High Risk Underserved Clinic – Improved Outcomes Corewell Health

Corewell Health is a large integrated health system within Michigan composed of three regions: Corewell Health in Southeast Michigan (previously Beaumont Health System), Corewell Health in Southwest Michigan (previously Lakeland Health System) and Corewell Health in West Michigan (previously Spectrum Health). In addition, Corewell Health has an integrated payer, Priority Health, that covers 1.3 million lives.

In 2019, Corewell Health in West Michigan undertook a transformation to value-based care, with a goal to have 52% of all revenue in risk arrangements by 2026, including a fullrisk arrangement with Priority Health as part of that goal. This $900 million risk arrangement included Medicaid, Medicare and commercial market segments. Corewell Health in West Michigan focus for redesign started in primary care.

Within the United States, the top 5% of the publicly insured population under the age of 65 accounts for 55% of all health care utilization and cost2. The key drivers of cost and utilization for High Needs High Utilization (HNHU) patients within Medicaid are substance use disorder, homelessness, incarceration, and childhood adverse events 3. When looking at our internal Medicaid market data, we found that the top diagnoses for our extremely high emergency department (ED) utilizers (> 10 ED visits per year) were alcohol abuse with intoxication, other chronic pain, chronic obstructive pulmonary disease (COPD), chest pain and low back pain. Furthermore, 100% of our Priority Health risk contracted patients who have Medicaid or Medicare and were very high ED utilizers had a mood disorder of some type, with 66% having depression, 66% with anxiety and 41% having a substance use disorder.

Adopting the Scaled Agile Framework for Enterprises (SAFe®), Corewell Health developed cross-functional teams comprised of individuals from operations and digital services that quickly adapted to changes, new insights and information, embodying transparency, alignment, respect for people and continuous improvement. These teams aligned around a common purpose, vision and understanding focused on the problem first, and then allowed the best solution to emerge through iterative end-user feedback and personcentric development. With this new collaborative agile approach, the teams were able to maintain continuous delivery of viable, desirable, feasible and sustainable innovative solutions to address these health opportunities.