Jennifer Mitkowski, like most of her colleagues, went into medicine because she wanted to take care of people. However, over the course of more than a decade specializing in family practice, she witnessed concerning shifts in the healthcare industry. The industry became increasingly costly and fragmented, creating a divide between specialists and primary care. Accessibility to healthcare services also declined for those in need. Worst of all, she saw a health care system that didn’t always have the best interest of the patient in mind.
Then she discovered Optum Colorado, an integrated, comprehensive team of physicians and advanced practice clinicians committed to helping people get and stay healthy.
“Optum is value-based, which is what really drew me in,” says Mitkowski. “They’re focused on the roots of taking care of patients and making sure they get everything they need in a way that is affordable to both them and the network.”
To optimize care across platforms, Optum collaborates with SCA Health, a network consisting of physician specialists, orthopedists, and outpatient surgical centers. Their shared goal is to establish a seamless continuum of accessible and affordable healthcare for all individuals. Specifically, the partnership aims to transform a health care system that has become increasingly dependent on emergency rooms and hospitals where people only see doctors when something is wrong.
“The benefit of this partnership is that not only are Optum and SCA Health under the same umbrella, but we’re aligned,” says David Rankey, associate chief medical officer for Optum Colorado. “Right now, the health care system is reactive and based on need-for-service where most care is received at the most expensive place: the hospital. We want the right care to come at the right place and the right time. This is better for the patient, who can get preventive care saving them pain, trouble and money, and it places less burden on the system. And, since Optum and SCA Health have that alignment, we can make sure we’re all heading in the same direction.”
Touch Points
The key to this alignment is controlling the point of entry, or touch points, by which patients first encounter the health care system. Because of rising costs and limited insurance, many people avoid routine check-ups and screenings. Instead, they opt to wait until there’s an emergency to go directly to the hospital or urgent care.
“The first question a patient in the ER used to ask was ‘Am I going to be okay?’ Now it’s ‘How much is this going to cost?’” says Dr. Rankey. “People are so scared about the cost, they ignore things like pain and illness. It results in poor access for them, and in the end, it’s costly for the patient and the country. And it all could’ve been avoided by us doing better.”
Optum is working to do better by flipping that model on its head and starting the patient experience outside of the hospital in its primary care clinics. The thinking is that if a problem is addressed first by a generalist, that primary care physician can consider all possible causes, symptoms and solutions. This ensures that the patient starts their journey on the right path.
For example, say a patient comes into an Optum clinic with knee pain. Instead of jumping right to an intrusive and costly knee replacement, the primary care physician can take time to talk to a patient and dig deeper. Is there a problem causing undue stress on the joints? Maybe they need a nutritionist. Do they have a family history of arthritis? Perhaps they should see an orthopedist. Might depression be playing a role, making them sedentary?
“The patient just wants their pain to go away in the least disruptive way possible,” says Davis Hurley, orthopedic surgeon at Orthopedic Centers of Colorado and operates at Mile High Surgicenter. “Now this alignment can maximize the social determinants of health, recognize any and all contributing problems, and decrease pain, need for narcotics, and admissions or readmissions to the hospital.”
Comprehensive, Integrated Care
Once a patient sees a primary care physician and, hopefully, starts building a relationship there, it should still only be the beginning of the journey. But today, all too often, it’s the end. The physician treats the pain, and the patient never returns for a follow-up. Alternatively, the primary care doctor makes a referral to a specialist without knowing whether the patient followed through. Meanwhile, the patient is essentially starting over, having to re-explain everything to a new doctor who may or may not have all the necessary medical records and information.
“You don’t want patients having to explain the same thing to 10 different people,” says Dr. Rankey. “You don’t want complicated results and histories. Patients want to know that each health care professional has all the relevant information, and it’s not some merry-go-round.”
In Denver, the Optum/SCA Health partnership streamlines the process. The primary care physician not only knows the specialist, but the two work together with a shared approach personalized to each individual patient. And the same extends beyond the specialist to the surgeons, physical therapists and even the pharmacists so that each patient gets exactly what they need at minimal cost.
“Referrals are often a hiccup, and it can take so long to get a patient in to see a specialist,” says Mitkowski. “Now we can call the specialist and tell them this is urgent and get the patient in as quickly as possible with better communication. It lessens patient frustration.”
In addition to the fluid alignment from primary care to specialist to surgeon, the Optum/SCA Health value-based partnership works across the separate realms of care.
“Integrated care alignment allows a seamless patient journey from surgeon to physical therapist to recovery,” says Dr. Hurley. “The patients are getting the right surgery at the right time in the safest environment possible.”
What Makes Us Different
SCA Health surgery centers are accredited by The Joint Commission or AAAHC. These accrediations surpass nationally recognized standards we seek them out because we wish to provide our patients with the best possible outcomes and experience. We also see to meet quality reporting standards as determined by the Centers for Medicaid Services (CMS).
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Satisfied Patients, Happy Doctors
The Optum/SCA Health value-based model not only emphasizes patient accessibility, affordability and satisfaction, but it also ensures professional fulfillment for the physicians, surgeons, nurses, technicians and clinicians involved.
Part of the benefit is as simple as lightening the administrative load — less frustration with patient intake and records. Other benefits include more scheduling autonomy and time to master their specialty. But more than anything, this seamless integration of touch points enables these professionals to do what they set out to do when they joined this industry: Keep people healthy.
Also the alignment of people and resources between entities enables physicians to offer better service to their patients. The quality assurance is bolstered by support from the extensive SCA Health network. When a physician has the backing of SCA, they receive more than just access to the network’s resources and expertise, they also get a seat at the table when it comes to making decisions about their patients and the system as a whole.
“The partnership empowers us to affect change in our patients’ lives,” says Dr. Hurley. “There’s less helplessness and less burnout. You don’t feel like you’re trying to help, and no one can help you. And you have a voice that is listened to.”
To learn more about what SCA can do for you as a physician, visit www.sca.health/aboutus
