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Chapters Health System: Reinventing Community-Based Healthcare Delivery in a Value-Based Landscape

By Andrew Molosky, FACHE, CHPCA

The movement to community-based care had momentum even prior to the pandemic but never has the opportunity for change been more ripened than present day. At Chapters Health System, this change was really an expansion of the mission we’ve always served. While our roots are in end-of-life, the real mission has always been a holistic, interdisciplinary approach to delivering the highest quality, lowest cost care in the ideal setting for patients and families. Given the exceptional track record of delivery for the past 40 years in this space it was only logical to extend that same innovative approach to care and thereby solve many of the issues facing our fragmented healthcare delivery system today.

As a result, Chapters Health has grown both horizontally and vertically as we expand the number of services we offer and attract new member organizations into our family of companies.

The concept is rather simple in nature to explain but the feat here is in execution. Our cultural and operational underpinnings being rooted in individualized care planning have perfectly set the stage to incorporate community health services, social determinants of health and primary care in value-based designs. Using a matrixed approach incorporating home health, advanced illness management, telemedicine, social determinants of health, and primary care we have been able to move our chronic illness care further upstream delivering the low-cost, high-quality experience that has for so long been the provenance of hospice to our patients, families and communities.

The unique nature of our continuum-based approach is one of the rare wins in business where one can truly do the right thing for everyone and come out with benefits for all parties. By focusing on the unique care plan needs of each patient or the unique pain points of each payor or partner, Chapters Health employs the solutions that bring maximal return while reducing waste and redundancies that are created when using the fragmented healthcare system at-large. Think of it this way, when one is truly listening to the patient and what they really want, one avoids using or providing things they don’t want. That part is easy, right? The value to our payors and partners lies in listening to them the same way. If their primary goal is member engagement, we customize our approach to meet that need. If their need is emergent care reduction, we build our response accordingly. Having the full continuum of services at our disposal is the key. When you don’t have that you’re forced as a payor to rely upon multiple organizations who almost certainly lack alignment of incentives and goals.

I’m often heard reciting the old line “if you’ve seen one model, you’ve seen one model” and I think it applies here as well. The answer lies in the realization that what makes emerging models successful is an ownership mentality. The very premise of risk-based medicine is you do what is right for the patient so the outcome is optimal and your success is too. That very basic concept provides 80% of how you align concurrent models of thought or business. There will likely be a great deal of individualization or customization as you expand your business but having highly engaged employees, a strong company culture of care and accountability, and innovative spirit will be key as you look to bring your company along on the journey from traditional to emerging. It is also key to remember it is a journey that is never complete. What was emerging last week is traditional next week. It’s always going to be a balancing act but that’s the fun part.

The most common question Chapters Health System gets is “how to bring this sort of approach to our market. Where do we start?” The answer, while very straightforward, does require a great deal of organizational planning. The top three strategies I would encourage anyone considering a leap of this magnitude would be:

  1. Clear definition of organizational goals. One can be anything, to anyone, really. However, the steps to getting there are often complex and sophisticated. Having a very clear set of end goals in mind is critical.
  2. Define your build, buy, partner strategy. There are an exceptionally small number of organizations that have ownership of all the entities and capabilities needed to execute a plan of this nature. Having a full continuum—whether owned, managed or partnered with is key.
  3. Invest in communication. Having an understanding and buy-in from all key stakeholders in the organization is paramount. You will be doing something very few others have done. It will lend itself to excitement and anticipation but also confusion and potentially hesitancy or fear. Managing that early on and assertively will be critical to maintaining the momentum needed for long-term change.

Andrew Molosky, FACHE, CHPCA, is president/CEO, Chapters Health System

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