Navigating Care Coordination: A Q&A with Greg Garza


Q&A with Greg Garza the Vice President of Integrated Care for Fresenius Health Partners (FHP), the division of Fresenius Medical Care North America (FMCNA) focused on value based payor programs.

Q: How would you describe Fresenius Health Partners and how has it grown over the years?

GG: The goal of coordinated care through FHP is to ensure patients can access the right care at the right time, helping them move from high to lower risk on the healthcare continuum while reducing the overall cost of that care.

In 2011, the conversations within the healthcare community started to focus on Accountable Care Organizations (ACOs). After FHP completed a five-year Medicare demonstration program under CMS, we partnered with the team to develop ACO Partners. We saw the potential for our unique model of coordinated care to have significant impact in the realm of healthcare coverage.

What began as a small group of six or seven focused individuals trying to identify patients who were not adhering to their dialysis treatment regimen, has matured into a robust organization of specialized nurses and service coordinators managing patients with late stage chronic kidney disease (CKD) through end stage renal disease (ESRD).

This led to the inception of the Care Navigation Unit or “CNU”. The CNU works hand in hand with Fresenius Kidney Care (FKC)Azura and other Fresenius Medical Care North America departments to identify the most at-risk patients in the clinics who need specialized services to improve their outcomes. Their ability to successfully connect those patients to these services has an obvious impact on patients, as well as the financial health of our value based programs. Value based programs place a heavy emphasis on quality of care, and there are specific quality metrics which must be achieved prior to any financial gains being realized.

Q: How would you define value based care?

GG: In a value based care program, providers are paid based on the quality of care they provide to patients instead of on the quantity of services provided. The goal with our value based programs is to provide the most effective clinical care for patients while delivering optimal financial performance as a result. This follows suit with the triple aim of healthcare as well, which really targets improving the patients experience, improving the overall health of the population being served while reducing the total cost of care for that population.

Q: Describe the growth you’ve seen in value based care.

GG: At the start of 2014, we didn’t have a single patient in a value based program. Today, we have more than 50,000 patients in our value based care programs, which means that about a quarter of FKC patients are supported by these programs today, and we only expect that to increase. That’s tremendous growth for a new health care delivery model in a relatively short period of time.

We’ve been able to grow rapidly through government programs because we’ve shown the ability to improve care quality for our patients while reducing the overall cost of care for Medicare. Looking forward, continued success will be dependent upon our ability to coordinate total patient care. We know that with the rising cost of care, especially for the population of patients we treat, we can’t continue to look at just one facet of care in our patients’ lives. We have to look for other opportunities where we can provide value.

Q: How do you manage the quality of care for patients in value based care programs while also reducing costs?

GG: One way we do this is through very sophisticated predictive analytics. Working closely with the Integrated Care Analytics team, led by Dr. Len Usvyat, has helped us identify those patients who have the potential to decompensate at a faster rate than other patients, causing them to miss treatments or have other clinical factors that tend to lead to unnecessary hospital admissions. We look for trends with all our patients to find the “needle in a haystack” patient before a negative event happens, so we can prevent the need for costly hospitalizations.

Most health plans would automatically classify all ESRD patients as high risk, but since we have up-to-date clinical data, the predictive analytics have helped us to stratify patients into low, medium and high risk categories and provide interventions as appropriate. Using this kind of technology and data to inform our health care delivery decisions makes what we are doing every day that much more effective and exciting.

The difference is that we are proactive in our approach instead of reactive. Most health plans use insurance claims data and lab information to determine a care path. We know there’s a 90- to 120-day lag time in claims, so that causes lengthy, unnecessary and costly delays in making decisions on care. And by the time those decisions are made, they are being determined based on old information. Identifying trends, spotting the patients at the highest risk and making good care decisions based on this information is our secret sauce.

Dialysis is unique in that we know where these patients are supposed to be and how they are doing three times a week when they are receiving dialysis with us. With our proactive approach, we look at data in real time to improve their overall quality of care, therefore reducing expensive hospitalizations. Our data show that hospitalizations are concentrated around particular issues, such as fluid management, infection and psychosocial issues. We spot these problems ahead of time and intervene in a much faster way, leading to better health outcomes and cost savings.

Through our next-generation predictive analytics and the data we have at our fingertips 24×7, we can take that many steps forward to actually being able to tell who is likely to be hospitalized within the next 72 hours. This model was recently highlighted in a poster presentation this April at the National Kidney Foundation Spring Clinical Meeting. We get in front of these patients and guide their care in a proactive manner. Having that kind of information on behalf of our patients is incredibly powerful.

Q: What is different about the way FMCNA approaches care coordination?

GG: FMCNA has developed a large national network of services, skillsets and solutions that consider the needs of our patient population. This provides FHP with a tremendous opportunity in determining how their patients’ healthcare is delivered and coordinated. An important component of FHPs care coordination is the CNU. They serve as air traffic controllers on behalf of our patients and their needs. We identify issues before they escalate. We coordinate all facets of their care, leveraging our national network of Outpatient solutions. We put our patients at the center of the care model and surround them with our assets, including a wide range of care services, such as renal pharmaceuticals, labs, dialysis centers, urgent care facilities, network of contracted hospitals, vascular care and more.

We are constantly testing what’s working today so we can look to tomorrow and further improve on the coordinated care we are providing. I know with the shifting sands of healthcare, the only constant in the near term will be change. What’s reassuring is that the teams of dedicated individuals I interact with daily across our enterprise are excited about what they do and ready to meet these ongoing challenges because they love what they do and who they do it for, the patients that we all serve.

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