Care Transformation Center Blog

From prevention to intervention: A Q&A with Sentara's CMO


Yulan Egan

Dr. Terry Gilliland became Sentara Healthcare's senior vice president and chief medical officer in March 2013. In this role, he oversees the system’s quality and clinical care initiatives. Previously, he served as the associate medical director for Kaiser Permanente’s Mid-Atlantic Region.

We recently sat down with Dr. Gilliland to understand how Sentara built their population health infrastructure.



How do you define population health?

Dr. Gilliland: Population health is fundamentally about managing and keeping people healthy rather than simply treating those who are already sick. Our role as providers is to help keep people well, and to the extent possible, prevent them from a steady decline in health over their lifespan.

Population health encompasses the entire spectrum of health care, from prevention to traditional episodic care. The prevention end of that spectrum is fundamentally about keeping people healthy by the judicious and evidence-based application of screening tests and health maintenance, while the episodic, illness-based end of the spectrum is providing timely, venue-appropriate access to high-quality, cost-effective care.

This is the value equation our nation is desperately seeking in from our health care system: better prevention, higher quality, cost-effective care.

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So it sounds like keeping healthy patients well is a top priority. What kind of interventions do you prioritize for this low-risk population?

Dr. Gilliland: It’s common knowledge that an annual physical exam does not improve health for low-risk populations and results in over $300M in unnecessary screening labs. So we have to figure out other ways to engage this population.

This is where remote, interactive health care screening using mobile applications has great promise. Using a standard set of questions to ascertain health, wellness, and potential illness, combined with evidence-based use of screening labs, we can apply more efficient and appropriate screening and prevention to an entire population.

One challenge we face is identifying that 1% of the healthy population that have unexpected, catastrophic health events in any given year. All of us can think of a friend or family member who has developed significant illnesses with no real warning. These can be really tough to identify and prevent, and they tend to drive substantial health care costs each year.



More traditional care management is likely still essential for higher-risk patients. What key investments are you looking to make as you build out Sentara’s care management capabilities?

Dr. Gilliland: It’s important to invest wisely in care management capabilities. Probably the single most important component of care management is patient engagement. We have quite a bit of opportunity to better engage U.S. citizens regarding their health and illnesses, in part because we’ve been accustomed to forcing patients and people into our systems, rather than delivering care at the point of need.

» Read our study, Competing on Patient Engagement.

Our investments in care management will need to be flexible and adaptable, and not strictly confined to traditional “case management.” Developing capabilities that understand and engage each segment of our diverse population so we can have the greatest impact using any venue—mail, mobile, text, video, telephone, or in person—will be key to effective care management.

Health care is fairly rudimentary in this regard compared to very sophisticated mechanisms in finance, for example. But we’re developing the infrastructure and learning quickly to better understand and drive value for our customers.

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Can you tell us about the population health infrastructure that you’re building at Sentara?

Dr. Gilliland: As a diversified health care organization that includes 11 hospitals, Optima Health Plan, Sentara medical group, a large network of aligned physicians, as well as skilled nursing facilities and medical transport, Sentara Healthcare has been engaged in population health for a number of years for highly-selected populations. Now we’re rapidly building the infrastructure to integrate what we’ve learned with selected populations across the continuum and spectrum of care delivery.

The most basic infrastructure is an electronic registry of the population that interfaces with an electronic medical record at any location of care allowing stratification of risk which drives the level of care from prevention to intervention.

Our platform for achieving population health is Sentara Quality Care Network (SQCN), a clinically integrated, technology-enabled network of employed and aligned physicians committed to population health and high-quality, cost-effective care. Most folks are in health care to provide this kind of value, and SQCN is our vehicle for helping us get there.

Next, Check Out These Resources

Read our research briefing, Three Key Elements for Successful Population Health Management, to examine the foundation of population health management: information-powered clinical decision-making, a primary-care led clinical workforce, and patient engagement and community integration.

READ THE BRIEFING

And while you're here, be sure to check out two of our most popular posts: our take on the annual physical and how the answer to one simple question could be a more accurate predictor of health care utilization than any IT system.

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