Friday, November 13, 2009

Atrius-BIDMC Relationship

We announced yesterday an important partnership between the state's largest multispecialty group practice, Atrius Health, and BIDMC. This is a promising new relationship between a physician practice group and an academic medical center.

Here's the press release. Please note, in particular, the comments by Don Berwick, which help explain the context and significance of this.

While exciting to me, I also know that this will also require a lot of work to pull off, and I expect we will learn much from each other. I would also be happy to hear comments from my readers as to your experiences in similar ventures, and your advice to us to help make this a success.


Atrius Health and Beth Israel Deaconess Medical Center are expanding their relationship to establish a new model of health care delivery between a large ambulatory multi-specialty practice and a leading academic medical center, according to Gene Lindsey, MD, president and CEO of Atrius Health.

The boards of directors from Atrius and BIDMC both voted Wednesday evening to build the expanded relationship. The first step will be that Harvard Vanguard internists from the Kenmore, Copley Square, and Post Office Square offices will send their patients who need emergency care or hospitalization to BIDMC. Over time, Atrius Health will also look to collaborate with BIDMC in ensuring hospital care for patients with more complex needs, including cardiovascular and oncology patients as well as other surgical specialties. The organizations will utilize electronic medical records to help coordinate patient care. Atrius Health will continue all of its existing hospital relationships to serve patients in communities it serves.

Guided by an overarching goal of patient-centered care, Atrius Health and BIDMC also envision a robust agenda of quality improvement and cost efficiency strategies. Both parties have a vision of working together far into the future. Additional details about joint clinical, quality, and cost reduction programs will be introduced over time.

This new expanded relationship comes amid the current statewide and national debate on cost control and health care reform, and the move toward global payments in Massachusetts. The collaboration will be built around a strong emphasis on primary care and a continuum of care from the ambulatory setting to the hospital and beyond.

“The goal is to demonstrate that by working together, the two organizations can provide the highest quality, best service, and lowest cost health care in the Commonwealth.” Lindsey said. “We have the utmost respect for the progress BIDMC has made towards eliminating preventable harm and doing so with transparency,” he added.

The collaboration is also part of a larger Atrius hospital strategy to work together to improve quality and reduce costs with hospitals that share their vision and want to work on lowering cost and improving quality. Atrius Health and BIDMC have a long history together and both were involved in the Blue Cross Blue Shield of Massachusetts LEAD program for process and quality improvement.

“We intend to establish the model for health care delivery in the Commonwealth,” said BIDMC President and CEO Paul Levy. “That model offers a full spectrum of health care services that are patient-centered, compassionate, integrated, and evidence-based. Fundamental to our model will be an emphasis on primary care, alignment of the organizations, and transparency. Atrius Health has demonstrated leadership in all these areas, which is why we are so excited to be working and learning together.”

“Almost for certain, the American health care system is on the threshold of a leap into a new era of integrated, coordinated care. Patients as individuals and society as a whole badly needs that leap to achieve better quality at lower total cost. That re-forming of care will require new, highly cooperative relationships between foresighted hospitals and progressive medical groups,” according to Don Berwick, MD, MPP, President and CEO, Institute for Healthcare Improvement. “I cannot think of two organizations better equipped to welcome that reinvention, and to succeed at it, than BIDMC and Atrius Health. Each has a strong and distinguished track record of innovation, and their combined efforts will blaze a trail for many others,” he added.

The goals of the new relationship follow many of goals and principles outlined by the Massachusetts Health Care Quality and Cost Council, the Massachusetts Payment Reform Commission, the Mayor’s Task Force on Improving Access to Primary Care in Boston, and the Institute for Healthcare Improvement (IHI), including: Putting primary care at the center of patient’s care; Making sure that physicians work together as a team with nurses, technicians, and other allied health professionals; Enhancing and further integrating electronic medical records; Advancing health equity and ensuring a diverse, culturally competent, interdisciplinary workforce; Preventing and reducing medical errors and being transparent about results; Improving the efficiency of health care delivery by continuous process improvement as exemplified by the Lean methodology; Empowering patient involvement in the design of the health care delivery system through advisory councils, secret shoppers, patient satisfaction surveys, and other mechanisms.

Harvard Vanguard and its predecessors have a long history with BIDMC. Harvard Community Health Plan originally formed as a combination of a Brigham & Women’s practice and a Beth Israel practice, and benefited from the relationships with both of these outstanding institutions. Today, Atrius Health has existing relationships with BIDMC for obstetrics and oncology.


Anonymous said...

I strongly second Dr. Berwick's comments about the future, and about BIDMC's ability to pull this off. Paul, you are indeed a seer.
The devil is always in the details, but determined retention of a spirit of cooperation will pull you through.

Jim Accord said...

I agree with Anonymous, "The devil is always in the details." The success of the stated objectives must be measured over time. There is a measurable first objective contained in the press release, "The first step will be that Harvard Vanguard internists from the Kenmore, Copley Square, and Post Office Square offices will send their patients who need emergency care or hospitalization to BIDMC." Given,this is a press release and not a White Paper, will a more comprehensive strategy be shared? Specifically how Step 1 meets the larger goal? (e.g.“The goal is to demonstrate that by working together, the two organizations can provide the highest quality, best service, and lowest cost health care in the Commonwealth.”)

James Accord

Anonymous said...

Oops, while reading that someone actually agreed with me (!) I realized I forgot to add my moniker at 0740.


76 Degrees in San Diego said...


Lachlan Forrow, MD, FACP said...

I actually tell people that "God is in the details". When they correct me and say "I thought that's where the Devil is" I explain that "Yes, that is where they fight it out..."


Kevin Callahan said...

Do you mind if I ask what EHR platform will be used in the venture?

Anonymous said...

The two organization use different systems, but we have designed links that enable cross-commmunication. Here are some, but not all details.

BIDMC clinical information is on webOMR - includes lifetime medical record with problem lists, medication lists, laboratory results, radiology results/images,
microbiology, departmental reports, scanned inpatient records. Will include cardiology images by Summer of 2010.

Read Only Access will be available to all authorized Atrius personnel via the “Magic button” in Epic, per the Epic authorization controls assigned by Atrius.

Write Access - The ability to post consult notes into webOMR will be given to specialists who need to communicate with BIDMC PCPs. Hospitalists will print Epic notes for insertion into the chart or cut/paste notes into webOMR.

Provider Order Entry at BIDMC includes all inpatient ordering, discharge summary creation, dashboards of patient location/order status.

Read/write access will be available to all credentialed providers who have BIDMC usernames/passwords.

Atrius uses Epic at their platform. Access to Epic
Access to Epic via Citrix will be granted to selected BIDMC clinicians who require it. Order Entry into Epic will also be available in the dedicated Atrius workspaces on the East and West Campus which have the LAN to LAN tunnel.

Kevin Callahan said...

A great partnership to improve the efficiency and quality of health care. I wish you all the best.

Anonymous said...

As a patient who goes to Kenmore for my care and has had all my surgeries at BWH, I have to wonder that the first letter I get about this merger was from BWH to say I can still go there for care. I have worked at both institutions and know that my care would be good at either place, but if forced to change my relationships I will be hard-pressed to stay. Having PPO gives me some latitude, but I think communication up front would be good for patients affected.