Rethinking the Health Care Team in a Bundled Payment Environment

Orsolini: And those health systems that really take care of the populations' health needs, that really have great outcomes, those are going to be the health systems that will thrive in a regional bundled payment environment. Hi, I'm Liana Orsolini. I'm a nurse by training and I'm the Care Delivery In Advanced Practice System Consultant for the Center of Clinical Excellence and Innovation at Bon Secours Health System Incorporated.

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Mulvihill: I'm Sean Mulvihill, Associate Vice President for Clinical Affairs and CEO of the University of Utah Medical Group. So tell me what would you say your insolvable problem . . . what's your biggest problem in the work you're doing? What would you like to see people focus more on?

Orsolini: I don't think it's insolvable because it's my job to help us solve it. I'm an optimist. But we are pushing to be providers of population health and those health systems that really take care of the population's health needs that really have great outcomes as far as providing most patients with all the UPSTF screening recommendations, immunizations, smoking cessation outcomes, those are going to be the health systems that will thrive in a regional bundled payment environment.

Mulvihill: And I think we agree that that focus on population health is really going to be the driver of decreased utilization and control of health care costs in the future.

Orsolini: Well, and as a middle-class taxpayer, I want that to happen. I want quality care that's safe, that's effective that we can all afford.

Mulvihill: We were talking about different members of the team and you mentioned behavioral specialists and I'm very interested in what you see the role of these individuals in our health care teams. What's the role of the behaviorists and how does it fit into our health care system as a whole?

Orsolini: I would like them to have training in how to help people verbalize what their health care goals are and to help them get there. Over 70% of people who smoke in this country want to quit, yet they're addicted and they can't. So a behaviorist would help them if they decide it is time and they're ready to quit, to help them do that. We know that if you look at the evidence of the most success smokers that want to quit smoking have is when they do cognitive therapy and medications.

So the behaviorist could tell other parts of the health care team, "This patient needs this drug or a drug for smoking cessation and we need to refer them to a psychologist for cognitive therapy." And the behaviorist can provide this at a more reasonable cost and free up the primary care physician to do what they're specializing in and work to the top of their education and training.

Mulvihill: So I think there are these big thematic areas of the amount of activity, physical activity our patients have. Their dietary choices, their compliance with medications, smoking cessation, these are the kinds of thing that have been very difficult to move patients forward on and we need new models and this behaviorist health specialist is one of the tools that may be more successful than what we've had in the past. Liana, those were terrific observations. Thank you so much for spending a few minutes with us.

Orsolini: Well, thank you so much for this opportunity.