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Building a Virtuous Circle of Care

by Caroline Smart, CloudView Editor

Welcome back to Population Health(ier), a recurring series featuring athenahealth and The Atlantic’s best storytelling on America’s population health revolution. To catch up on our series, you can find the first story here, or read the second one here. Today, we explore how thorough communication and care coordination in Lowell, Massachusetts made population health really work in this mid-size American city.

Let’s start with Jennifer Gilliatt, a breast-health navigator at Lowell General Hospital. Wondering what that means exactly? Gilliatt is responsible for guiding patients through all the appointments and procedures involved with a breast cancer diagnosis. And in the midst of a national crisis of runaway healthcare costs, Gilliat’s role has been crucial for saving both money and lives.

Her unique role also embodies a fundamental transformation in American healthcare, from competition to cooperation, and from volume to value-based care. Instead of segregating by specialty and facility, and focusing on acute or chronic conditions, this new approach aligns the entire medical-care system around the same goal: keeping patient populations healthy one human being at a time, across the spectrum from wellness to catastrophic illness.

That transition has worked particularly well in Lowell, Massachusetts. Over the last decade, the city has evolved from a hotly competitive, two-hospital town in a sea of independent doctors and specialized group practices to a unified system meticulously brought together through mergers, affiliations, and rigorous, daily efforts for positive change.

In 2008, Lowell’s healthcare system was beset by an intense rivalry between its two community hospitals: Lowell General Hospital and Saints Medical Center. Like the rest of the American healthcare system, the two hospitals were paid based on how many procedures they performed. As more patients meant more services and more money, the two hospitals were forced to compete for the loyalty of Lowell’s residents.

The hospitals’ competition allowed insurance companies to negotiate lower reimbursement rates for the treatments they provided. To keep their doors open to as many patients as they could, the two hospitals were left with no choice but to accept the lower rates, swallowing losses that, in Saints’ case, threatened its survival.
By 2010, a community health needs assessment found competition between the two hospitals to be “the greatest weakness within the area’s healthcare system.” So in 2012, Saints merged with Lowell General Hospital to form Circle Health. 

Alongside the new, two-campus Lowell General Hospital, Circle Health brought together more than 600 independent physicians throughout the city as well as the Lowell Community Health Center and the Circle Home Health Agency. In keeping with Circle Health’s vision of “complete connected care,” communication was tightly integrated among all levels of care and across the system, and redundant services were consolidated.

The merger was also key to aligning all the providers in the community. Ever since the mid-1990s, Lowell General had been building a strong physician hospital organization (PHO), a coalition of the hospital’s physician partners.

The PHO served as a governing body for the growing association of independent physicians, one that could establish best practices and work to answer the fundamental question facing the hospital and community caregivers as they made the difficult transition to a unified system: What is the best way to help a patient navigate the health system?

This question brought into sharp focus the need to create a virtuous circle of communication and care coordination embracing every provider in every patient’s healthcare journey. And once this kind of collaboration proved its benefit in cost savings and patient outcomes, it began to achieve outsized impact across the city’s entire healthcare system.

Take breast-health navigator Jennifer Gilliatt and her team, who form the connective tissue among primary care physicians, radiologists, surgeons, nurses, and every other healthcare provider in the community. It takes that depth of care coordination to provide value-based care and achieve the triple aims of population health: Patients love the sense that they are surrounded by a knowing, caring, closely connected team, the cost of health care is reduced, and outcomes show dramatic improvement. 

That focus on population health and on a healthcare system that puts patients at its center can be achieved in a variety of ways. It has been realized in Lowell through the comprehensively integrated Circle Health, which has helped Lowell General Hospital and its affiliates keep more than $13 million in cost savings over the last two years. But it can also be enacted through care coordination across a community’s separate healthcare entities, from hospitals to urgent-care facilities to home care.  

In the end, the successful enactment of population health eventually wins over most healthcare providers by giving them more of what brought them to the profession in the first place: the chance to make people better and to save lives.

Tune in next week to read about how Lowell hospitals combined medicine and public health to cut costs and improve health outcomes. 

To experience an interactive feature along with access to the full Population Healthier series, visit The Atlantic.


Caroline Smart is a Senior PR Associate and CloudView Editor.

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