Interview with Darrold Bertsch, CEO at Sakakawea Medical Center and Coal Country Community Health Center
Caravan Health’s proven methodology and expertise in building, designing, and managing successful population health programs and collaborative ACOs is helping Medicare providers across the country transform their organizations as they transition from the fee-for-service to fee-for-value reimbursement model. Our clients are achieving the highest quality scores in the nation, improving their workflows, and lowering costs -- key factors to sustainable operations and profitability.
Clinicians must be fully engaged for value-based programs to work, and Caravan Health’s collaborative ACO model drives engagement from all levels of an organization. Our team-based care approach empowers nurses to lead wellness and prevention initiatives, giving greater opportunity for increased reimbursements while leaving more time for physicians to focus on patient care and less time worrying about administrative duties.
Caravan Health recently spoke with Darrold Bertsch, CEO at Sakakawea Medical Center and also of Coal Country Community Health Center, about the success his organizations have had participating in a collaborative ACO. According to Bertsch, participating in an ACO is work, but it’s not that hard. Results come with engagement throughout the organization coupled with collaboration and networking with other providers in your community and others within your ACO.
What were your organizations’ challenges prior to joining Caravan Health’s ACO?
Darrold Bertsch: I think the biggest challenge we faced was the uncertainty of what an ACO is and what work would be involved once we joined. Those questions were soon answered as we started participating in webinars and the educational sessions Caravan offered. We learned that we were already doing much of work and that we can succeed at this. It created more confidence within our organization, with our providers, and our staff that participate in the ACO.
What guidance would you give leaders at other organizations who are considering joining an ACO?
Darrold Bertsch: In order to participate effectively with an ACO, they really need to engage and identify staff within their organization that can lead the initiatives. Don't bring someone to the table to be the ACO champion or Medical Director solely because they may have some extra time on their hands. For the ACO be successful, you need someone who's committed to doing the job and committed to work with providers.
The whole leadership team at Caravan did a great job in providing the education that we need. We learned a lot. The other key to success is networking. We network with other facilities that are part of the ACO, and we share lessons learned and challenges that we've had.
When I first hear Lynn Barr describe her vision about an ACO that involved bringing together rural providers into a group that was not geographically aligned, I thought: 'Boy, I don't know how that can be made to work.' Slowly over time I became thoroughly convinced that this is a model that works.
In what areas have you been most successful?
Darrold Bertsch: Our Federally Qualified Health Clinic and our critical access hospital collaborate very well together. We've been most successful with our care coordination at each location. For example, we have care coordinators at the FQHC and at the hospital, and we have a care coordinator in the community. We all work together to help our patients navigate the transitions of care regardless of where she or he might be needing services.
How have you improved your health care delivery system?
Darrold Bertsch: We've improved our health care delivery system by collaborating more and working together to coordinate care for patients that have chronic conditions. We make sure that they understand the need for preventive tests and to work with our providers to improve their health. Another area we’ve shown improvement is in our transitions of care. Whether our patient is in the clinic environment, hospital environment, at the nursing home or home health, it’s important for our providers and staff to work together in those transitions of care to make that navigation among service providers the as simple as possible for our patients.
How has joining an ACO impacted your physicians and nurses?
Darrold Bertsch: When you start in an ACO, providers are initially concerned that they are going to have more work to do. They worry: “I'm already busy. How can I make even more time to spend more time with these patients doing these jobs?” It’s not that they don't want to participate, but they have concerns about time commitment. What they learn soon after is that they're part of the team, and the nursing staff are the ones who are most engaged with the patients. They provide information to the providers, so that both the nursing staff and the providers are operating at the top of their licensure.
How has it impacted the patients in your community?
Darrold Bertsch: I think in general our patients are very pleased with the outcomes and the work that we've done. A good example would be, we've had a patient that was utilizing local emergency medical services three times a week. An ambulance would transport the individual to the hospital. The frequency of emergency room visits maybe weren’t necessary. Through our work with the community care coordinators, the primary care and the hospital care coordinators, we reduced the number of ER visits to two or three per quarter instead of two or three per week. Successes like that are what it's all about.
What's the most surprising thing you've learned since you joined an ACO?
Darrold Bertsch: It's not that hard but it takes work. There's a difference between hard work and normal work that achieves the results. We were afraid when we started in the ACO that this was going to be really a burdensome on our providers and our staff.
It's come to be second nature now. This is how we provide health care in our communities so that we can achieve the triple aim. We want to do a better job of how we provide care, we want to do a better job of improving the health of the population that we are serving, and of course, in the end we want to reduce costs to our payers as well.
How was Caravan Health most helpful in getting started with the ACO?
Darrold Bertsch: When I first heard Lynn Barr describe her vision about a [collaborative] ACO that involved bringing together providers into a group that was not geographically aligned, I thought: "Boy, I don't know how that can be made to work." Slowly over time I became thoroughly convinced that this is a model that works and provides a greater opportunity for rural providers to participate in a value-based initiative. We engaged our staff, then we engaged our board to get approval to move forward, and that made us successful. It required a process to begin feeling comfortable with the model itself and the vision that Lynn had had when Caravan first started. The lessons we’ve learned through our ACO participation with Caravan has also helped us be better prepared for our participation in commercial and Medicaid value-based initiatives.
To learn more about how an ACO can help your organization achieve its goals, you can view our recent webinar here.
Watch Darrold Bertsch's interview here.
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