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The Formula For Transforming Health Care
Ever had an idea everyone agrees with but still takes a year to implement? Nutrition Services Director Carissa Christensen faced a dilemma as she developed a weight management program for patients struggling with obesity: even after you’ve defined your vision, how do you engage an entire system in an ambitious improvement project?

besity is an epidemic. According to the CDC, 36.5 percent of US adults are obese. Closer to home, 27.6 percent of U of U Health community clinic visits in 2017 included a diagnosis of obesity and/or a BMI of 30 or greater. And yet, until recently, our system did not provide a weight-loss program that could be prescribed by providers.

Why? Because insurance companies rarely reimburse for nutrition services unrelated to specific visits. Once a patient receives a hefty bill for weight-loss counseling, there’s a strong chance they may refuse to continue with the treatment.

I realized my team could solve this problem. My team of 24 dieticians wanted to be more involved in weight management services, teaching classes and coaching patients on simple lifestyle modifications that would benefit patients long-term and be utilized system-wide. They were willing to do the work—all I had to do was get it approved and make it available.

As a member of the Air Force with 14 years of experience working for some intense commanders, I thought, “How hard could this be?” Everyone agrees that obesity is a problem, how much work could this be to implement?

Then, the real fun began.

I realized I needed the system to help me implement this idea. Here are the four things I learned about influencing an entire system:

#1: Be curious about the patient’s perspective–and start with the value equation.

Patients want to do the right thing. But when their insurance doesn’t pay for our weight-loss program, we can’t expect patients to pay out of pocket. I needed to come up with an option that would have a minimal financial impact but ensure the quality outcomes that patients wanted: weight loss.

It turns out we could develop something that insurance companies would cover. I read about the CPT code for Intensive Behavioral Therapy (IBT) for Obesity in a toolkit provided by the Academy of Nutrition and Dietetics. For patients diagnosed as obese, IBT is 100% reimbursable by Medicare and most private insurances for 22 visits over 12 months.

What really excited me was how meaningful this work was for our dieticians. Empowering them to take on this ambitious improvement project led to enhanced engagement. While providing a needed service, work done under the CPT code also led to a steady stream of revenue— potentially at no cost to the patients. Dieticians could increase their contribution to the bottom line, feel good knowing that their services are valued, and decrease their high no-show rate.

#2: Expanding your team transforms obstacles into opportunities.

I felt extremely discouraged by the thought of delving into the finance and insurance world, but I quickly discovered I had a system of people that would help me. My team of dieticians grew to include members of other departments I never met: outpatient coding, systems integration, compliance, billing, revenue cycle, business services, legal, ethics, scheduling, intelligence analysts. Suddenly, I realized how important each and every one of us are to delivering patient care.

Of course, a program can’t succeed without a provider champion. Susan Terry, Hena Kundra, Mark Hyde, and Matt Nimer supported our program and provided invaluable feedback. David Owen helped us fine-tune the program, agreeing to refer his patients in South Jordan, where we recently started implementing the new program.

#3: Define your vision to the team.

What I learned most is something I thought I already knew: the importance of having a vision. Interacting with a wide variety of non-clinical professionals, it was extremely important for me to articulate why this project was so important. It’s not fair to ask our colleagues to put effort and time into something unless we can stand by its purpose and the benefit for our patients. The obesity problem really affects our patients, and we can do something for them. That’s why we remained painstakingly focused—we knew we couldn’t fix the problem overnight, but we could make a difference. Everybody I worked with understood our vision. They really wanted to help and see us succeed.

#4: Be patient as you measure for success.

Titled “The NEW You”—NEW stands for Nutrition, Exercise, and Wellness—the program we developed covers patients for 22 visits over 12 months. Those include individual and group sessions, recipe demonstrations, motivational interviewing, and mindful eating techniques. If we’re successful at South Jordan, our hope is to implement this at Huntsman Cancer Institute’s Wellness and Integrative Health Center soon. But we know we’ll have to have to be patient as we measure for success.

I’ve spent a lot of time in my career fighting to get programs noticed, and now that instinct comes naturally. However, I’ve learned that patience is truly a virtue. Never assume that because someone’s not responding to your email they’re shunning your program or disregarding your self-made deadlines. They’re just as busy as you are, with their own self-made deadlines. Take a breath, relax, appreciate their time, and thank them for their service.

Meet the team that moved the system:

  • Adrian Williams — Manager, Outpatient Coding
  • Brandy Woodbury — Systems Integration Director
  • Dana Frederiksen — Compliance Officer
  • Michelle Densley — Director, Billing Compliance
  • Debbie Miller — Manager, Revenue Cycle
  • Marci Wessman — Business Services Supervisor
  • Staci Taufer — Revenue Cycle Manager
  • Shelley White — Manager, Wellness-Survivorship Center, HCI Wellness
  • Brian Watts — Chief Compliance Officer
  • Mark Hyde — PA-C, Huntsman Cancer Institute
  • Eileen Glass — Referral Specialist
  • Kris Nelson — Social Worker, Huntsman Cancer Institute
  • Jeannine Rushton — Director, Contracting Operations
  • Michele Ballantyne — Associate General Counsel
  • Cindy Spangler — Senior Value Engineer
  • Steve Tuttle — Business Intelligence Analyst

Annotated transcript from Carissa Christensen's presentation at the Nov. 30, 2017 Leader Development Institute in Salt Lake City, Utah.



Carissa Christensen

Director, Clinical Nutrition, Nutrition Care Services, University of Utah Health

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