief of medicine at Women & Infants Hospital.
“We recognize that women have very unique and specific health care needs,” Rosene Montella said at the time of the launch. “So we were excited to pull together these specialties under one roof to provide women with the best care possible. This fits Lifespan’s strategic vision to provide our patients with an optimal care experience that is unique to Rhode Island.” Initially, some 16 doctors who were former colleagues together at Women & Infants jumped ship to begin the new medical center. Six months later, the collaborative now includes some 23 providers, most of whom had previously worked together at Women & Infants, according to its director, Dr. Margaret “Peg” Miller.
“We felt it was important to take a broad approach, looking at health needs from adolescence to older-age women, and to develop new models of care, focused on prevention,” Miller said, discussing the genesis of the collaborative. In Lifespan, she found a willing partner, Miller continued. “Our strength is in our numbers, and in the way we collaborate and work very closely together. We are connected, in the same office, under the same roof. We can collaborate, interact and talk to different specialists. This model works well for women. We are providing a one-stop shopping experience for women; they can see their primary-care doctor, have any lab work done, and see specialists as needed, all at the same time, at the same office.”
The collaborative is in continuing conversations with other providers who have expressed interest in joining the new medical center, according to Miller. As a result, there is beginning to be some discussion about the future need for more square footage to meet the demand for expanded facilities, she said.
In December 2011, Women & Infants, pursuing its own agenda, created a limited-liability corporation known as the Health Care Alliance to serve as an umbrella affiliation group for ob-gyn providers in Rhode Island. Alliance members currently include 23 ob-gyn physicians, eight midwives and four ob-gyn practices in Rhode Island, according to Constance A. Howes, president and CEO of Women & Infants. “It’s a blueprint for what health care reform is all about,” she explained to Providence Business News. “It’s about improving the population’s health, improving a patient’s experience of health care and reducing the cost of health care.”
Under the arrangement, the doctors maintain control of the day-to-day operations of their offices, while they also receive a salary from Women & Infants. Doctors can also qualify for bonuses if they meet certain quality and patient-satisfaction standards
Dr. Pablo Rodriguez, president and CEO of Women’s Care, one of the four practices to join the Alliance, is serving as the chairman of the board of directors of the new partnership. The effort, Rodriguez said, “is key to positioning Women & Infants and Care New England to respond to opportunities that will be presented by clinical integration, bundled payments and accountable-care organizations that may develop from health-reform efforts.” The alliance is designed to provide seamless care continuity, Rodriguez said.
An immediate opportunity fell into the lap of the newly organized alliance – the decision by Thundermist Health Center in Woonsocket to move its patient population for obstetric services to Women & Infants. “I would like to take credit, but I can’t,” said Howes, explaining that Thundermist felt that it needed to have “more adequate” coverage for its patients, something that Women & Infants and the alliance could offer around the clock.
“It blends in nicely with our plans, but it wasn’t intentional,” Howes said. “It is a population that we are proud to serve, but to a great extent, it is not a financial windfall.”
How will the new paradigms for women’s health care play out in Rhode Island?
For Dr. Maureen G. Phipps, the challenge is to be as “agile as we can be as we’re changing health care environments.” Phipps is chairman of the Division of Obstetrics & Gynecology at Women & Infants, as well as principal investigator with the National Children’s Study, a 21-year study of children’s health and development that will follow 1,000 children in Providence County. She said she hopes that the alliance would be able “to capture new innovations that translate into evidence-based medicine and improvements in clinical care.”
Dr. Michael Fine, director of the R.I. Department of Health, stressed that there were years of “important collaborations” between Women & Infants and Rhode Island Hospital on pediatrics, and on ICU services, and he hoped that the state would continue to build upon those collaborations.
“Hospitals compete because that’s what we incentivize them to do,” Fine said. Instead, he offered an alternative vision, “that by creating vertically integrated health care systems that are quasi-public or public, that [reimburse per capita], and that are charged with the responsibility of caring for the population of geographic areas, [such systems] would compete only on the population health outcomes, cost and the patient’s personal experience of care.”
Medicine is changing very rapidly, and it is inconceivable it is not going to undergo huge changes in the next few years, said Dr. Barbara Roberts, the director of the Women’s Cardiac Center at The Miriam Hospital, and one of the leaders in establishing a gender-specific practice focused on women’s heart health.
Roberts said she is trying to keep her eyes on the prize. “My concern is trying to take the best care of my patients, and not lose sight of the forest for the trees,” Roberts said. “My forte is taking care of patients, and I love what I do.”
For Dr. Rochelle Strenger, an oncologist at The Miriam who specializes in breast cancer, the big push in Rhode Island needs to focus on a collaborative effort about how “we engage with women.” Once women have been diagnosed with cancer, she continued, “we can place them in a continuum of care, and surround them in a cocoon with other modalities.” We can treat the cancer, she continued, “but that’s not the end of the story. Women need to understand that they’re in control of their health, and can make changes in their lifestyle.” •