Innovative Baltimore Health System Proves ACA Reform Can Work

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John-Chessare-thumbOne community healthcare system in Baltimore, Md., has taken a pioneering approach to reform, making it work long before the Affordable Care Act was passed into law.

The GBMC HealthCare System, which includes Greater Baltimore Medical Center (GBMC), is run by Dr. John B. Chessare, a pediatrician by training who has been in healthcare for more than 30 years.

Through his experience as a pediatrician who has moved into administrative roles, Chessare has an understanding of the many layers of the U.S. healthcare delivery system and the areas in which it is broken. He is passionate about reforming healthcare into a system that provides the best outcomes for patients at a lower cost and allows physicians to practice medicine as they were trained to practice it.

Making the transition from practice to leadership

During his early years of training and work, Chessare had the chance to study under mentors who were ahead of their time in applying evidence-based care techniques and in implementing quality improvement. He eventually left regular practice to focus full-time on administration, working to redesign care at Albany Medical Center, then becoming chief medical officer at Boston Medical Center.

“My time at Boston was great,” he said. “I was part of a small group of leaders who were committed to redesigning care and making care for poorer people just as high quality as for those of higher means.”

In 2005, he became president of Caritas Christi Health Care System’s Caritas Norwood Hospital in Boston, Mass., and joined GBMC in June 2010. GBMC is a 300-bed acute-care not-for-profit hospital. The GBMC system also includes Greater Baltimore Health Alliance, a group of more than 200 multispecialty physicians in locations throughout the region, and Gilchrist Hospice Care.

Bringing reform to patients and physicians

When Chessare came to GBMC, the board was nervous because many standalone hospitals were folding or having to join with larger organizations. The current U.S. healthcare system doesn’t offer much support for smaller hospitals to remain independent, and Chessare was not content with that future.

“I started educating the board about the need for reform, not in terms of the Affordable Care Act, but about the absurdity of the status quo,” he said. “The board started embracing the need to redesign a better system, and we developed our vision statement.”

This was when the Greater Baltimore Health Alliance was born.

“We decided to make the hospital become a cost center and build a primary-care company that could coordinate care and fight to keep people out of the hospital, but still take advantage of our wonderful hospital when needed,” he said. “We had no future as a standalone hospital, but we had a phenomenal future if we could become a community-based health system.”

By system, Chessare refers more to the patient experiencing a system designed to keep him or her healthy. He is frustrated with the country’s healthcare infrastructure being designed to provide many services without reflecting on the coordination of the patient’s care and trying to prevent hospitalizations. The lack of coordination may benefit investors, but it impedes physicians’ ability to get the best possible outcomes for patients.

Those feelings have driven Chessare to redesign GBMC’s care delivery and implement many aspects of reform. He touts not only the benefits to patients and the uninsured, but also the benefits to American business through large cost savings with more efficient care.

Making the vision effective and evidence-based

GBMC follows the national Triple Aim of providing better care and a better experience at a lower cost, but adds a fourth aim of more joy for those providing the care. The organization’s four-paragraph vision statement defines what drives every decision made by the board, administrators, providers, and staff.

It begins with the need to change and continues into a goal of providing patient-centered care that “manages the patient’s health effectively and efficiently while respecting the perspective and experience of the patient and the patient’s family.”

Chessare has been supportive of a fee-for-performance over fee-for-service structure for many years and has been moving GBMC in that direction since 2010.

“The fee-for-service world is a problem,” he said. “We have to become fee-for-health. We are not waiting for the system to change. We take every penny we’ve been saving and reinvest it into our patient-centered company.”

The third part of the vision statement talks about creating the infrastructure to support “evidence-based, patient-centered care” and being accountable for care delivered. The creation of the Greater Baltimore Health Alliance made GBMC the first hospital in Maryland to be associated with an accountable care organization operating within the Medicare Shared Savings Program.

Through all the changes GBMC has made, Chessare said he expects when final data is available, his organization will have saved the country money by reducing Medicare cost per beneficiary, while providing better outcomes in health and service.

Because of state regulations, GBMC gets paid less for the same services than larger academic medical centers. This has previously been a negative, but with the recent movement toward value-based purchasing and price competition through the healthcare exchanges, payers are looking to GBMC as a high-value facility.

“We are fighting to keep patients out of our hospital by keeping them healthy, but we have people knocking on our door to put patients in because we are such high value,” Chessare said.

He encourages other healthcare organizations to take action on the Triple Aim by redesigning their delivery systems. GBMC has embraced the patient-centered medical home model and believes it is key to making this new delivery system work.

“We need to redesign our primary-care system, change the way it is organized, allow our primary-care physicians to do what they were trained to do,” Chessare said. “The question should not be, ‘How many patients did you see?’ It should be, ‘Did you generate better health, better care, at a better cost?’”

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