Editors’ Note

Along with his current role, Dr. Kristofer Smith is medical director of Northwell Health Solutions. Board certified in hospice and palliative care, Smith was previously an assistant professor and the assistant program director at the Mount Sinai Department of Internal Medicine. Smith is also an associate professor at Hofstra Northwell School of Medicine. Holding a medical degree from Boston University School of Medicine, Smith completed his residency and chief residency at Mount Sinai Medical Center. He also received a Master of Public Policy in health policy from Harvard University, JFK School of Government.

Will you touch on your areas of focus within Northwell Health?

I’m an internist and, clinically, I have always been involved in the care of the homebound elderly. I was brought into the organization six years ago to work in the post-acute space with home care and our rehab facilities, as well as hospice. As a result of that work, I was asked by Michael (Dowling) to start the care management organization. We had been dabbling with new payment and delivery models but we weren’t seeing the success we had hoped. We believed this was largely because we were asking people to take on yet another job in this new space. We knew we needed to set up a business unit whose job was to strive to be successful in these new care models and payment models either by building new programs or by activating, supporting, and helping the existing clinical delivery arm.

What is the key to being successful in this area, and what have you found to be the most effective strategy?

There are a few important elements. The first is getting the right team in place. It needs to be a combination of good physician leadership partnered with great administrative and executive leadership.

Another piece is being very diligent in trying to portray ourselves as a service, a partner, and an ambassador as we work with the other physicians, service lines, and clinical delivery arms within the organization. We’re here to help and to be supportive.

The other key to success is staying the course. These programs are complex and the changes we need to see are complex in both process and mindset. It takes a while, so many of the programs we start take 24 months before they really start to show the clinical returns as well as the financial returns.

The last, more mundane thing involves the details of the contractual arrangements. Many of these contracts have poor logic around attribution or target pricing methodology that doesn’t work for the population or favors one party versus the other. We have to develop a deep understanding of the financial arrangements to see whether the deck is stacked against us or if it’s fairly stacked so payers, parties, and providers can all be successful.•