In 1872 St. Louis, all that would later become SSM Health could fit in the basket Mother Mary Odilia Berger, SSM., carried from house to house – bread for the poor, medical supplies for the sick and clean linens for her patients. As she walked “with a very purposeful step,” people she met on the street would slip a donation in her basket.
Nearly 145 years later, woven in today’s SSM Health “basket” are 30,000 people – including 1,300 employed physicians – working in four states at 19 hospitals and more than 60 outpatient clinics. In addition, the system operates an insurance company, two nursing homes, comprehensive home care and hospice services, a telehealth company and two Accountable Care Organizations (ACO).
Among the hospitals is the system’s first academic medical center, Saint Louis University Hospital, which it acquired earlier this year from Tenet, and a children’s hospital. Most of the outpatient clinics and many of the physician employees arrived with the 2013 acquisition of Wisconsin’s Dean Health System. Dean also brought a health system rarity, ownership of a growing pharmacy benefit manager along with a string of retail pharmacies and eye care centers.
Process, Purpose, Patient
The base of today’s SSM Health “basket,” with its focus on process, purpose (mission) and patient, took shape in the hands of another purposeful leader, Sister Mary Jean Ryan, FSM. It took a dozen years, beginning four years into her leadership of a newly centralized system:
- Process (1990): She and the system’s leaders committed to continuous quality improvement. They aimed to “create a culture in which every employee at every facility and at every level of the organization would constantly seek to improve processes – every single day.”
- Purpose (Mission) (1998): Three thousand system employees, at all levels, in all locations, condensed a wide variety of mission statements into one succinct declaration: “Through our exceptional health care services, we reveal the healing presence of God.” The system had discovered it needed develop a more compelling mission after practicing with the Malcolm Baldrige National Quality Award criteria.
- Patient (2002): The system attributes its 2002 Baldrige Award to a focus on its core customers, patients, and “connecting the dots” from Baldrige criteria through core processes and results. SSM Health had begun submitting applications as soon as health care organizations became eligible for the award, in 1999, and became the first in the category to win.
In July of this year, Quality Management Journal published a study comparing 34 Baldrige winners, including SSM Health, with their 153 geographically closest competitors. It found that the “award recipients provided care equal to or better than competitors while at the same time providing a better patient experience.”
The “patient, purpose, process” culture SSM Health created as it pursued the award, and nurtured thereafter, has proven to be a dependable guide for the system amidst health care’s transformation from volume- to value-based care.
To Join or Not to Join
Earlier this year, SSM Health committed to put 75 percent of its business into value-based arrangements that focus on providing higher quality at lower costs by 2020. It did so as one of 24 provider organizations participating in the Health Care Transformation Task Force, which also includes payers and employers among its members. Dr. Gauroy Dayal, health care delivery vice president for SSM Health noted that the system “began working on transforming itself five years ago….when it began assuming risk and responsibility for improving the quality of care while lowering costs.”
On the other hand, because of its unique culture, SSM Health knows what not to join. Several years ago, the system chose not to participate in the Medicare Shared Savings Program (MSSP) by creating a Medicare Accountable Care Organization (ACO). It had concluded that the assignment of beneficiaries based on claims history, not choice, was inconsistent with SSM Health’s transparent, patient centered care model.
Instead, SSM Health embarked on a path to “True North,” as it explained in a Mayo Clinic Proceedings article, “The SSM Health Care Approach to Achieving ‘True North’: Improving Health Care Quality While Reducing Costs.” True form, it created a process based on a functional definition of accountable care. The system then chartered five teams to design “an organization capable of assuming and managing global clinical and financial responsibility for the care of a defined population.”
The Volume to Value Process
Flashes of process appear continually from SSM Health as it makes the change from volume to value. For example, the system has:
- Created a methodology to eliminate unjustified variation in their medication formulary using available data from purchase history, quality management systems and electronic health records.
- Established a “single source of terminology truth” that effectively manages and maps data to industry standards, ensuring accuracy across the enterprise in advance of ICD-10.
- Developed more efficient processes for utilizing hospitalists, decreasing readmissions.
- Deployed a digital app, which learns and adapts to self-reporting patients, reducing 30-day hospital readmissions by 57%.
Even the legal department is doing its part, earning recognition as a 2015 Association of Corporate Counsel Value Champion.
Process at SSM Health may be very rewarding, but it is certainly not easy. Take clinical device technology. Teams now have data at their fingertips enabling business decisions based on fact, data such as mean-time-between-failure, according to Heidi Horn. However, “It took a vision and years of work and tenacity by all 100+ team members of Clinical Engineering Service,” she added.
SSM Health’s commitment to process likely played a decisive role in its merger with Dean. Although both organizations had worked together for decades, neither assumed a successful integration would necessarily follow. In fact, SSM paid “an excessive amount of attention” to culture, according to Dr. Dayal, who originally had been with Dean. An “organizational heath index” of several hundred parameters characterized the two cultures, identifying the presence or absence of overlaps.
SSM Health More Like Dean
Trustee Magazine reports that, as a result, SSM Health has become more like Dean since the merger, putting doctors on the board and appointing Dayal and another physician to lead two of its three divisions. Objective accomplished, because SSM Health acquired Dean not for its financial assets, but for its talent, knowledge and capabilities, especially around health plan and physician practice management. As Dayal explained, the 90-year-old, fiercely independent, physician-run Dean has given SSM the capabilities needed to transform into an integrated value based organization.
Operating a health plan since the 1980s and a population health model since 2009, Dean can accept performance risk for almost 70% of its business. An innovative medical value program brought clinicians, staff and data analysts together to identify opportunities to improve clinical processes and care management. The program used claims data from Dean’s insurance arm and electronic health records from area hospitals owned by SSM Health – before the merger.
Now, after the merger, the fully integrated SSM Health Care of Wisconsin now offers some of the lowest public exchange health insurance costs in the state for Janesville-Beloit consumers in Rock County south of Madison, on the Illinois border. It did so through its St. Mary’s Janesville Hospital, Dean Health System and Dean Health Plan.
In fact, when Rock County consumers select health coverage, they choose between health providers, not health insurers. Competing in the same area is a similar fully integrated health system, also with an insurance component, Mercy Health System. Citizen Action of Wisconsin, which compiled the rate comparisons, gave both Dean and Mercy four-star ratings. Only Gunderson Health Plan received five stars.
“Vertical integration has a lot to do with the lower rates,” explained Dean’s Jamie Logsdon. “When you’ve got a network, such as Dean and St Mary’s Janesville in that market, they are all working together to provide more efficient care.”
Twenty-five years in the weaving, the “basket” that is SSM Health could very well be a model for value-based health care.