St. Charles Takes Triple-Aim Approach


At a time of soaring health care costs, declining patient health and much-needed reform, St. Charles Health System wants to take a transformative step in the way it operates. That’s why the Bend-based provider has partnered with Cambridge, Massachusetts -based Institute for Healthcare Improvement – to take a “Triple-Aim” approach. Story by Jeff McDonald CBN Feature Writer

The partnership, which was announced August 5, will last about three years and redefine what health care looks like in the region today, said Alisha Fehrenbacher, director of strategic improvement at St. Charles.

The change will involve everyone from front-line caregivers to providers within the St. Charles network to patients themselves, Fehrenbacher said. “With health reform, we are looking at ways to step out of the box and be innovative with our approach in a streamlined and proactive way,” she said. “We are looking for ways to move the dial.”

St. Charles has already been implementing “small tests of change” at its employee level, she said. ”We looked at our employees’ health plan and realized, what better way to test this than to test on our employees?”

St. Charles managed a 30 percent reduction in overall costs by engaging 60 percent of its caregivers in a new health and wellness program. It hired nurse coaches and provided open access for care coordination to improve outcomes.

“Because we’re truly living the Triple Aim, our employees become engaged to make sure they have the care when they need it instead of waiting,” she said.

The partnership will be looking for ways to spread the model on a much broader scale across a broad geographic spectrum that covers about 33,000 square miles. Within that coverage area, St. Charles will be looking to partner with institutions that are traditionally outside the health care model, including schools, said Trissa Torres, senior vice-president for IHI.

These partnerships will help transform the community’s overall health, Torres said. “If we want to reduce mortality from cardio-vascular disease, we are looking at a more preventative model.

“We want to find ways to get people to stop smoking or to never start. We’re looking at a patient’s access to healthy foods, their physical activities.”

While IHI has worked with St. Charles in the past, this will be the first time it has formed a strategic partnership that will help the overall system transform from an old model of care to a new one. Only 10 other organizations will have this strategic partnership with IHI, including Kaiser Permanent and the country of Sweden.
“Some groups will say, oh yeah, that’s what we always do, but this is unique,” she said. “We want to bring down costs. We want to decrease the total burden of costs on society and reduce unnecessary care. We want to improve the health of the population so they don’t need additional care.”

At Pilot Butte Rehabilitation Center in Bend, the shift towards greater accountability toward patients and their care has already begun, said Tom Hathaway, administrator of the nursing home located near St. Charles.

Pilot Butte is one step removed from St. Charles on the pyramid of patient health. The rehabilitation center, which is a lower cost alternative to hospitalization, takes steps needed to prevent relapse of a patient’s condition. Hathaway said, “Transforming the health care model will be difficult because some patients with recurring or chronic diseases such as diabetes, alcoholism or obesity are, by nature, habitual in their ways.

“We call them our frequent flyers,” he said. “They go to the hospital and have tens of thousands of dollars in bills, then go to the nursing home to stabilize. When they get back home, they sometimes go back to their old habits and end up in the hospital six months later.”

But the partnership with IHI could help St. Charles and his rehab center ensure this does not happen. “I’m sure IHI has a much more in-depth focus,” he said. “Also, it sounds like through the partnership with St. Charles they will disseminate that information to my type of facility to make sure that the patient is linking up to these types of services.”

Lessons from the St. Charles model of change will be used to transform health care in other systems in the country and around the world.

“IHI’s role is to support St. Charles in their journey,” Torres said. “But we will be learning side-by-side. We want to make sure that the benefits reach those who are learning with us as well as take that learning out so others can follow along a similar journey.”


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