The Eastern Connecticut

Health Collaborative
Peter Shea, MD

In January 2018 I attended a Medical Executive Committee meeting to discuss preventive medicine and value-based
payment. Discussion quickly turned to the parameters of value and physician payment. One member appropriately
challenged the physician’s ability to affect outcomes and therefore final payment. He offered the example of one of
his patients with complicated, poorly controlled diabetes who could not afford her prescribed medication regimen.
His comment really struck on the physician’s challenge of how “value” translates into payment. How does he
properly assure high-level care for his patient who cannot afford to pay for her medications? Will the physician
receive reduced payment because the patient is recurrently readmitted? This brings to mind a series of further
questions. Can a surgeon be responsible for a post-op infection in a patient with inadequate housing? Should that
surgeon be “hit” twice for a quality metric and the cost for managing the complication? Should an internist be held
responsible for the multiple admissions for an opiate addicted patient?

The discussion highlighted the very clear reality - that ultimately quality and cost outcomes are dependent on a
range of issues beyond the provision of medical care. These are socioeconomic, behavioral, environmental factors
that often have a greater effect on quality outcomes than medical care does alone. Is there a way to provide care to
a population where these “social determinants of health” are effectively addressed and physicians are supported in
their efforts to provide high quality outcomes? And, what is the physician’s role in developing such a care model?

Over the past year The William W. Backus Hospital has partnered with multiple community agencies and local
employers to start approaching many of these issues. The group came together as the Eastern Connecticut Health
Collaborative (ECHC) and has defined its mission as, “Connecting people and resources to create a healthy
community”. The group has developed initial priority areas including healthy eating, active lifestyle, mental health,
and substance abuse. Over the next two months ECHC will define a series of objectives and strategies to address
specifically some of these priorities. As the group deliberates its actions it is of the upmost importance that it work
with physicians to define important health outcomes. At the same time ECHC must work to understand how to
integrate with the current system of care delivery and healthcare providers.

The collaborative has several physician members at this time, but could benefit from more. Physicians must remain
the leaders of healthcare for our communities. They best understand how the system works and the most relevant
measures of health. A successful collaborative with member support and participation has the potential to aid
physicians by identifying and addressing the social determinants of health in our local areas. When these issues are
analyzed, physicians will be far more effective in reaching optimal outcomes for their patients.

If you would like to be part of ECHC, please contact me at peter.shea@hhchealth.org. g

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