Healthcare 360: Building New Systems to Close Care Gaps

Podcast: Building New Systems to Close Care Gaps

On this week’s episode of Healthcare 360, Dr. Rob Fields sits down with Spencer Rittner, MD, medical director for population health at Beth Israel Lahey Health (BILH) Primary Care, to learn about the work he’s done to close disparities in health outcomes.

Population Health as a Pathway to Better Care Access

Dr. Rittner didn’t start his career in population health. He was drawn to the specialty after realizing there were numerous social and economic barriers that prevented some of his patients from accessing the care they needed.

“I had a patient that didn't have any access to food,” he said. “I tried my best to take care of his diabetes, but all he could eat was cornmeal. His care was really dependent on his access to cornmeal.”

It seemed that no matter what Dr. Rittner did, his ability to provide proper treatment was limited. That led him to begin thinking about what he – and the wider healthcare system – could do to improve access to care and better meet the needs of all patients.

This mindset has helped shape Dr. Rittner’s approach to population health, not just as medical director at BILH Primary Care, but throughout his career.

“I think about the 500,000+ patients we take care of in primary care; how do we deliver better care to them?” he said. “Some of those solutions are transformative efforts, like ways to keep people out of the hospital. I also work on projects trying to expand group visits and shared medical visits, which is a different way to deliver care for patients.”

Creative Solutions to Improve Health Outcomes

Large health systems like BILH are designed to provide better quality care to patients. But bringing large hospitals and other health organizations together can create some unintended gaps in care.

Risk-based contracts have received much of Dr. Rittner’s attention. Under these agreements, insurers offer providers financial incentives to encourage certain health outcomes, usually for groups with specific conditions. Those not included in those contracts simply don’t receive the same care.

“We see that with hypertension,” he said. “I worked on a project looking at the differences between our patients under these risk contracts and those that are not. We saw a 4% difference in terms of their outcomes, meaning those under risk contracts had their conditions better controlled.”

Dr. Rittner and his team thought creatively about how BILH could develop new systems to better serve patients who don’t benefit from risk-based contracts but require the same level of focused care.

“We implemented robust systems within our primary care practices,” he said. “We worked with the innovation team to try to bring blood pressure cuffs for patients to borrow and created systems so that blood pressures were repeated for all of our patients.

“We were able to not only improve the outcomes of both the risk and the non-risk patients, but we decreased the gap by 2%.”

Despite that astounding success, any solution designed to close care gaps has to balance the health needs of patients and the financial needs of the health system to avoid harming patients in the long run.

That’s part of the work Dr. Rittner is engaged in every day.

Every other week, we’ll chat with a leading expert in healthcare to learn about the many challenges and opportunities facing the industry. Click to watch or listen to the full conversation with Dr. Rittner, and check in regularly for new episodes of Healthcare 360.