"How well do you know your ICU patients? How well do you know your patients coming through your ED? What is the profile of your patients going from your ED to OR to ICU? What does that look like in your hospital?"
David Theodoro, MD, wears many hats.
He has practiced as an adult cardiac surgeon for the past 18 years, with another three years spent in training at Rochester, Minn.-based Mayo Clinic. He divides his time between clinical and administrative responsibilities, as he also serves as chairman of the cardiovascular department at St. Louis-based SSM Health, a $5 billion integrated delivery network across four states.
Dr. Theodoro also has other administrative and governance commitments: He sits on a 10-member board that governs SSM's employed 350-physician multispecialty group and another 10-member board that governs the clinically integrated network of which SSM is a sponsoring healthcare provider. The CIN is comprised of 1,200 physicians, including those from St. Louis University, a large independent primary care group in St. Louis and a network of independent primary care physicians.
"I have a very well positioned, front row seat to how our large organization is addressing population health, accountable care organizations and CINs," he says. "I've never been busier clinically than I am right now, so I practice all day and go to meetings all night."
Dr. Theodoro says many healthcare executives and providers enjoy discussing population health in broad, conceptual way, but the idea really comes down to individual patients, illnesses and how physicians manage each. Population health is often characterized by preventive care, early intervention, care managers and care coordination — efforts that are undeniably important and valuable. But Dr. Theodoro says those population health initiatives are more influential for a relatively broader, healthier segment of patients who spend a smaller portion of each healthcare dollar compared to the top 5 percent. In a hospital, these population health efforts don't have as direct of an effect on acutely ill patients in the emergency department, operating room and intensive care unit.
"How well do you know your ICU patients? How well do you know your patients coming through your ED? What is the profile of your patients going from your ED to OR to ICU? What does that look like in your hospital?"
Dr. Theodoro often describes images to convey concepts, including that of a pyramid representing healthcare patients. In this pyramid, the top 5 percent of patients account for the majority of annual healthcare spend. At the other end of the spectrum, half of the population with the lowest spending accounts for roughly 3 percent of total healthcare spend per year. About 15 percent of the population has no spending whatsoever.
"It's this top 5 percent of patients who consume somewhere between 45 to 50 percent of the healthcare dollar on an annual basis that I have the biggest interest in the from the population health perspective," says Dr. Theodoro. "These 5 percent of patients are the most critically ill and represent the largest cohort of patients with care variability and care gaps compared to the other cohorts."
When this group of patients, who are in the poorest health, enter the hospital ED, OR or ICU, there is a high degree of variability in their overall course. Physicians need a sophisticated and timely way to better segment patients and detect clinical deterioration or something abnormal with patients' clinical wellbeing as early as humanly possible. Otherwise, any small sign of clinical deterioration may result in more use of resources. In a capitated world, if healthcare providers cannot manage patient cases that require the most clinical resources, their systems will border on failure.
"Trying to intervene and avoid these cases of outsized resource utilization — that concept is blurry," says Dr. Theodoro. "Think about a Venn Diagram where one circle is the ICU, one is the ED and one is the OR. Where those circles cross, that's where the 5 percent of patients have the most resource utilization. In those areas, further characterization on a moment-by-moment basis of clinical overall status has a lot of room for improvement."
To learn more about this area of population health — better managing clinical outcomes and resource utilization for the most ill and highest spending segment of patients — register for the complimentary March 4 webinar featuring Dr. Theodoro and experts from Covidien Respiratory & Monitoring Solutions and PotentiaMetrics.