Hank Schlissberg – Gaining The Home Field Advantage For Care
President – DaVita Health Solutions
So much of the good work surrounding healthcare starts with getting into the shoes of the people who are in the most critical stages of their journey. Authentic leaders are making this a priority for their teams. The need is amplified with regards to difficult categories like mental health and palliative care where the road can be particularly challenging.
In a recent all hands meeting, Hank Schlissberg and the DaVita Health Solutions team gathered around a table in an effort to intimately build a framework in their own minds of what the patients they aim to serve go through on a daily basis. They’ve coined a term for this group of people….Most Vulnerable Patients or MVPs.
Hank described an exercise where each team member spent some time quietly thinking and journaling about a personal end of life experience with a family member or friend. They shared it with a few team members and were then presented a Netflix documentary titled “End Game” which chronicles the end of life journey for five different patients.
“The reason we did this is that the subject matter is just too difficult for a purely intellectual pursuit,” Hank said in a recent conversation with The Parnassus Group. “It’s just not enough to be smart and experienced. You’ve got to have such a commitment to walking into the harshest realities. This is the hardest job for our team and we have to remind ourselves that this is what our caregivers go through every single day.”
This missional outlook on the country’s MVPs is what continues to drive DaVita Health Solutions to reach and serve the 5% of patients who drive 50% of the cost of US healthcare. And due to DaVita’s history of working with chronic kidney patients they’re uniquely positioned to move the needle in care for these poly-chronic patients as well.
“It’s just not enough to be smart and experienced. You’ve got to have such a commitment to walking into the harshest realities. This is the hardest job for our team and we have to remind ourselves that this is what our caregivers go through every single day.”
“We have a fundamental belief, and the data will back it up, that the care needs and care model requirements for the sickest 5% are fundamentally different from the other 95%. And when you talk to PCPs, they tell you that there’s no way these patients can have all their clinical and social needs addressed in a 15-minute office visit. It is simply not possible for them.”
Vulnerability comes in many forms and often patients have clinical, economic and frailty factors that push them into margins and degrade their care. It is nearly impossible to trace the decline with traditional care metrics. When you consider the additional challenge of healthcare economic incentives that restrict re-admission of patients, the isolation continues to expand as their propensity for extended care needs grow. There has to be a re-orientation of care that moves provider resources toward the patient, designing new conduits for care that fit daily realities.
This idea drives DaVita Health Solutions belief that a house calls program can be created specifically to serve these patients. Instead of accepting the fact that 5% of the patients in each PCP’s practice needs something different yet treating them identically, DaVita Health Solutions is working toward a solution that pulls the 5% out to create something unique for them that can be delivered on a meaningful scale.
Hank speaks of an entirely new reality where “teams of caregivers can go into the patient’s home instead of them coming into a doctor’s office. It offers the ability to manage the entire environment and bring a different level of depth into the care solution. Our teams can look at things like fall hazards, food insecurity, medication, transportation, social support, and all things that are nearly impossible to address in a clinical setting but much easier to solve for in a home-based setting. That’s the core of our care model.”
Mental health often plays a factor in patients with multiple chronic conditions. DaVita sees this as another distinct focus for their expertise. Quality care that identifies and addresses the impact of depression, for instance, has proven to impact the overall cost of care in dramatic ways, but most importantly, it opens up the options for treating patients with a view to the complete range of determinants that are driving their condition.
Hank also spoke about DaVita Health Solutions’ intentions toward palliative care. “80% of patients would say that they’d choose to spend the end of their life at home; yet, only 20% of patients actually do.” There are a series of cascading decisions that can affect a patient and their caregivers that swirl around patient preference and physical realities. Mapping an individual’s preferences and offering an authentic pathway to reach these goals as life ends is something that DaVita Health Solutions provides as a critical component of its house calls program.
2019 will likely see a new wave of innovation that enables patients and caregivers with a personalized approach that impacts cost of care and more importantly the experience of fragile patients. Real progress can only occur if providers are personally enabling empathy on a regular basis.