St. John's again tops national integrated health systems list

Springfield is one of only four cities to have two health systems on an annual list of the nation's Top 100 Integrated Health Systems.

St. John's Health System earned the top spot for the second time in three years, and CoxHealth cracked the Top 50 for the first time.

Pennsylvania-based SDI Health Inc. examined hospital utilization, financial stability, physician participation, services and access to services, outpatient utilization, contract capabilities, integration, and use of technology to compile the list.

The health systems are rewarded on how well multiple components of care work together, and only two other Missouri systems made the list. St. John's Mercy Health Care in St. Louis is the only other Missouri system in the Top 50, landing at No. 28. St. Luke's Health System in Kansas City was No. 62.

Top of the heap

St. John's Health System has been working to integrate its health system since it first began hiring its own doctors in 1994.

This year marks the second time that St. John's topped the list of integrated health systems nationwide in three years.

For St. John's President and CEO Kim Day, the ranking is not as important as the benefits patients and employees get from an integrated system.

"I've lived on the other side, where you have doctors looking out for their best interest, the hospital looking out for its best interest, and health plans looking out for themselves," Day said. "What I know is that model causes significant fragmentation, duplication of care, it's more costly, and tests get duplicated."

At its core, the integrated health system model is based on efficiency.

A fully integrated system employs its own physicians and hospital staff and contracts its own health insurance plans. In return, the physicians, hospital staff and insurance professionals have a voice in the health system's decision-making process.

The result, according to Day, is a health provider that is focused on providing the best care possible, as quickly and cost-effectively as possible.

"We believe the integrated model allows us to serve the health care needs of the community better than any other model out there," Day said. "It's easy to understand that any time you have everyone pulling in the same direction, you're going to get better results."

The integrated model is also advantageous to physicians, according to Dr. Dominic Meldi, chairman of the board at St. John's and a physician at St. John's Clinic-Smith-Glynn-Callaway. He said the management model at St. John's, which pairs each member of the management team with a physician counterpart, ensures the doctors have a strong voice in decision-making.

"The way our integration works, it really is a physician-driven organization," he said. "With this model, physicians really are engaged in making decisions about how we treat our patients - we deliver the care and are interested in financing the care, and we're accountable for what we put out there."

Moving on up

Elsewhere on Springfield's medical mile, CoxHealth made the list, moving up nine spots from 2008 to No. 49.

CoxHealth Chief Financial Officer Jake McWay said the health system's integration efforts, under way since the mid-1990s, include every aspect of the health care continuum, from the hospital to physician clinics to home health services and insurance.

"If you can bring up the level of care from the moment (the patients) enter the ambulance all the way through to when they're on the way home, you can improve people's lives," McWay said.

In addition to improved care, however, McWay said the integrated model also reduces costs and speeds up the health care process by eliminating redundancies.

"If all the providers in the system have access to the same information, maybe you don't have to run that test again or they don't need another (magnetic resonance image)," McWay said. "It's those type of things that benefit not only the patient but the whole health system."

The integration model entails making the best use of technology, from electronic health records - in place at CoxHealth and St. John's to allow caregivers to see patients' up-to-date medical information - to major diagnostic and treatment equipment that can be shared among multiple practices or divisions.

"If you look at the U.S. health system, it's very fragmented in some places, and I think that's what has driven a lot of hospitals to try to develop these integrated health systems," McWay said.

A changing industry

The federal government is taking notice of the effectiveness of integrated systems.

The Centers for Medicare & Medicaid Services is in the fifth year of its Physician Group Practice Demonstration, in which 10 health systems nationwide - including St. John's - examine patient care improvements for diabetes, coronary artery disease and congestive heart failure.

Part of that demonstration includes Medicare making a single combined payment to each health system for both its hospital and physician services - a move that McWay said indicates the government's interest in moving toward the integrated model as a preferred structure for health systems.

"It seems that government payments are driving us more to integrated delivery," he said. "For that system to work, physicians and hospitals have to work together to manage that care and make it high quality and efficient."

The model seems to be working. All 10 health systems in the CMS program hit at least 93 percent of their patient care benchmarks, and five of the 10 - including St. John's - hit 100 percent of the goals.

Dr. Meldi said one reason for improved care is the fact that physicians don't have to compete with each other.

"We're not out there trying to cherry-pick the patients that can pay, leaving the patients that can't pay for the hospitals to take care of," Meldi said. "That's an advantage for everybody - the community, the hospital, and in these down economic times, for the physicians."

St. John's CEO Day said one positive aspect of the integrated system model is that it gives the health system the ability to make decisions quickly.

"We can get all the right people in the room together quickly to talk about an issue," he said. "We're a relatively large organization, and I won't say we can turn this organization on a dime - but I will say we can turn it on a quarter."[[In-content Ad]]