St. Louis-based SSM Health finalized a merger with Dean Health Systems in 2013. The partnership arose in respect to the changing healthcare landscape that saw both practices calling for a triple imperative for more coordination, better collaboration, and more seamless care delivery. Both SSM Health and Dean Health Systems are nationally esteemed for their quality of care, and their amalgamation brings together a breadth of specialties with Dean Health System’s expertise in managing physician practices and SSM’s expertise in acute care.
SSM Health’s merger with Dean Health Systems was a strategic move in joining the value-based revolution. SSM Heath’s former Executive Vice President and President of Physician and Ambulatory Services, Dr. Shane Peng, employed a system-wide approach to break into five working groups. These groups drive the cultural changes taking place at the practice to make way for both value-based care and clinical integration. They demonstrate a best practice case study in how transitioning to value-based care and clinical integration can successfully occur.
Value Contracts Optimization
Led by the system Chief Financial Officer and contracting professionals, this group is composed of operators and clinicians from the hospitals, medical group, care delivery, and also strategy personnel. The diversity of this working group allows for an optimal level of support to the task of developing a grid with key metrics to gaining value across all contracts. Once the indicator has been identified, the next step is moving to quantify and monetize the activities that are needed to be successful.
Metrics and Analytics
Led by the regional president of the physician’s organization, this group includes members from IT support, a variety of clinicians, individuals from contracting, and people from SSM’s current analytics infrastructure, including representatives from Dean Healthcare Plan. The support of representatives from Dean Healthcare Plan is extremely beneficial, as being a payer, there is actuarial support to analyze risk data. The task at hand for risk analysts is to utilize analytics to drive necessary changes to improve contractual success.
Care Management
Led by the President of Hospital Operations and supported by leaders from the hospitals, the physician’s organization, and post-acute care. Care management is the most critical element of value-based care. Stakeholders are challenged by the variation of care management and further challenged to create a standardization approach for care management if it is not already present.
Core Competence
Led by the president of physician and ambulatory services, this group must evaluate and develop the core competencies, infrastructure, and processes required to drive success in value-base care.
Information Technology
Led by the system Chief Information Officer, this group includes representatives within the clinical and management areas at SSM and is charged with assessing, developing, and deploying the information technology necessary to ensure the value-based care initiative is successful. The Information Technology working group achieved a breakthrough in just three months of work in the form of a grid created from the input of all five working groups. All SSM contracts are listed by region and are broken down into opportunities to monetize. Execution of this should add up to around $40 million. That grid is used by the analytics and metrics working group to understand how the contracts actually work, and helps SSM understand how best to reverse-engineer its care delivery by creating successful processes.
Conclusion:
Transitioning to value-based care and clinical integration is supported by care delivery, hospitals, post-acute care, IT, and finance and strategy through these five best practice mechanisms. Shane Peng has described SSM Health’s Wisconsin as a model region because it has all three of the quintessential elements for an integrated system: hospitals, physicians, and its own health plan.
Although some regions within SSM Health don’t exemplify the three-component styled IDN, SSM Health’s merger with Dean Health Plan can give insights into learning what health plans want delivered. This strategically positions SSM Health to have opportune partnerships with any health plan, government, or otherwise to drive better care for their patients and introduce efficiency standardization and higher performance.
The utilization of Dean Health System’s capabilities adds to the merits of this merger. For example, SSM Health’s placement of Dean Health Systems’ health plan experts charged with managing its self-funded employee plan has produced immediate cost savings through steps such as switching to Navitus, a pharmacy benefit-management organization that was jointly owned by Dean Health System and SSM Health, but is now part of the wider system. Capabilities like this have shaped the true value in the acquisition; transforming SSM Health into a carefully constructed value-based, integrated organization.