by Stephanie L. Motter, CEO, Monument Health, LLC

When providers are given room to innovate, they can make tremendous gains for medicine and pave the way for the future of health care. I have seen this firsthand as the CEO of Monument Health, a clinician-led clinically integrated network (CIN) and population health services organization, and through my background as a nurse practitioner. Having spent my entire career collaborating with physicians to provide direct care to our patients and working with them on innovative processes and value-based care arrangements, I deeply understand that clinical training and direct patient care experience give providers a special perspective.

Monument Health started in 2016 in Mesa County – conceived through a collaboration between Primary Care Partners, St. Mary’s Medical Center and Rocky Mountain Health Plans – and our products and services are now available in Mesa, Delta and Moffat counties, supporting almost 15,000 people.

At Monument Health, we invite providers to consider what is most meaningful to them and to innovate on how they believe they can best move the needle in our communities. We get the conversation started during contracting. We ask them to consider what will drive better health outcomes, improved access to care, fewer inefficiencies and better engagement among their patients. Our primary care practices, most of which are independent and are not part of a hospital or health system, have identified certain opportunities related to improving access to care. They are creating new workflows for new patients to be seen more quickly, and they have created better new-patient intake processes.

An example is helping existing patients get more engaged and seen quickly. A group of pediatricians wanted to focus on pediatric wellness exams and ensure all their patients were being seen regularly (not just those kids who remain on a vaccination schedule and whose parents are therefore more likely to bring them for visits), so they developed a metric focused on driving pediatric wellness visits.

Another example of physicians innovating when it comes to process and metric development are the radiologists in our network. They developed a new and locally developed metric to monitor high-cost imaging procedures that are ordered by their colleagues in the community, and these radiologists get involved not just in tracking the data, but reviewing it and engaging their colleagues in the community who appear to be outliers with the ultimate goal of reducing unnecessary imaging tests and procedures.

Our physicians also regularly innovate with our health insurance carrier partner and self-insured employer groups on health insurance plan designs. For example, through multiple interactions and robust discussions with the right stakeholders at the table, we now have a Monument Health product through Rocky Mountain Health Plans that offers a handful of “free” (i.e. $0 co-pay) visits to a primary care provider, in addition to the no-cost annual (preventive) visit. For patients with chronic conditions or those who require primary care visits five or six times a year, the financial barrier related to co-pays has been minimized, and complex, higher-need patients are being seen more regularly. This plan design and benefit to our members was primarily advanced by our primary care physicians who saw the need and were being responsive to their patients’ feedback. We have seen a few self-insured employer groups adopt a similar approach to plan design.

Current actual and proposed legislative activities in Colorado today (e.g., reinsurance, public option, etc.) and the group purchasing alliance (Peak Health) represent a good start to health care reform, but they seem limited and potentially unsustainable because they only focus on reducing price. Health care costs are indeed an issue – and we all have various perspectives on who should be accountable and how to fix the pricing issue – but costs are only the tip of the iceberg. There must also be a focus on health and wellness. Monument Health focuses on both price reduction AND improving health and wellness. We require all contracted providers (hospitals, physician practices, etc.) to lower their rates. We also insist that providers commit to certain clinical processes and metrics that will improve health outcomes, enhance members’ experience (or their engagement) and/or reduce inefficiencies that exist in the health care ecosystem. It’s this second part that sets us aside from all the other “solutions” that are being discussed and deployed throughout the state, and these processes and metrics are developed by physicians.

In sum, our provider partners – whether independent practices or those who are employed – are innovating by way of rate relief, access to care and highly targeted metrics that improve quality and reduce waste, and enhancing the design of health insurance products.

Categories: Communications, Colorado Medicine, Cover Story