By Dr. Ninfa M. Saunders and Geoffrey G. Martin
The rise of regionalized healthcare using the hub-and-spoke model of care delivery has the potential to help hospitals address critical challenges, from expanding access to care to achieving both economies and opportunities of scale. We must transition from thinking about healthcare to thinking about equitable health for our communities.
Navicent Health, based in Macon, Georgia, has been on a multi-year trajectory to build a high-performing organization that is culturally and operationally capable of serving as the hub for a clinically integrated network serving central and south Georgia. Step by step, this journey has led senior leadership at Navicent Health to confront a number of issues, and our experience may help others just starting their transformation.
From a business model perspective, the changing landscape of reimbursement is top-of-mind at Navicent Health as it is for healthcare organizations across the country. With instability disrupting insurance exchanges in Georgia, we’ve seen reimbursement decline, affecting our ability to push a strong operating margin. The problem was worse five years ago when the hospital ran at less than half capacity. Today, we are full or over capacity on most days but must become more agile, efficient, and think beyond the walls of the hospital. Other metrics—days cash on hand and debt capacity—have been healthy. To remain competitive, access at scale has become our primary focus as we look outward and consider approaches to systems integration and magnification.
While optimizing the business metrics is crucial, it is the mission-facing challenges that animate and drive our vision for the future. We want to move our business model from healthcare to health and we don’t have ten years to do it. That means not waiting for patients to come to us but reaching out to help people before they need in-hospital services. For example, we’re adding nontraditional access points, such as partnering with community centers and homeless shelters. Five years ago, we had one or two such relationships; today, there are more than a dozen.
Ensuring equity of care is another touchstone. Healthcare organizations have an ethical imperative to provide the same high-quality process of care to all patients and achieve equivalent outcomes, irrespective of a patient’s race, ethnicity, gender or religion. Navicent Health has dedicated significant resources to address identified disparities in the communities we serve, and today there are no disparities in outcomes across all patients in our primary diagnostic categories. And we are achieving that metric while keeping care affordable.
Laying the foundation to evolve the organization and reach our aspirational goals required a well-defined plan to tackle foundational, transformational, and aspirational initiatives. While the executive team focused on strategy, we wanted an experienced outside partner that could help us execute our strategy faster and bring new thinking and vast resources that we could tap into. While it is easy to understand and applaud the idea of migrating from healthcare to health, it is tough and time-consuming to come up with a definable process to make it a real, working entity that can coalesce a community. That was our directive to GE Healthcare Partners: make sure we were building a strong foundation that would support the transformational and aspirational work to come.
What was unique about this relationship was the way Navicent Health and GE Healthcare Partners took the time to fully understand the priorities and desired outcomes for each organization. That allowed us to co-author a collaboration that leveraged our collective capabilities. It’s powerful when you combine a $1 billion health system with a $20 billion organization with the resources of GE Healthcare.
An innovative outcome of this collaboration is a Navicent Health system command center—a “mission control” that will provide a constant flow of relevant real-time and predictive data analytics to help our staff coordinate care delivery throughout the hospital and transfers from across the region. The hub-and-spoke model depends on the ability of our large tertiary hospital to create capacity in order to meet needs. If we can’t do that, our relationships with referring hospitals will fail. The command center will aggregate processes related to port of entry, port of transfer, and port of exit so we can achieve the efficiency and turnover required to support all of the hospitals and patients who depend on us.
The command center and other planned initiatives have tremendous upside potential for Navicent Health, for the hospitals and community resources we cross-link with, and for patients across south and central Georgia. They involve risk as well. By entering into a ground-breaking risk-sharing relationship, Navicent Health and GE Healthcare Partners both have put skin into the game and sit on the same side of the table. With mutual goals, the two organizations are defining the clinical, operational, and financial outcomes that will determine success—such as generating care delivery improvements worth $160+ million to Navicent Health over the next six years.
The pace of change and scale required in healthcare is beyond the capabilities of a single entity. The winners of tomorrow will figure out ways to better leverage technology, grow organically within communities, cross-link and up-link with other healthcare organizations, and form non-traditional relationships to innovate and evolve faster.
Dr. Ninfa M. Saunders, FACHE, is President and CEO of Navicent Health and Geoffrey G. Martin is Managing Principal of GE Healthcare Partners