Editor’s note: This commentary is by Tomasz L. Jankowski, of Newport, who is president and CEO of Northeast Kingdom Human Services. Prior to that he was director of the Neuroscience Institute at Mercy Health and director of Ambulatory Rehabilitation at Ohio State University’s Wexner Medical Center. He is a member of the board of OneCare Vermont and Vermont Care Partners, among others.
If designing the ideal integrated health care delivery system was easy, it would have been conceived a long time ago. So, why is it so difficult to accomplish this task? And if and when we get there, how will we know that we finally got it right? I submit that we do not really know what an “ideal” system of care should look like. We have made significant strides over the past 60 years, moving from a model steeped in the “build it, and they will come” disease-based approach to a nimble, value-based, population health-oriented line of attack.
For years, Vermont has been on the cutting edge of progressive thinking, experimenting with new ideas, and has not become discouraged in the face of adversity. That is what is so unique and exciting about this state and its people. After an unsuccessful attempt to create a single payer health care system in 2014, the state quickly pivoted and partnered with OneCare Vermont to achieve its aim of bending the health care expenditure curve and improving health outcomes by uniting the physical health, mental health, and social services sectors. Now that we are heading in that direction, our collective goal should be laser-focused support of our network of care and continued investment in it. Its success depends on our collective confidence, patience, and understanding that the OneCare network is our investment in the future of “well care” in Vermont. If we can dream it, we can achieve it.
Unlike other health care models, only three years into the all-payer model, OneCare Vermont has coalesced more than half of the state’s primary care providers and specialty practices, most hospitals, all federally qualified health centers, home health agencies, area agencies on aging, and designated mental health agencies. OneCare does not provide services, but facilitates and coordinates care among providers by leveraging data. OneCare is not in the business of making profits – instead, it distributes any savings to the communities it serves. OneCare projects its value by establishing accountability for care delivery, aligning resources with patient and population needs, stabilizing health care costs, supporting providers, and providing data analysis, and risk management services in an effort to improve health. During the coronavirus pandemic, OneCare has continued paying providers even when traffic may have slowed down or come to an abrupt halt, providing stability and certainty in health care when it is needed most.
Northeast Kingdom Human Services, a designated provider of mental health, substance use, and intellectual and developmental disability services, has seen the value of our work developing community-based outreach programs in collaboration with OneCare. Our active involvement in the care coordination model through OneCare has allowed NKHS’s staff to offer wrap-around services to individuals with moderate and high medical needs and to develop closer ties with clinicians across the health care delivery spectrum. As a result of this close relationship among providers, Vermonters benefit from a comprehensive care team where all members are aware of and can better address client goals, needs, and wants.
Through another joint project, NKHS has embedded an emergency services worker at North Country Hospital to decrease unneeded emergency department visits for mental health-related concerns. We have streamlined services at the point of referral by triaging patients in real-time. Of nearly 100 consults provided at NCH in the last quarter, approximately 31 clients have been placed under care management with NKHS. Of those 31 clients, only five revisited the emergency department within 30 days of their first contact with NKHS. Our work in the hospital referring patients to much-needed mental health services has reduced emergency department reutilization. OneCare is weaving a tight net between providers and community agencies and reinvests funds in innovative and value-generating projects, with the idea that those projects ought to, eventually, become self-sustaining.
As CEO of a designated agency and member of OneCare’s board, I see, firsthand, OneCare’s progressive vision for the future and believe that this network will help us get there. We are building a future and OneCare is our investment in it. As we go forth, we will see improvements along the way, but to fully change our system will take time. As with every investment, its success requires our resolve, patience, and sustained financial influx. Only if we align behind our collective vision — no matter the differences — and work together, will we create a system that truly works for Vermont. And, perhaps, what we are building is not for ourselves, but rather for our children and for our children’s children. May this help us all learn to be more patient.
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December 10, 2020 at 06:55AM
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Tomasz Jankowski: Health care system change takes time, patience and investment - vtdigger.org
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