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How CommonSpirit Health is using systemness to drive population health

The Covid-19 epidemic forced the health care industry to work together in ways it never did before. But now, with the end of the epidemic now in sight, how can stakeholders in the industry maintain systemness going forward?

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Alisahah Cole, system VP of population health innovation and policy at CommonSpirit Health, sat down with Radio Advisory's Rachel Woods to talk about how the health system is using systemness to drive its population health efforts.

Read a lightly edited excerpt from the interview below and download the episode for the full conversation.

Rachel Woods: When it comes to population health, how would you describe the goal of CommonSpirit? And what makes the kind of strategy and operations of pop health different at CommonSpirit compared with what we see with other organizations?

Alisahah Cole: I would say one of the biggest things that sets us apart is our scale, our size and our scope. And quite frankly, the diverse populations that we serve.

Woods: In fact, it's probably the most diverse population that a health system serves.

Cole: Yes, since we serve everything from urban to big academic medical centers, to small, rural, critical access hospitals and everything in between, we have to take geography into account. I mean, every market for us is so different. For us in population health, we really look at how do we standardize certain elements and how do we bring certain resources across the entire enterprise, but allow for that local market autonomy? Because we really do truly believe that health care at the end of the day is local.

And so that's one of the goals we have. We also are focused on really helping our organization move into more value-based care arrangements. And currently we have over 2.5 million lives that we serve that are in value-based contracts.

Woods: Yeah, you mentioned scale. And honestly, if I think about where we started, the size and scale of an organization like yours, I can honestly spin that as a positive or as a negative.

On the positive side, you now have this structure of a common mission and vision as it relates to population health and all of its manifestations. Whether we're talking about value-based payment, whether we're talking about health equity.

The downside, though, is size itself. Implementing any kind of common strategy is hard enough at one hospital, let alone at 137 hospitals and counting. Is that challenge something that you've experienced?

Cole: I would be lying if I said no. And I think all systems that are going through these mergers and strategic partnerships and combinations are experiencing the same thing. We refer to it as systemness.

How do you build in that systems thinking while at the same time, like I said, allowing for that local market autonomy?

Woods: You perked my ears because you said one of my favorite words. And anybody who's read anything that we've done at Advisory Board knows that there is a lot of focus on systemness. And I kind of think about that as an organization's ability to overcome challenges and make progress because of its scale—not in spite of it.

And people talk about systemness in a whole host of different ways, but in my mind—and I'm curious what you think about this—the ultimate execution of systemness is being able to inflect the outcomes of an entire population. And a population who quite literally is coast to coast. Do you agree with that kind of definition?

Cole: Yes, that is spot on. I couldn't have explained it better. Thank you for that. And we are really being thoughtful about how do we encourage systemness? How do we really embed that thinking? Because it is a different way to think for a lot of people. So how do we embed that thinking?

Woods: Yeah. It's not just an abstract concept, right? It requires a systemized approach to actually implementing systemness. From our perspective, one of the foundational elements of how you do systemness well comes down to leadership and the leadership structures themselves. How does the structure, when it comes to population health, work at CommonSpirit? How does it cascade across so many different areas?

Cole: We have a corporate, enterprise level population health function. But we also have connections all the way down to every local markets. And so, one of the things that we realized as we were all coming together, and again brand new. And most of us knew from outside of either of the legacy organizations.

Making those connections and building those relationships with local leaders was critically important. And we wanted to make sure that we did that in a strategic way. And so, one of the frameworks that we set up was an establishment of different councils.

For example, I have a Vulnerable Population Council that I set up that is made up of a physician of a clinical and administrative leaders all across the entire spectrum of the organization.

Corporate all the way down to local. And our focus is really about how do we take better care of our vulnerable populations? Whether that's from a policy issue, from a process issue, from a clinical care delivery issue. And so we meet on a monthly basis to really talk through the strategy around our vulnerable populations and the operations and execution. It's one thing to have the strategy, but you have to have that local market buy-in in order to execute.

Woods: And I imagine one of the big conversations at one of those council meetings has to be, how do we decide what to do next? Especially if you have representation from local leaders and the corporate office. And again, prioritizing is difficult at any institution, let alone one of this size. How do you actually surface kind of best practices from the local areas and decide which ones do we want to make consistent across our whole market?

Cole So there are a couple of different ways. And again, this is one of those areas where I do think it's important for the local market leaders to be the ones helping to drive those conversations. Because often, or I would say what we've found, is that nine times out of 10, what one market may be dealing with is another market is also dealing with it, as well. Maybe just with some nuances, differences.

Woods: Even with all the diversity that you described.

Cole: Even with all the diversity. For example, right now, equitable Covid-19 vaccine distribution is something that has been very consistent across every market. Now it may be for different reasons. In our rural markets, it's tending to be our elderly population that we're trying to make sure have access to the vaccine. In some of our urban markets, it may be some communities of color that we're really trying to encourage. And there may be other barriers. The barriers may be a little bit different, but the issue as has been consistent across all our markets.

Woods: Or maybe the process is consistent. Whereas the people who are identified as being maybe resistant to getting a vaccine or have legitimate hesitancy, like you described with communities of color. It's a matter of setting up a process that would identify those people. Even though it might be different organization to organization or area to area.

Cole: Well, yeah, the people, the process and even our own internal process. I think that's been one of the things, even when we have seen that, for example, in certain markets, communities of color aren't hesitant. They weren't hesitant.

It was just they couldn't get on to the website to go in and figure out how to sign up. Or they didn't actually have transportation to get to the mass community vaccination site. But really focusing on that work allowed us to figure out what really are the barriers in the markets that we have?

But what we agreed upon, as far as standardizing, was the data collection. For example, we're going to collect data around vaccine distribution in the same manner. We're going to stratify it by race, ethnicity, gender, and ZIP code. Looking at social vulnerability index and making sure that those community members were getting the vaccine as well.

That's just one example of where we at the kind of national population health level really helped out in regard to data and the standardization of the data. And then also the sharing the best practices. For example, in our Los Angeles market, they held a mass community vaccination event with the NAACP in one of the historically black college and universities there. And that partnership really increased the number of community members of color who received the vaccine. We were able to share that across other markets to say, "Hey, have you reached out?"

Woods: Yeah, how did you share that? Because right, that best practice sharing is something that I think could be a massive benefit to an organization like this, if you can actually do it in a structured way.

Cole: We have regularly scheduled meetings for our leadership on a monthly basis. And one of the things that we also did was create the website. And part of the website is open to the public so everyone can see some of the work that we're doing, but it also has a membership portion to that.

All of our providers, our leaders are able to sign into that and then access toolkits and resources and data whenever they feel like it. That's a 24-hour access to information. Because that was one of the things that we heard from our local markets. Was how do we learn about this and how do we do it in real time? So we may not necessarily have to wait until the next vulnerable population council meeting, for example.

Woods: Yes. Exactly. That way, I'm going to make up an example, if a practice in the west coast is saying we're really struggling to re-engage our patients and get them to come back, they could go onto this website and find another practice that has figured out the marketing technique or whatever it is to get folks to reengage and say, "That's what I'm going to do next."

Cols: Yes. And we even go so far to even offer if we've created certain patient materials, education materials, even marketing or collateral materials. All of that is located on that website. So people can access that and they don't have to spend time and energy recreating something.

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