Value-Based Care Stories from Sutter Health with Austin Ord, Director of Post-Acute Care, Sutter Health Bay Area

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: Welcome back once again to the outcomes or rocket podcast where we chat with today’s most successful and inspiring health leaders. I really thank you for tuning in again and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today’s podcast because we have an outstanding guest. He’s a phenomenal leader in healthcare. His name is Austin Ord. He’s over in San Francisco California. He’s a director of Post-Acute Care at Sutter Health Bay Area. He has done so many wonderful things in health care but he’s just dialed in on how to make health care more efficient. From areas such as the sniff community care management areas all the way down to making it just the most interesting decisions for community based organizations to take care of that post acute area and health care which often times goes ignored. We’re going to dive into some of the specifics that he’s done at Sutter. But what I want to do is open up the microphone to Austin to fill in the gaps in that introduction. And Austin welcome to the podcast.

: Thanks all. I think you did a good job on the intro I’ve been doing the director of close to Q Carol for the last two years and I think we’ve done a lot of great work around breaking down silos bringing different providers and the community together. So I’m excited to share some examples of what we’ve done today.

: That’s awesome and we’re excited to hear about them Austin because at the end it’s these conversations that help us get better. What is it that got you into health care to begin with?

: I feel that I have a little bit of a unique history of health care and that my exposure to it was probably greater than your average average child and that in the U.S. My mom unfortunately was diagnosed with cancer when I was five and she had a couple of bad outcomes over over a few years. One in small town or dad and then another two years later in rural Oklahoma that led to her then seeking further treatment in the world renowned M.D. Anderson. And it was you know this this battle over several years that I think certainly influenced my decision later on to get involved in the health care and that it was such a big part of our life live for so long. So years later when I was working in high school community rec center and then in college I was pretty interested in helping people improve the quality of their lives. But but it really wasn’t as meaningful or as complex as I would have liked. So when I was looking to get get more involved in my career plan that decision that experience really stuck with me. When I write whenever I was feeling about my next steps and how I could help other people maintain the quality of their lives so I decided to get my Master’s in Healthcare Administration and move on into the health care field to help other people and hopefully help others avoid bad outcomes like like we had growing up.

: Austin, thank you for sharing that. It’s woven into the fabric of who you are and you just kind of found an opportunity there to help others have have better lives through health administration and as you fast forward into your career and the wonderful things that you’ve done some that we’ll touch on here in the end on the podcast. What would you say that hot topic needs to be on every medical leaders agenda and how are you guys approaching that at Sutter.

: Well I mean there are so many hot topics today I but my personal favorite is this transition away fee-for-service into value-based care. And I I really think using this change in reimbursement model to help you that economic force to really just change how we deliver care across the board whether it’s improving the patient experience,using more technology, changing delivery models,etc. I think using that as a forest look at hit the reset button on how we go about our care. And we’ve got that across the board. I think it is just a major opportunity that that really excites me and makes me want to get out of that and help do a better job for the patients that we serve each day. We’re approaching it at least in my role and a number of different ways. Sutter health was involved in that CJR pilot that CMS had going on and still going on. We opted out of that recently but we approached. Yes correct. Yeah, bundled payment are on a placement program. So we helped redesign some of the elements which we involved care by, I had a nurse on my team who would start doing pre-assessment protocols for patients who had elective procedures about two weeks out just to do a full on risk assessment so we could find out about their home situation and find out about their medical history from a care coordination perspective so that when the patient had their surgery, all the documentation was in the chart and every care team member could go in and actually have an informed conversation with that patient. They were starting from scratch. They were able to go and introduce themselves. Hi Mrs. Jones let’s see the present we’ll be taking your home after surgery after you’ve got a flight of stairs and really kind of little things like that that make the patient feel like they matter, like they care, like they’re known, they aren’t just some stranger walking into a room that facilitated much better hand-offs throughout the rest of the episode. But whenever they went to a skilled nursing facility, my nurse was still following them for the 90 day period. So that way, the staff knew who they were, the home health agency knew where they worked. The operation rehab, we were really guiding every step of the way and then calling them when they made it home to make sure any barriers were removed so that not only did this lead of course to better financial documents for the episode because we were making sure the patient received the right amount of care no more and no less. But this really led to I think a much better patient experience. So versus the new care provider having to ask the same questions over again. Everyone was informed and everyone on the same page and that patient was we don’t we wasn’t just lip service about putting them at the center. They actually were at the center. So I’m really excited about the opportunity to participate in DTC Idex to do this for more diagnoses.

: Very interesting. So as hospitals start to look at the end. By the way congratulations on that. It’s tough to dig deep and be consistent enough to have results and improved outcomes decreased costs in these types of programs so kudos to you and your team for doing that.

: Oh thank you. We’re very proud and we’re going to get super excited for the next challenge.

: Yeah. And so what is that challenge? So you mentioned the program and maybe diving into some different disease states or chronic illnesses. Is there anything that you want to maybe share that you’re excited about there?

: So nothing’s confirmed yet we voiced just submitted our application to CNN so we’ll have to see when we actually end up walking away with. But I think that again using these types of reimbursement structures so that redesign things just that’s what excites me. Whether a part failure or sepsis or job placement I look forward to helping helping all of our different providers at every different part of the continuum, just really rally around a better patient care to the continuum.

: That’s pretty cool. And folks if you don’t know this Austin was actually appointed by the mayor of San Francisco to represent hospitals and health systems on their long-term care Coordinating Council so definitely a trusted source in this field. You know curious what you think about this as we think about long term care Austin, what do you think about the Humanas wanting to buy the kindreds and now that like what are your thoughts on that in general?

: I’m excited about some of these innovative disruptive partnerships. I think that it will be good for some competition to enter the market in a new way. I think again further accelerate the changes that are coming from outside forces. The more the merrier is what I think. I’m pretty excited to see things shapen up. I want to see people get crazy. I want to see the old structures will be new and exciting again and whatever we can do again to help help the patients at the center. I’m I’m all for.

: Now for sure spoken. Spoken like a true innovative San Francisco man. So give us an example of Austin something that you guys have done to improve outcomes and by doing things differently?

: There are so many where do I start? Can I give a couple examples.

: Yeah, please, you can have it here.

: Or I can save one example for later in the conversation.

: No, let’s hear them, I love it, if you have a couple of them that you’re excited about. We want to hear about them.

: OK.

: So I think the first you mentioned earlier in my introduction my relationship or worked on with some of the community-based organizations. So how housing in the Bay Area is I mean to say it’s a crisis I think is putting it lightly. There’s you know a large number of people experiencing homelessness throughout the day. And when they come into our emergency departments really needing care. It presents a large dilemma for our care teams in terms of making sure we’re utilizing our limited resources efficiently to serve all our patients but also doing the right thing for those patients make sure they receive the right care. In my first 30 days in this role,I was really saddened to identify a community partner called Bay Area Community Services or BACS and they specialize in providing shelter or transitional housing for the homeless. And what we did with BACS is we partner with them based after the nurse and we would end up sending them patients who really weren’t appropriate to return to the streets just yet and needed further further therapy whether physical therapy or some kind of ongoing need where they just needed a place to recuperate and we could send home help into that shelter if necessary. And what was really exciting was when we brought our partners into the vault we could even further up the stream from the patient to a skilled nursing facility who would then go to BACS and that just help build our care continuum because I don’t know if you know but there’s no skilled nursing facilities and would take these patients because they were afraid that they would end up living in there and occupying one of their limited post-acute resources that are again becoming more and more constrained with an aging population. So by partnering with a community based organization to identify someone and entity that their expertise was working with this clientele it is definitely been the right thing for us from improved outcomes perspective. But it’s been the right thing for that patient population too, because in that organization, there are caseworkers that can help them find permanent housing, is that the clients interests that can help get them plugged in with jobs, that can help get them back on their feet in a way that the hospital is not equipped to do. And it’s been a super heavy partnership. We’ve since duplicated, I replicated that model across the bay area with a couple of different partners and it’s actually got another meeting later today to explore a new partnership in San Francisco. So that’s one way where we’ve we’ve certainly done things a little bit differently.

: Austin, that’s super exciting right. And listeners if you’re tuning in whether you’re a provider or a community-based organization these types of synergies that Austin and his team over at Sutter have moved forward with really make a lot of sense and the results are there with the hospital. You could only do so much but a community-based organization focused on those social determinants of health and being able to plug in people with housing or other types of mental health potentially. It really makes a lot of sense. And so an encouragement to you to think about this and check out some of the models that Austin and his team have used. During at the end of the podcast will give you an opportunity to have a place to reach out to Austin or follow him. So don’t go away. Austin, So what else you were going to give us a couple other examples?

: Yeah this one is near and dear to my heart. And we’re actually a finalist for the Center of health President’s Award for this program.

: Really.

: So we we we called our community Case Manager Program and what we and what we have done is we have a nurse who rounds with our community skilled nursing facility partners to really support strong transitions of care. You know, if you are not aware, the patients going to school nursing facility are often are our sickest or most vulnerable patients could be, they still require facility-based wth 24 hour nursing care.

: Yes.

: And so those are certainly at high risk of readmission. And then again with bundled payment, controlling post acute care cost was our biggest opportunity. So this nurse would support transitions of care for all patients discharged from any Sutter Health Hospital starting in Oakland Berkeley but we’ve since expanded the model to cover our CPM CR Chart or pardon me are California Medical Center San Francisco partners sniffs and what what was the community case managers do with their on site with the sniff care team on a weekly basis to make sure that sniff care team has all the information they need to provide high quality care to support this starts planning from the skilled nursing facilities, they don’t just bounce back at the hospital. And then when they come back to the hospital they represent the skilled nursing facility. And if there were flaws in the discharge are opportunities for improvement. So again improve patient experience, it’s real time communication and feedback in a way that is really unprecedented. Because we don’t often hear about those kinds of things once they leave the hospital. So when you’re leading the constant improvement across all areas of discharge planning for our care teams and so with this program, we’ve seen a tremendous reduction in readmission rates from our skilled nursing facilities and also skilled nursing length of stay which is important in bundle payment but also helps create capacity for that next patient that is in need a fee for service perspective. So having that model, the skilled nursing partnership is a huge asset because it’s a real time point of access into the hospital who’s dedicated there to help them do the best job they can and the hospitals love it because it’s a real you know arm in real time operational support. Again strong just strong discharge planning and partnerships with our community providers.

: That’s pretty cool.

: I am super excited about it.

: That’s exciting and so true Austin. Now once the patient leaves the door, the onus is still on us to continue taking care of them in order to avoid adverse outcomes or readmissions. And Austin just out of curiosity you know as the dialogue goes of high touch and high tech,sounds like you guys are are definitely doing a good amount of high touch, getting the folks involved in that. How about the tech side of things are you guys incorporating any data analytics or technology to help in that transition?

: You know it’s all about. It’s like you knew what button to push. It’s not as much as we as I as I wish we would I think,.

: OK.

: But I think we’re moving in that direction.

: I don’t think that thing though Austin you know I don’t think it’s a bad thing to not have because a lot of these things do require human touch.

: Certainly but I think that the technology could just help us make our limited human capital so much more effective. And I was lonely and I do believe that is certainly recognizing the value of so many of the analytics tools that are now created with a point of supporting. But the large student no long term outcomes of patients and I expect the near future will hopefully have some more analytical resources. Now, my nurses are much more effective when they can go out and really get to the root cause or do something a little bit better with their limited time. But right now much of the process that we’ve done is is pretty manual or kind of a MacGyver I would say but we’re doing a move in that direction.

: That’s awesome. I definitely feel you Austin and you guys are doing a phenomenal job. I mean keep up the awesome work and just a little tidbit here folks. If you’re listening to this here’s an example of how human touch is here to stay. No matter how crazy you think AI or any of these technologies are going to be. Technology is human and the human touch is still going to be important to improving outcomes and Austin and his team are proof that this continues to be a necessity. So Austin give us a time when you guys had a setback and what you learned from that setback in some of these programs?

: This is my favorite topic to discuss personal failures. So I think I’m a pretty fast moving guy if you can tell by my rate of speech. I like speak quickly, and move quickly and do things quickly and I think that sometimes my enthusiasm can be a tremendous asset. And sometimes my fast moving nature can be a drawback. And I know just whenever I first became a manager of our in-patient care coordination department two years ago I wanted to do a lot very quickly and that was you know that wasn’t the best way to go about change. For some of them are our team members who have been in the industry for a long time and that that can be very threatening and intimidating to people who have been in the industry or for anybody, change is scary. So I learned the hard way that it’s really important to go slow to go fast. And I think that my take away from an earlier stage whenever I had some staff members who gave me some very critical feedback, Some in the form of resignation that they knew went that for .. but it’s really important to engage all key stakeholders and the element of change be to take time to learn the ins and outs about current state about what a proposed future state would mean, the impact that it would have on everybody and to really make sure that the work we’re doing our due diligence because there is so much happening, there is such a huge volume of information to conceal. You could really get involved in anything now. I think it’s important to pick your battles and to be judicious and not just implement something for the sake of implementing something because it was bound to be better. But really taking time to make sure you’re going to understand the impact that it will have on the people that are closest to the work. And I think that that’s been a lesson that I’ve learned and something that in all these innovative pilot that I do now. I really tried to sit down with all the key stakeholders , talk through it and make sure people were comfortable andthey could express their feedback in advance of a change rather than pushing something down and suffering the consequences later.

: That’s awesome. Really appreciate that share you know engaging stakeholders is key. And you said you know I got feedback even resignation that’s like a very clear feedback but you know what, the beauty Austin is that you you learned from it. You’ve pivoted since and now you’re very tuned in the organization and the key players. So folks if you’re trying to make change can’t do it on your own. You’ve got to tap into those that are that are at the frontlines. What would you say is one of your proudest leadership moments in healthcare right now?

: I can tell you that my proudest moment at a heartbeat. So same role I was manager of care coordination. I was fresh out of my administrative fellowship. I was young,I was a clinician I was managing clinical nurses and social workers support utilization management discharge planning and transitions of care and they had no reason to respect me, they had no reason other than my title. They had no reason to listen to me. I really had to work to earn their trust and their confidence. But I was not going to be more than just another burden for them to jump through because you know our case managers and social workers they are moving at a million miles an hour to help them make sure that our patients leaving the hospital have everything they need to be safe. And I did a lot to help us to build those relationships in the beginning and offering any way I could. Iremember my proudest moment was when one of my nurse case managers, she actually came forward to me with a case and she asked for my help and that was probably in my first six weeks on the job. I I remember finally she was the first one we processed that we got the patient what they needed to get to be safely discharged. And after that moment like I remember I she put a little sticky note on my desk and I came back from a meeting and thought like I need your help with the patient in Room 608. And I hung that on my wall because that was the first moment. As a non-clinician I was able to be of assistance to clinical staff and to support the patient experience. It’s been a real reminder that even though I’m not a nurse even though I’m not a physician, any way shape or form you can help help support someone who is and really get back to the core mission of the core root of why we’re in this industry to help serve others. And I have since saved that sticky note and I carried around with me. Just remember that you have to take time to earn the trust and buy. But that was a big moment for me and ever since I’ve been proud of that. That’s a monumental shift to finally getting getting the buy in of those who weren’t my biggest fans in the beginning.

: That’s wonderful Austin. What a great story. Sort of took me back there. I felt like I was in a room with two guys and it’s kind of like that nurse sensed your frontline hearts because you do have a frontline heart Austin. You know you spent time with your family taking care of your mom and she sensed that in you. And you also earned it but that’s something that you have. So kudos to you for being able to have that aha moment and just kind of see the areas where you could add value. And that’s pretty exciting. So Austin tell us a little bit more about an exciting project or focus that you’re working on?

: Yes certainly. So with and I had mentioned earlier that you know there’s a housing crisis in the Bay Area and that housing crisis really limited the amount of community resources that we can. You know we could send patients to safely which is like you know these lead to further blockages and the search continue. So what I’m trying to say by that social security income SSI can no longer cover the cost of abortion care or residential care facilities for the elderly in the Bay Area. So when patients can’t afford that if they have medical or Medicaid what they’ll do is they’ll often live custodial in a nursing home and that occupies again a post-acute resource that we’re finding more and more used for from an acute or short term perspective. So there’s all this all these resources across the Bay Area that that are being consumed at levels that are not at their highest capacity. And so to address this, the hospital Council Northern California has convened a post acute task force in the San Francisco area particularly where the crisis I think is the most extreme. And so there are members all across this city, representatives from different hospitals from different post-acute sites from government agencies coming together to talk about this issue and trying to think about creative ways where we can help bypass or help you to kind of circumvent the extreme issues that we’re experiencing because now having having an impact in the acute setting where we are seeing patients stay in the hospital for an extreme amount of time which really is an appropriate use to solve the housing crisis. So we’ve been meeting monthly out for a little over a year and looking at different supportive housing models or different community-based services where we can help maybe help ensure people return to their community independently. And we were making some exciting recommendations to the city Board of Supervisors and the health commission in San Francisco and I’m pretty excited to see what that task force will come up with. So that’s one other initiative in which we’ve been engaged in recently.

: That’s really interesting Austin. I mean you’re really digging deep into not only acute but because you are in this post-acute area. You’re really digging deep into public health issues and the reality is as healthcare leaders, we really do have to be involved in public health because health is just one right. It doesn’t just happen within the four walls of a hospital so that’s pretty interesting. It will be exciting to hear what you guys come up with.

: I certainly hope that there is a viable solution. What one of the things that we’re looking at doing across the city is implementing standardized measurement of these patients who really don’t have a medical need but end up staying the hospital for a long period of time so we can start to quantify what their need is and what the availability of community resources are and then working with different leaders across different community based organizations or government agencies to help build out those resources or engage people who can help create those create those resources. So I think that will be one of the low hanging group will implement here in the next few months.

: That’s awesome man and hey, we’d would love to get you back on maybe in about a year or so to hear what comes out of it.

: I’d be happy to.

: Hey so we’re getting close to the end here Austin. Let’s pretend you and I are building a medical leadership course on what it takes to be successful in healthcare leadership. It’s the 101 of Austin Ord. And so we’re going to write a syllabus. I’ve got four questions. Lightning round style for you followed by your recommendations of a book and a podcast for the listeners. You ready?

: Yes sir.

: All right. What’s the best way to improve healthcare outcomes?

: I would put patients at the center. when patients are at the Center on all their metrics online.

: What’s the biggest mistake or pitfall to avoid?

: Going too fast too hard and as I mentioned in my earlier example.

: How do you stay relevant as an organization despite all the change?

: I personally like to subscribe to a lot of different newsletters or articles that come out whether from CMS or from different health care publication organizations just to stay on top of all the changes and find the ones that are really going to be impactful to our work or have a really great influence and change on how we are patient. So I like to just stay informed the best of my ability.

: Love it. What’s one area of focus that should drive everything in a health organization?

: I have to say put patients at the center. That’s really what I think we’re here to do.

: Fantastic and what book and what podcasts would you recommend on the syllabus?

: I’m a big fiction reader so I’m going to read anything unfortunately not probably about organizational change but what if I did have to pick one, I think that The Tipping Point is a really great one, Malcolm Gladwell. It’s all about affecting organisational change and how to make make ideas sticky and getting people to buy into those buy into your idea. I think that’s a fantastic book to read.

: Awesome. You’re definitely creating tipping points over there at Sutter so a great recommendation. And how about a podcast. You have a favorite podcast?

: Obviously Outcomes Rocket.

: I appreciate that I appreciate that. Listeners if you want to get more information on this interview, the transcript, links to the recommendations, links to Sutter and all the amazing things and Austin’s doing just outcomesrocket.health/austin A U S T I N, and you’re going to be able to find all of that there. Before we conclude. Would love to just get your closing thoughts Austin and then maybe a place where the listeners could get in touch with you to collaborate or follow you.

: I’m certain that and changing how we do things innovatively taking the models that we know have patience but finding ways to improve upon them to only make them more effective. I love the sense of enthusiasm that we’re starting to see from you know new entrants into the market like the JP Morgan Berkshire, announcement that came out two weeks and months ago. Time flies. You know some of the new payment payment models moving forward like the PCI Advance. So I’m just super excited to see where the industry is headed. I think it’s a great time to be in healthcare. If you want to dig in and do something innovative that now it’s time to get crazy. So if you would like to get in touch with me, Langton’s a great place, Austin order you’re welcome to shoot me an email, orda@sutterhealth.org.

: Outstanding there you have it folks. Austin, rhis has been a pleasure. We definitely learned a lot in this post-acute area housing. And so I really want to thank you on behalf of me and all the listeners for spending time with us today.

: Hey, thank you very much for having me.

Thanks for tuning in to the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don’t forget to check out the amazing healthcare Thinkathon where we can get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is “implementation is innovation”. Just go to outcomesrocket.health/conference that’s outcomesrocket.health/conference. Be one of the 200 that will participate. Looking forward to seeing you there.

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