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Bringing the Triple Aim to Central Oregon

Lessons from the St. Charles model of change will be used to transform healthcare in other systems in the country and around the world.
August 27, 2013


August 27, 2013 -- St. Charles Health System sits atop the Central Oregon healthcare pyramid. That is why the hospital network’s recent announcement that it would partner with Cambridge, Mass.-based Institute for Healthcare Improvement – to implement the Triple Aim philosophy of improving the population’s health while reducing costs – will have a huge impact on the region, said Alisha Fehrenbacher, director of strategic improvement for St. Charles.

The change will involve everyone from front-line caregivers to providers within the St. Charles network to patients themselves, Fehrenbacher said.

“With health reform, we are looking at ways to step out of the box and be innovative with our approach in a streamlined and proactive way,” she said. “We are looking for ways to move the dial.”

St. Charles’ partnership with IHI, a globally-minded think tank which developed the Triple-Aim philosophy, means taking care of the patient not just at the hospital, but also finding ways to prevent hospital readmission or admission in the first place.

St. Charles will be looking to partner not only with providers within their network, but other institutions not typically associated with health care, said Trissa Torres, senior vice-president for IHI.

“If we want to reduce mortality from cardio-vascular disease, we are looking at a more preventative model,” Torres said. “We want to find ways to get people to stop smoking or to never start. We’re looking at a patient’s access to healthy foods, their physical activities.”

St. Charles is one of only 10 organizations in the world to partner with IHI, according to Torres. Others include Kaiser Permanente and the country of Sweden.

While IHI has worked with St. Charles in the past, this will be the first time it has formed a strategic partnership that will help the overall system transform from an old model of care to a new one, Torres said.

“We want to bring down costs,” she said. “We want to decrease the total burden of costs on society and reduce unnecessary care. We want to improve the health of the population so they don’t need additional care.”

Signs of change will include a greater focus on what happens to a patient after he or she leaves the hospital.

“The new model thinks about a whole group of people and whether they are showing up in the office or not,” she said. “This is a fiscal responsibility, but it is also a community responsibility.”

IHI and St. Charles will be looking for ways to spread the model across a broad geographic spectrum that covers about 33,000 square miles.

“There are significant disparities even within a population,” Torres said. “Some parts of the population may be quite fit, but others might not have that.”

At Pilot Butte Rehabilitation Center and many other providers around Bend, the shift toward greater accountability for patients and their care has already begun, said Tom Hathaway, administrator of the nursing home located near St. Charles.

Pilot Butte is one step removed from St. Charles on the pyramid of patient health, Hathaway said. The rehabilitation center, which is a lower cost alternative to hospitalization, takes steps needed to prevent relapse of a patient’s condition.

“I’m sure IHI has a much more in-depth focus,” he said. “Also, it sounds like through the partnership with St. Charles they will disseminate that information to my type of facility to make sure that the patient is linking up to these types of services.”

Transforming the healthcare model will be difficult because some patients with recurring or chronic diseases – such as diabetes, alcoholism or obesity – are, by nature, habitual in their ways, Hathaway said.

“We call them our frequent flyers,” he said. “They go to the hospital and have tens of thousands of dollars in bills, then go to the nursing home to stabilize. When they get back home, they sometimes go back to their old habits and end up in the hospital six months later.”

The partnership with IHI is unique because it will focus on learning, IHI’s Torres said.

Lessons from the St. Charles model of change will be used to transform healthcare in other systems in the country and around the world, she said.

“IHI’s role is to support St. Charles in their journey,” Torres said. “But we will be learning side-by-side. We want to make sure that the benefits reach those who are learning with us as well as take that learning out so others can follow along a similar journey.”

Jeff McDonald can be reached at [email protected].