Cheyenne Regional Leads State with Wyoming Institute of Population Health

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WIPHDr. Phyllis Sherard, Chief Strategy Officer and Vice President of Population Health; Greg O’Barr, Director, Business Development and Analysis; and Dr. Judit Olah, Director, Analytics for Population Health Division, Cheyenne Regional Medical Center

Cheyenne Regional Medical Center is the largest hospital in the state of Wyoming. With 222 beds, it was honored by CMS with the Health Care Innovation Award that includes a three-year, $14.2-million grant to develop a trademarked division of the organization known as the Wyoming Institute of Population Health (Institute).

Given the large percentage of rural populations in Wyoming, the need for population-health management is great. CMS chose Cheyenne Regional to represent Wyoming in developing strategic platforms that would enable healthcare organizations across the state to take a more proactive approach to population health.

“It was unique in that we have an organization that is willing to look at the statewide needs, not just our own system’s needs,” Greg O’Barr, director, business development and analysis at Cheyenne Regional, said. “It created this interesting dynamic where those that we see as competitors every day are now also our collaborators and our partners.”

As the grant nears the end of its three years, Wyoming healthcare has undergone a makeover in which organizations are less siloed and more collaborative under the Institute’s leadership.

Helping practices achieve PCMH certification

Wyoming is classified as a Frontier State. Only two cities are considered urban areas, and even that’s a stretch, O’Barr said. For example, the system’s hometown, Cheyenne, has a population of over 60,000.

Because of the state’s classification, the Institute was primarily concerned with using the grant to bolster primary care throughout Wyoming. It created multiple programs that were focused on assisting primary-care practices in achieving PCMH certification through NCQA.

The Institute also established the Wyoming Rural Care Transition Program© with the goal of expanding care beyond the traditional four walls of standard healthcare entities.

For participation in this program, inpatients who were 65 years or older with one of 10 diagnoses were signed up. These patients were then followed post-discharge for 90 days by an RN, who made home visits, conducted medical reconciliation within the home, and followed up to ensure doctor appointments were made.

The results were so positive in reducing readmissions, O’Barr said the program now includes two additional locations with pilots for patients 18 years or older and features a behavioral-health component as an additional diagnosis.

Furthermore, the grant has enabled the Institute to oversee the largest investment in telehealth infrastructure in Wyoming. The Institute has also partnered with the state on medical donations, working with a pharmacist to acquire unused, unwrapped pharmaceuticals from hospitals and giving them to the uninsured and underinsured.

Measuring outcomes against five strategies

Dr. Judit Olah, director of analytics within the Institute, said they are tracking outcomes from these programs according to the standards of the Triple Aim. The quality of the services are further measured against five strategies.

“We are basically looking at the breadth and depth of the programs, the number of connections that are available, the number of PCMHs , and the number of access points that are available,” she said.

Olah said they have consulted with physicians, practice managers, patients, payers, and other stakeholders to develop a subset of nine NQF measures, including preventive and high-risk standards. After being vetted by the advisory group, the measures were then pushed out to participating facilities for monitoring outcomes.

Payers have since intensified communication with the Institute and the program participants, Olah said. In fact, five major payers in Wyoming have partnered with Cheyenne Regional to ensure the reporting of these nine measures.

“We were able to sidestep the reporting burden that you read about across the nation by bringing everybody to the table, presenting regularly, giving feedback on movement, and having that buy-in,” Olah said.

“It’s quite amazing how willing people are to report on the data when the payer comes back and says there’s an incentive with an enhanced reimbursement because you are reporting,” O’Barr added. “When payers see that they are measuring, they are willing to pay to keep that patient well. And that’s why we think we’ve had good luck with the program.”

Learning and growing through partnerships

Dr. Phyllis Sherard, chief strategy officer and vice president of population health at Cheyenne Regional, believes the success her team has experienced with the Wyoming Institute of Population Health should encourage other rural executives to partner within their care communities.

“It’s the only way you’re going to attract investment capital in the form of grants that will allow you to make the investments in shifting from the acute-care hospital to population health,” she said.

However, in making this shift, she advises that executives take their wins where they can get them, implementing strategies only when their organization is ready, not because an urban-community timeline dictates they should.

“Find the things that work for your community, work for your size hospital, work for your hospital’s culture, and then start to recognize that in creating a medical neighborhood,” she said. “It is mostly about the relationships you form in that medical neighborhood.”

O’Barr agrees with Sherard. He said it can seem like a dictatorship when one hospital is overseeing a program similar to the type the Institute facilitates. Therefore, “success equals personal relationships.”

Additionally, regular feedback from participating practices is important, Olah said. However, this feedback needs to be shared with all participants, so they are aware of more than just the progress of their facility.

Sherard said the mid-sized and smaller hospitals in the program had to adjust the roles they played within their communities as they partnered with each other and as they reached out to other nonhospital-based programs in their service area. She likened it to a learning laboratory in which all participants educated and sharpened each other.

“Be committed to drawing a perimeter of health around your service area,” she advised, “but don’t neglect the nontraditional partners that are out there in the community.”

by Pete Fernbaugh

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