Whitney Palmer

Healthcare. Politics. Family.

Does the ACO Model Commoditize Radiologists?

Published on the Oct. 30, 2014, DiagnosticImaging.com website

By Whitney L.J. Howell

For U.S. healthcare, new payment models are no longer the catchphrases of the day. They’re also not yet realities. But that doesn’t mean health systems aren’t trying them on for size, searching for one that makes the biggest impact in controlling costs, and pumping up patient experiences.

The question is – what has this meant for radiology so far?

Accountable care organizations (ACOs) are at the top of the new payment model list, but there’s no consensus about whether they’re fulfilling patient-satisfaction and cost-savings goals. In fact, out of the 32 original Centers for Medicare & Medicaid Services (CMS) Pioneer ACOs from 2012 that opted to test this system design, only 19 remain active. The rest dropped out of the pilot, citing either too much financial risk or the inability to meet Medicare savings goals.

Read the article in its entirety at its original location: http://www.diagnosticimaging.com/practice-management/does-aco-model-commoditize-radiologists?GUID=EF943FEE-BD0C-44C7-A1BC-C82F32210979&XGUID=&rememberme=1&ts=31102014#sthash.6BldBTSs.dpuf


October 31, 2014 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

The Changing Role of Nurses

Published in the March 2012 Hospitals & Health Networks Magazine

By Whitney L.J. Howell

Increasingly, hospitals rely on RNs to fill the primary care gap and meet the many new health care imperatives

The Mayo Clinic in Rochester, Minn., is no stranger to repeat patient visits. But providers were stunned when they realized one individual had 76 encounters in 2010. “According to the care coordinator, the patient came to urgent care, the emergency department, the primary care office and the hospital sometimes as often as two to three times a week,” says Diane Twedell, vice president and chief nursing officer for Mayo’s Austin Medical Center. “So, we took the needed steps and got those 76 visits in 2010 down to just four in 2011.”

Curbing this excessive health care system use and ensuring that the patient received the appropriate care called for a simple solution, Twedell says: getting the care coordinator — in this case, a nurse — more involved at every step of the patient’s care. The nurse followed up with the patient after each appointment, designed different care plans and facilitated transitions between clinical settings. The result: health care that maximized quality and minimized cost.

Ultimately, that’s the intent of the accountable care model. Many industry leaders consider expanding the role of nurses and using their skills to the utmost essential in giving patients more coordinated, team-based care. If nurses have more responsibility over care management and a louder voice in designing workflow, not only will public health improve, but the health system also will be leaner and more effective, they contend.

Expectations and pressure are high as the field faces the impending influx of more than 30 million people with expanded coverage under health reform. However, there are still many questions about what responsibilities nurses should assume and how hospitals can best assess their own needs. There are also concerns about whether enough nurses will be available in the coming years to meet the needs of an aging and increasingly complex patient population.

Out from under the radar

In every clinical care environment — hospitals, nursing homes, ambulatory care centers — nurses nearly always have the closest relationship with patients. They are the front-line providers who monitor and meet patient needs; they are the information conduit from patient to physician; and they are the dogged patient advocate who lobbies for both patient and family.

But, as a group, nurses often neglect discussing their contributions to high-quality patient care and overlook opportunities to offer input on workflow design, says Pam Thompson, R.N., chief executive officer of the American Organization of Nurse Executives, an American Hospital Association subsidiary group. Effecting change will require nurses to be proactive.

“Nurses have pretty much always been invisible, but we must ask to be included in conversations about care management,” Thompson says. “We know how care is supposed to be delivered. From working across the continuum, to smoothing handoffs, to working to prevent readmissions, nurses cannot be silent. We must speak up and say, ‘We can do this.'”

The Future of Nursing: Leading Change, Advancing Health, a report published by the Institute of Medicine in October 2010, highlighted nurses’ ability to reduce gaps in care and stressed the imperative that they do so. According to the report committee, nurses are ready to stretch their wings as primary care providers to increase access to services and organize complex care plans for wide ranges of patients. They often prevent medication errors, reduce infection rates and facilitate patient transitions from hospital to home.

If allowed to work to their full potential, nurses can help hospital administrators strike the right balance between providing the best possible clinical care and controlling costs, says Patricia Hines, R.N., clinical and operations expert and vice president for the Camden Group, a health care consulting firm. “We must try to create an environment that optimizes the role of the professional nurse,” Hines says. “They can engage in value-based purchasing for the client; they can spend time on patient education, prepare for care coordination and increase their interaction with primary care providers.”

In many cases, nurses already are serving as care coordinators, health coaches, disease managers and community liaisons. Others conduct research at the bedside and analyze the data. But for nurses to assume these roles officially on a broad scale, a number of things need to happen, says American Nurses Association President Karen Daley, R.N.

The biggest is expanding the scope of nursing practice, she says. “The current hierarchy and archaic, traditional way of doing business within a lot of hospital environments impedes nurses’ ability to provide care,” Daley asserts. “Nurses must own their power and the potential of their practice.”

Not everyone agrees. The physician-led team is a tested strategy, according to the American Medical Association, and changing tactics when health care is facing a significant major influx of patients could impact all providers’ abilities to give patients the best, most cost-effective care.

“With seven years or more of postgraduate education and 10,000 hours of clinical experience, a physician is uniquely qualified to lead the health care team,” says AMA President Peter W. Carmel, M.D. “Physicians, physician assistants and nurses have long worked together to meet patient needs for a reason — the physician-led team approach to care works. Patients win when each member of the health care team plays the role he or she is educated and trained to play.”

Scope of practice is a controversial legislative issue. Most states restrict the services nurses, including nurse anesthetists and nurse practitioners, can provide without supervision. Only 14 states allow NPs to diagnose illness and prescribe medication without physician oversight, but the battle is building nationwide.

What nurses can do

As health care shifts toward a more team-based approach, many nurses already are moving into roles that build upon their previous responsibilities, such as developing greater care coordination and conducting population analyses.

As clinical leaders, nurses can have a significant impact through discharge planning, says Marilyn Chow, R.N., Kaiser Permanente’s vice president of national patient care services. They are uniquely qualified to recognize and provide tailored guidance for patients at risk for negative outcomes or a readmission. “At discharge, nurses can improve a patient’s outcomes by going through their medications, discussing any side effects, and asking if they have any questions,” she says. “Being proactive is very important.”

In many cases, Chow says, NPs serve as care coordinators, guaranteeing continuity under the collaborative model. As the primary provider, he or she can follow patients easily cross settings to monitor their progress and needs, as well as catch problems early.

NPs with Harvard Vanguard Medical Associates proved that point when they launched a program for congestive heart failure patients, many of whom received conflicting advice from their various physicians. Each patient is assigned an NP who works with specialists to design a single care plan. Within a year, the program slashed emergency department visits by 92 percent for that group of patients.

Nurses also can improve care in a patient’s home. Pittsburgh Regional Health Initiative’s CEO Harold Miller says the organization saw a 40 percent drop in readmissions for advanced lung disease patients when nurses began conducting home visits.

A nurse’s first-hand knowledge of a patient’s condition also can lead to discussions with colleagues about disease management for complex patients, says Patty Jones, R.N., a health care management consultant with independent actuarial firm Milliman. Floor nurses, she says, can expand their practice scope by providing follow-up care through home visits.

Maintaining these relationships bolsters nurses’ abilities to manage the needs of certain groups proactively, such as patients living with diabetes or children with asthma, she says. Through analysis of patient data, nurses can create interventions that potentially improve the group’s overall health.

Doing so makes nurses cost managers, as well. Not only do they augment the patient experience, they also positively impact population health. As a result, hospitals often see a drop in their patient per capita care costs, Hines says.

Broader nurse activity saved Wisconsin-based Marshfield Clinic $118 million during a five-year project funded by the Centers for Medicare & Medicaid Services. The clinic beefed-up its 24-hour nurse hotline to serve both adult and pediatric patients and added physician-directed, nurse-managed heart failure, high cholesterol and anticoagulation therapy programs.

A similar hotline program at the Mayo Clinic allowed nurses to provide more than 11,000 treatment protocols over the phone, including for urinary tract infection and sinusitis, within 18 months, freeing up office visits for patients with more acute needs, says Stephanie Witwer, R.N., a primary care nurse administrator with the clinic.

Skills nurses need

To fulfill their roles under an ACO or other coordinated care model, nurses will need additional skills in many areas — from technology to evidence-based research. Enhanced education will be the foundation of it all.

The IOM report called for at least 80 percent of practicing nurses to have a bachelor’s degree by 2020, and industry experts are supportive. “Nurses with a BSN have the skill set and critical-thinking abilities needed for evidence-based practice,” Hines says. “They have more exposure to collaboration and team-building and readily can create a culture of quality and safety.”

Many hospitals already have begun moving toward an all-BSN workforce. In October 2010, shortly before the IOM issued its recommendation, North Shore–Long Island Jewish Health System in New York mandated that all newly hired nurses hold a BSN, says Elaine Smith, R.N., vice president for system nursing education.

The Future of Nursing report bolstered our conviction that it’s necessary for nurses to be better educated,” Smith says. “As we look to change how the health care system is designed and better manage patients across transitions of care, our nurses need to have the skills that only can be acquired with higher education.”

Although the initiative is still too young to determine what, if any, improvements or benefits an all-BSN workforce brings to patient care, Smith says response to the move has been enthusiastic. There are, however, steps hospitals must consider to facilitate baccalaureate education for staff nurses who desire it. Institutions should negotiate with nursing schools to secure employee tuition discounts, partner with schools to provide classes on hospital grounds, and determine what type of tuition reimbursement to offer.

Achieving a higher level of education will expose more nurses to one of the most important aspects of health care reform: the push toward greater use of health information technology. For example, nurses who are proficient with telemedicine can monitor their patients easily in their homes, keeping tabs on any daily activity or medication needs.

To date, electronic health records are the most significant IT investment for most health care settings. It is clear CMS expects all clinical care environments to achieve HIT proficiency, and nurses must be among the most enthusiastic adopters, Daley says.

“Nurses need the most in-depth knowledge and hands-on experience with health information technology,” she says. “Many nurses already are skilled far beyond basic competencies. They have a comfort level with this technology that can help them communicate with other providers and can allow them to make the most of their role in coordinated care.”

But it’s not enough for nurses to simply use an EHR, says Milliman’s Jones. Hospitals must include nurses from the beginning of the IT planning process and request their feedback about what works and what does not throughout the selection and implementation process.

Community care settings offer the biggest opportunity for nurses to use technology to improve the quality of care, Jones says. The data nurses gather from the older and underserved populations who receive health care in the community can be used to improve patient care processes within hospitals.

Community-acquired information also can be used to support evidence-based research, says the ANA’s Daley. Armed with outcomes data, nurses can present hospital administrators with process changes to improve both workflow and patient care. For example, nurses with the public-private Community Care of North Carolina analyzed claims data, including repeat emergency department visits and chronic-condition diagnoses, to pinpoint patients who likely would benefit most from case management. According to a 2008 Annals of Family Medicine article, by tracking utilization and communicating with other managers, CCNC nurses have saved the state about $160 million annually.

Bringing such an impact to widespread fruition, however, often means nurses must improve their communication channels with physicians and hone their leadership skills, Daley says.

According to Kaiser Permanente’s Chow, any skill improvements or systems changes should be achieved with a singular goal in mind: improving transitions not only between shifts but also between care environments.

“Everything we do and put in place as nurses should be done to strengthen handoffs, especially among inpatient, outpatient and home care settings,” Chow says. “We are always motivated to make situations better for our patients, and the best way to do that is to ask for their perspectives.”

Kaiser Permanente nurses routinely ask patients about any fears or questions they have regarding their care plan, how involved they wish to be in their health care, and what, if any, additional information would help medical staff provide better care, she says.

Hospital preparations

While most experts agree patients benefit when nurses are more active in designing care plans or working in the community, for many clinical settings, putting nurses in those roles will take time. Health care has a long-standing perception of nurses as providers who implement physician orders and have little impact on a patient’s well-being. For systemwide reform to succeed, that view must change, Daley says.

Pittburgh Regional Health Initiative’s Miller agrees, noting that the current silo structure can thwart efforts to expand teamwork.

But hospitals must be ready for the change, says HSS’s Goldberg. The first step toward broader nurse activities is to ensure that the facility’s executive committee is on board with the idea.

Secondly, the CNO must meet with all senior leadership to conduct a gap analysis and choose external benchmarks by which they can measure their success against other organizations. Goldberg suggested using patient satisfaction scores or data from the National Database of Nursing Quality Indicators.

“This is the time for the hospital’s administrators to take stock of what they don’t have, what they need to do to get there,” she says. “Then, they can lay out a two- to three-year plan on how to accomplish it all.”

During these conversations, Jones says, hospitals should assess whether their nursing staffs have the necessary skills to put any new policies into place. Administrators should look for nurses who are experienced in teamwork, familiar with evidence-based research, fluent in HIT, and armed with the knowledge and skills that will lead to quality improvement.

Hospitals also should create a long-term succession plan. Although the current weak economy has pushed many people to either continue practicing or enter nursing as a second career, the much-publicized nursing shortage will return, Hines warns. “It would be appropriate for facilities to identify their next tier of nurse leaders now and pair them with a mentor from a group that likely will leave the workforce once the economy settles,” she says. “This way, they can avoid having a nurse leader gap.”

The road ahead

Accountable care will change how and by whom services are delivered. Perhaps the greatest challenge for nurses, Jones says, will be to relinquish responsibility. Many nurses accustomed to carrying heavy workloads may have difficulty delegating tasks to other providers.

But reassigning the jobs others can do will free nurses to step into positions that will affect systems change and directly impact patients more readily.

“Nurses have so much to contribute to patient care by means of quality and efficiency,” Daley says. “We haven’t begun to tap even a small percentage of their potential within health care.”

To read the article at its original location: http://hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/03MAR2012/0312HHN_FEA_movingforward&domain=HHNMAG

March 15, 2012 Posted by | Uncategorized | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Accountable Care: Let the Work Begin

Published in the Dec. 12, 2011, Billian’s HealthDATA/Porter Research Hub e-newsletter

By Whitney L.J. Howell

One of the hottest topics in the health sector today is accountable care. The premise seems simple: Providers and clinical settings of all types will closely collaborate and share responsibility for providing patient care. Implementation, however, can be challenging, according to many hospital leaders and industry experts.

The Centers for Medicare & Medicaid Services (CMS) released its final rule on accountable care organizations (ACOs) in October, detailing how its version of an ACO – the Medicare Shared Savings Plan – should be structured. If facilities choose to enroll in this program, they must offer services to at least 5,000 Medicare recipients for at least three years. Providers and clinical settings are also free to design and implement their own collaborative care model that uses a network of physicians and facilities to provide coordinated care.

Past attempts at managed care have failed, and there is still a chance the U.S. Supreme Court could declare ACOs unconstitutional. But that hasn’t stopped some in healthcare from working toward more team-based care. They are advocates of a new form of healthcare – one that ultimately focuses on the health of the patient rather than the bottom line. They are betting that the changes that come with accountable care, repealed or not, will help to usher in and get providers comfortable with this more team-based approach.

“The path forward to accountable care seems brighter and more achievable to many health systems, community providers and small practices,” said Justin Barnes, Vice President of Marketing, Industry, and Government Affairs at Greenway Medical Technologies Inc. “There is flexibility within creating a model for accountable care; and, with the final rule, many care providers are seeing that accountable care is the future of where healthcare is going.”

Barnes was also central to the formation of  the Accountable Care Community of Practice, a group of healthcare information technology providers committed to helping providers and facilities successfully design and implement either a formal ACO business model or less formal accountable care strategy.

Although this care model is getting significant attention, Barnes said, much still needs to shake out before it can be declared a success. In the meantime, many providers are putting the pieces that will support it – healthcare IT, shared-risk plans and provider networks – in place.

Mentors can Make the Difference

However, pivoting from a fee-for-service delivery model to one that prizes teamwork and increased quality at a lower cost isn’t necessarily intuitive. Many hospitals – large, small, urban and rural – need guidance, said Julie Sanderson-Austin, RN, a quality management professional with the American Medical Group Association (AMGA).

“The ACO model and even accountable care are very different animals,” she said. “It’s clear that this isn’t business-as-usual and that the change to healthcare is significant.”

To support facilities moving toward team-based care, the AMGA launched its learning collaboratives program last year. The goal, Sanderson-Austin said, is to help hospitals design ACO models that fit their specific needs by pairing facilities just embarking on accountable care conversations with mentor institutions that are further along in implementation.

Defining and Addressing Challenges

Hospitals just approaching accountable care voice some of the same concerns and encounter similar challenges, Sanderson-Austin said. For many, the biggest problem is integrating their data across care settings to offer patients a complete continuum of care. Having an electronic health record (EHR) connecting the hospital to its outpatient clinics is a good start, but it isn’t enough.

“It’s great to have an EHR that connects to ambulatory sites, but it has to be connected to your other sites, as well,” she said. “Otherwise, how are you going to get data from your nursing homes or home health agencies? If your patients either have to or elect to go to a nursing facility, you need a way to access their information for any possible future care needs.”

The initial capital investment needed to acquire good technology or build fluid health information exchanges can also present substantial problems, especially for smaller facilities, said Erik Johnson, Senior Vice President of consulting firm Avalere Health.

Although physicians are slated to play a vital role in any collaborative model, they can also be a significant sticking point for administrators looking to re-vamp how their facilities provide services. Even hospitals that began looking to a more team-based approach years ago have struggled to bring any changes to fruition.

“Improving engagement between physicians and hospitals continues to be an up-at-night problem for hospital executives,” Johnson said. “It’s difficult to get this kind of alignment.”

The Greenville Hospital System University Medical Center (GHSUMC) encountered this problem when it first considered its own type of ACO roughly a decade ago. According to Chief Medical Officer Angelo Sinopoli, M.D., convincing the doctors was an uphill battle.

“It took 10 years for physicians to embrace the model,” he said. “The concept is foreign because physicians train as individuals and are not accustomed to working in teams.”

However, administrators repeated the facility’s long-term goal and worked to educate the doctors on the benefits of working with other providers. Eventually, Sinopoli said, the physicians became champions of the hospital’s new care model.

Laying the Groundwork

Even though these challenges exist, hospitals can lay the groundwork for accountable care success, said Eric Bieber, M.D., President of the Accountable Care Organization at University Hospitals in Cleveland.

“Creating a collaborative care system that works well requires a high-functioning, multidisciplinary team to work across the organization,” Bieber said. “This team will be responsible for negotiating how the different groups within the hospital come together and divide risk.”

In January, University Hospitals launched its own accountable care model – a self-insurance plan that covers approximately 24,000 people. The facility is still in the process of identifying what works well and what doesn’t, but Bieber said institutions looking to follow in his hospital’s footsteps should bring together representatives from human resources and the legal department, as well as case managers, to discuss best strategies.

Industry management consultants at Kurt Salmon Associates also recommend hospital administrators focus on a few fundamental changes to position their facilities ahead of the curve.

Perhaps the biggest shift for hospitals, according to Kurt Salmon consultants Kate Lovrien and Luke Peterson, will be that pivot from concentrating on what the facility provides to honing in on what the community needs. With the ultimate goal of preventing inpatient admissions, the hospital is no longer the center of healthcare.

“There needs to be a dramatic change in organizational culture from the inside-out thinking of ‘my care, my time, my location’ to the outside-in thinking of ‘right care, right time, right location,'” Lovrien and Peterson wrote in a statement about ACO preparations, adding that this altered view constitutes a vision change for many facilities, and to do it well, administrators must secure buy-in from their board and staff members.

In addition, a facility’s business model must change. Under accountable care, success will no longer be measured in patient volume or the amount of services provided. Instead, efficiency and efficacy will be based on how well facilities control their costs while providing superior quality. Lovrien and Peterson seem to agree with Bieber – outlining how responsibilities will be divided and shared is a critical step. This move will give the hospital a clear organizational model, bolstering the ambulatory care system and streamlining the continuum of care across settings. The result, they said, will be improved quality and cost control.

Physicians must also turn from being the biggest hindrances to accountable care to being the most enthusiastic foot soldiers in the ramp up to the new care model, they said.  With their knowledge of the interplay between clinical activities, healthcare economics, and provider-patient engagement, doctors can strengthen the bonds across care settings.

Lastly, success will also come easier if hospitals tailor any EHR system to quality measures that are unique to the populations they serve.

Whatever strategies hospitals choose to employ, all facilities would be wise to start giving serious thought to what their accountable care model might look like, Bieber said. Waiting for Congress to announce a directive would be a waste of time.

“Regardless of the result of the elections in November 2012, there’s real support on both sides of the aisle for accountable care concepts,” he said. “It would behoove all organizations to begin to think about a system that focuses on maintaining wellness and managing chronic disease.”

To see the article at its original location: http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2011/December/Accountable_Carex_Let_the_Work_Begin.html

December 14, 2011 Posted by | Healthcare, Politics | , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Academic Medicine Explores ACO Model

Published in the December 2011 AAMC Reporter

By Whitney L.J. Howell

The release of the Centers for Medicaid and Medicare Services (CMS) final rule on accountable care organizations (ACOs) in October is helping some AAMC members take a second look at ACOs. Experts are debating whether the final rule, which excludes indirect medical education payments from the shared-savings mix, will help academic medical centers embrace the ACO model.

In an ACO, a network of doctors and hospitals will share responsibility for providing patient care to a minimum of 5,000 Medicare beneficiaries for at least three years. CMS begins accepting applications for the Medicare Shared Savings program in January.

If the U.S. Supreme Court rules that the health reform law is unconstitutional, ACOs and shared savings could become irrelevant. However, many in academic medicine are proactively aligning resources to provide services in quality-focused, collaborative ways to control costs. For some, that means launching multi-disciplinary, patient-centered care centers. For others, changes include integrating health information technology or adding “total health” courses into curricula.

There is no cookie-cutter approach to adopting the ACO model. Academic medical centers must identify strategies that work best for them, but it will be challenging, said Scott Berkowitz, M.D., M.B.A., Johns Hopkins Medicine’s accountable care medical director.

“There will be cultural and financial obstacles,” he said. “But academic medical centers have a golden opportunity to create value in the post-reform era through providing exceptional patient-centered care, engaging in the science of care delivery to supplement more traditional research, and by educating the next generation of health care leaders.”

Johns Hopkins is still reviewing the Shared Savings program but has improved care quality in recent years through several initiatives. The institution expanded its community physician group to more than 250 doctors, including many to augment patient access to both preventive and follow-up care, Berkowitz said.

There are, however, academic leaders who doubt their centers can achieve the ACO model, said John Kastor, M.D., a professor at the University of Maryland School of Medicine. In a February New England Journal of Medicine perspective, Kastor reported that of 37 senior faculty he surveyed nationwide, most believe the ACO structure will prevent care coordination and cost savings.

“Of the people I interviewed, none has figured out how to make this concept work at their center,” Kastor said. “Medical school deans and hospital CEOs often report to different people. Clinical departments tend to be in silos, and training students takes time. These issues will hamper an institution’s ability to form a successful ACO.”

Changing characteristics of teaching hospitals, including paring down didactic resources, to cut costs requires a significant culture shift, he said. But not all would be beneficial. According to AAMC, siphoning money from educational efforts to achieve savings—such as indirect medical education payments—undermines academic medicine’s tripartite mission.

“In our philosophy, these payments are for education and care of the uninsured,” said AAMC Chief Health Care Officer Joanne M. Conroy, M.D. “Excluding them from savings calculations prevents negative impacts on patients, and it stops any gutting of our care system or educational programs.”

However, the onus now weighs heavily on teaching hospitals and health systems to identify cost-saving strategies and demonstrate that they work.

“It’s still a tough road,” Conroy said. “It’s a complex rubric. Academic medical centers must drill down quickly to see what will be successful.”

For Greenville Hospital System University Medical Center in South Carolina, success is already here. According to chief medical officer Angelo Sinopoli, M.D., Greenville began working toward collaborative care nearly seven years ago and first tested the ACO model on its 17,000 employees. Using a $2.7 million Duke Endowment grant, the institution increased preventive care for employees and provided case managers for the sickest patients. The result was a 26 percent drop in emergency department visits and a 55 percent decrease in hospital stays.

The true key to success, Sinopoli said, was when hospital administrators offered on-site health care services to area businesses.

“It was part of our system change. We took our wellness programs to them,” he said. “Depending on the organization’s size, there is a nurse practitioner or physician there to provide a continuum of care, give high-risk patients health education, and eliminate social barriers to care.”

Having a Greenville-affiliated provider in the workplace gives patients more than the typical 20-minute doctor’s visit. They also have access to social workers, case managers, and practitioners who address their needs between appointments.

Achieving this goal was difficult. According to Sinopoli, Greenville faced two challenges when creating its collaborative-care environment. It took 10 years for physicians to embrace the model. The concept is foreign, he said, because physicians train as individuals and are not accustomed to working in teams.

The medical center also purchased health information technology to track accurate patient data, integrate it between sites, and make it readily available to providers. Along with an electronic health record system, the medical center installed a data warehouse so practitioners can mine existing data.

The institution is a newcomer to academic medicine, having joined South Carolina’s University HealthSystem Consortium in 2006, but it pivoted easily to train students about team-based care.

“Our curriculum and students are oriented to total health,” Sinopoli said. “Instead of teaching just the biochemistry of heart failure and what drugs treat it, our curriculum teaches how to coordinate care for a congestive heart failure patient and what resources and evidence-based practices can keep that patient from being readmitted.”

Greenville is still considering whether to apply for the Medicare Shared Savings program, he said. Regardless of the institution’s eventual route, Sinopoli said one thing is certain: Leaders in academic medicine must continuously promote culture change to create a true shift toward patient-centered care.

To read the article at its original location: https://www.aamc.org/newsroom/reporter/december2011/268852/aco.html


December 12, 2011 Posted by | Education, Healthcare | , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Healthcare’s Consolidation Continues

Published in the Nov. 22, 2011, Billian’s HealthDATA/PorterResearch Hub e-newsletter

By Whitney L.J. Howell

The consolidation of healthcare isn’t a new concept – but doing it well and in ways that strengthen the industry is. Forging partnerships is now a hot trend across all types of healthcare organizations.

The 1990s were rife with disastrous attempts by hospitals to purchase medical groups. For the last three years, however, mergers and acquisitions (M&A) among healthcare entities have grown steadily. And, in today’s atmosphere of coordinated care and accountable care organizations (ACO), pooling resources could help providers meet the needs of a burgeoning patient population, especially with regard to financing new healthcare IT systems.

Whether it’s a partnership between health systems, a hospital and physician group, vendors, or payers, the majority of industry experts agree building these ties strengthens the healthcare system. Expanded clinical resources, updated health information technology, and streamlined payer structures all serve to improve the quality of care.

“We’re seeing a move toward the mega-health system as the one-stop-shop for all care needs,” says Mark Reiboldt, vice president of financial services for The Coker Group. “All segments of healthcare are affected by the same drivers. They’re pursuing integration to enhance their resources and value.”

The Rise of the Deal

Initial 2011 reports indicated M&A levels lagged behind 2010. However, a recent issue of The Health Care M&A Monthly, a newsletter produced by business intelligence publisher Irving Levin Associates, identified a late-blooming uptick in this year’s deals that surpasses 2010 numbers. Currently, 132 hospitals have finalized $6.9 billion in deals. The median value of each consolidation also spiked, rocketing from $12.9 million in 2009 to $35 million in 2011, says Reiboldt, who’s company provides financial advisory strategies and solutions to healthcare organizations.

“Three or four years ago, most of the deals we saw were distressed. Healthcare groups of all sorts were entering into deals just to survive,” he says. “We’re no longer seeing partnerships occur for pennies on the dollar.”

According to Dow Jones reports, medical device companies experienced some of the most substantial growth this year. A 15-percent rise in deal activity to 68 mergers brought $857 million into this sector and placed it above biopharmaceuticals (which garnered $715 million in 78 deals) for the first time since 1998. Medical information technology companies also fared well, finalizing 24 deals for $207 million.

Still, the M&A wave hasn’t yet reached its apex, and Reiboldt says he anticipates greater consolidation in 2012 and 2013 for two main reasons. As more buyers venture into the market and view healthcare as a sound investment, market deal values will continue to climb. Also, the Centers for Medicare & Medicaid Services (CMS) begins accepting ACO applications in January. By giving physicians and hospitals joint responsibility for patient care, the ACO model pushes clinical environments to link, fostering a larger, more diversified patient base.

Offering Patients More

If healthcare reform survives its legal challenges, the industry faces a simultaneous influx of more than 30 million people, and many hospitals and health systems are scrambling to gather the necessary resources to meet future clinical needs. In many cases, this means fusing with a nearby facility, such as the October merger of Olympic Medical Center in Port Angeles, Wash., and Swedish Medical Center in Seattle.

Under the 20-year agreement between the facilities, Olympic patients will have access to Swedish specialists, including endocrinologists, cardiologists, neurologists and sleep medicine experts, at the 80-bed Olympic site. Patients can elect to receive care on the Swedish campus if Olympic doesn’t offer a service. However, there is no mandate that they do so. Overall, this move gives Olympic’s patients greater access to quality care and controls the facility’s expenditures.

Olympic retains its independent, community-owned status. But, according to Olympic’s CEO, Eric Lewis, the complexity of healthcare reform regulations prompted his hospital to pursue the merger.

“If a hospital as small and rural as Olympic Medical tries to go on its own, it’s going to have significant financial problems,” Lewis says. “We now have a large, prominent and well-respected partner that will work with us to ensure our community is properly cared for.”

For Olympic, access to Swedish’s existing electronic health record (EHR) technology – an EPIC system – was crucial. According the Lewis, Olympic was too small to buy an expensive EHR system on its own, and connecting with Swedish helped Olympic fulfill a critical healthcare reform requirement. The facility also joined Swedish and other large Seattle-area healthcare systems in a large buying group to have greater negotiating power with vendors and payers.

Clinical and economic advantages aren’t limited only to hospital-hospital mergers. In many instances, hospitals gain much by acquiring physician-owned medical groups, Reiboldt says. The same acquisitions occurred 20 years ago with hospitals providing the entire purchase price upfront. Ultimately, those partnerships failed, but the purchase process is different now.

“This time, the partnership is true. Hospitals are willing to take all the risk, but the bulk of the value of the deal comes with the future performance of the physician group,” he says. “These deals don’t provide large sums up front. Instead, the deals are structured to pay out over three to five years.”

A hospital purchase of a surgical group is among the most beneficial pairings because it provides a smooth transition for patients. Rather than refer a patient outside the system to another facility, providers can easily recommend a partnering surgeon and, in many cases, facilitate scheduling the appointment.

Hartford Healthcare created this type of patient environment in October when it acquired Connecticut Surgical Group, a practice with more than 40 physicians in 12 locations. The institution, now known as Hartford Specialists, has 68 doctors and offers tertiary care, as well as colorectal, thoracic, podiatry, urology, and general surgery services.

Similar to the Olympic-Swedish merger, the Hartford deal expands services and brings all associated physicians under the umbrella of a single EHR. The partnership is also significant, says Hartford Hospital CEO Jeffrey Flaks, because it increases the organization’s footprint in the marketplace.

Vendor and Payer Consolidation

As with provider mergers, healthcare reform is also the impetus behind vendor and payer joint ventures. The drive for greater cost savings across the industry is pushing companies together as they attempt to strengthen their expenditure control services.

Based on Porter Research data, M&As among vendors and payers swelled by 50 percent in 2010. The trend is still moving toward increased consolidation, says Vik Torpunuri, CEO of CentraMed, and vendors must combine their strengths and resources to help providers meet healthcare reform requirements and standards. CentraMed emerged from the merger of software-vendor Analytix on Demand (AOD), of which Torpunuri was founder and CEO, and business intelligence-vendor Integrated Revenue Management Inc. (IRM).

“Hospitals must integrate technology into their systems in order to survive, but many are 10 to 20 years behind the times,” Torpunuri says. “Vendors that combine software expertise with the knowledge to help providers manage their clinical and financial data relieve a huge burden for facilities.”

In this case, AOD fused its capabilities with those from IRM to create a system to connect a patient’s clinical information across his or her travels in the healthcare system – from doctor to hospital to lab to skilled nursing facility, Torpunuri says.

Vendors aren’t the only organizations acquiring other vendors, however. Payers are also being aggressive in bringing vendors into the fold. The competition is intense, and the goal is to increase market share and bolster the number of enrolled beneficiaries, Reiboldt says.

For example, the 2010 acquisition of Axolotl, a health information exchange (HIE) vendor, by Ingenix, an EHR and revenue cycle management entity owned by benefits company UnitedHealthcare, opened the door for greater information flow beyond internal hospital users. Using Axolotl’s technology, Ingenix (now known as OptumInsight™) has been able to help healthcare clients – even those competing with UnitedHealthcare – share patient data in more secure, expedient ways.

At the time of the merger, Ingenix CEO Andy Slavitt said the partnership would ultimately serve providers and patients to strengthen the healthcare system.

“HIEs are bringing us closer to the point where all the healthcare professionals patients select to oversee their care can connect to share information and optimize outcomes,” he said. “We will work with Axolotl to continue to meet the needs of the multiple HIE stakeholders and to expand its technologies that serve healthcare communities.”

Finding a Successful Partnership

While a partnership between two healthcare entities can be beneficial, that doesn’t mean all mergers will work. There are certain characteristics company leaders and hospital administrators should look for the find the right fit, Reiboldt says.

Potential partners should both be willing to assume some risk in the deal and compromise. But the most important aspect of a mutually beneficial deal, he says, is that each side respects the role of the other organization.”I always tell clients to observe whether the CEO or the administrators are truly embracing the partnership,” he says. “It has to be something that’s completely engrained into culture of the deal or it won’t be sustainable.”

To read the article in its original post: http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2011/November/Healthcarexs_Consolidation_Continues.html

November 24, 2011 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Business Intelligence: Key to a Hospital’s Sustained Success

Published in the Aug. 10, 2011 Billian’s HealthData/Porter Research Hub e-newsletter

By Whitney L.J. Howell

Good patient outcomes might be the goal of healthcare, but the byproduct of these efforts is an avalanche of data. As healthcare reform implementation marches forward, providers are under increasing pressure to use collected information to improve quality and drive down costs.

But for an industry focused on diagnoses and plans of care for multiple service lines, aggregating, analyzing and repurposing patient data doesn’t come naturally. Some providers have, however, found a way to use these records to pinpoint spots for quality improvement, potential cost savings and enhanced patient care.

As a result, they are on target to abide by the mandates of the 2009 Patient Protection and Affordable Care Act and are better prepared for the advent of health information exchange (HIE) and accountable care organizations  (ACOs). They credit their successes with business intelligence (BI) solutions.

Make it Meaningful
Whether it’s a tool to create a cost-effective and efficient work place or one that measures physician performance through key indicators and metrics, BI solutions endeavor to help hospitals make decisions that will keep them competitive within the industry. Simply putting a BI system in place isn’t enough, however. Using these tools well requires a strong partnership between provider and vendor.

“In this reform era, business intelligence has given healthcare organizations a critical understanding of their performance in both cost and quality at both the individual encounter and episodes of care levels,” says Ken Lawonn, senior vice president of strategy and technology at Alegent Health, a faith-based health ministry that operates 11 facilities in Nebraska and southwestern Iowa. “In doing so, it’s useful to get outside expertise to assist you in developing your strategy and plan.”

According to Lawonn, Alegent is laying the groundwork for using BI technologies. The health system is currently developing its data warehouse  – a repository for storing, integrating and, at a later date, accessing patient information. Its nascent data governance model and executive steering committee will help determine who in the system owns the data and how best to use it as an asset.

In addition to useful technology, Lawonn says providers must develop the data management, data administration, and business analytics skills that, to date, healthcare as an industry has been slow to adopt.

Other members of the industry, such as Arkansas Blue Cross and Blue Shield, are using medical and drug claims data, as well as provider information, to identify best practices opportunities for cutting costs and improving operations.

Lean on the Experts
Under the ACO model, set to launch in early 2012, facilities and providers will be equally responsible for patient outcomes. For this goal to become a reality, all parties must share information freely to enhance the care provided and avoid duplicating procedures that waste money and resources.

Electronic health records (EHR) will make this cooperation much easier. As the database responsible for storing patient information from all service lines, EHRs hold the details providers need to make system-wide decisions as ACOs, says Ken Perez, Senior Vice President for Marketing at MedeAnalytics, a California-based company that develops and delivers performance-management solutions to hospitals, physicians and payers. These records also play a role in supporting HIEs in the effort to limit costs, errors and delays in care.

Delving into data through EHRs will allow hospitals to set benchmarks for measures they wish to track. As talk of cost cutting and reducing Medicare reimbursement continues, Perez explains, it will be increasingly important for providers to show how well they are performing.

Larger hospitals can choose to build their own BI solutions, including a data warehouse and report templates, but purchasing a system from a BI vendor can make the process easier.

“Providers don’t need to do all the work themselves,” Perez says. “A vendor can deliver the software they need to stay on top of any measures they want to track, such as outcomes for cardiac patients. The prebuilt report analytics and performance management can easily be considered a long-term investment.”

Buy-In Essential to Successful Implementation
Having the proper technology in place is essential, but it’s only part of the battle. Hospitals and providers must have a plan before they can turn volumes of disparate data into actionable information, according to Tom Simas, Managing Director for Arizona-based BI vendor Midas+ Solutions, a Xerox company.

“The most important thing for a client to succeed is to have the engagement of the leadership at the top,” he says. “Without that buy-in, it’s possible to spend time and resources learning a technology and then have it go nowhere. And the best way to get that support is to show how a BI solution can provide quantifiable data that will help you achieve your objectives.”

For example, a hospital can use BI to gather and analyze outcomes data for all the diabetic patients seen annually in the facility. Using the technology to create a bell curve allows providers to study why some patients responded exceptionally well and why others did not. This knowledge, Simas says, will not only help providers optimize the quality of care, but can also help them eliminate the costs of treatments that don’t work.

It’s also important for providers to select a BI solution that everyone can use, he adds. With quality no longer being the sole charge of one department under the ACO model, these tools can support providers and facilities in the effort to share responsibility for patient outcomes.

Future Thinking Critical to Success
So far, most BI solutions have focused on retrospective analysis of collected data. As patterns and trends in care and outcomes begin to appear, however, these tools will have a more real-time impact.

“I believe these technologies will be increasingly applied to the analysis of the effectiveness of care both retrospectively and at the point of care,” Lawonn says. “This will help identify best practices in care, as well as give care givers more assistance at the point of care to follow guidelines and avoid errors.”

Simas agrees that understanding old data is important and contends that providers will soon be able to use care and outcomes patterns identified in retrospective analyses to anticipate future results. In the next phase of BI solutions, vendors are working to offer predictive analysis abilities that can potentially be used to assist providers in designing new care plans or making proactive business decisions.

However, not every provider will succeed in analyzing the data to improve quality and control costs. The stakes are high for those who fail. It’s likely they will be marginalized in the industry within the next decade, Simas says.

“In the long term, we’ll start seeing a considerable number of smaller facilities being acquired by larger hospitals that do a better job of analyzing data and remaining competitive,” he said. “Although it’s impossible to say a specific number, there is a significant percentage of the 5,000 acute care hospitals in the United States that will be gone in five to 10 years.”

To read the article in its original form: http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2011/August/Business_Intelligencex_Key_to_a_Hospitalxs_Continued_Success.html

August 10, 2011 Posted by | Healthcare | , , , , , , , , , , , , , , , , , | Leave a comment


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