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GE Healthcare Camden Group Insights Blog

5 Tips To Cut Supply Chain Costs

Posted by Matthew Smith on Aug 29, 2017 11:27:57 AM

By Tom Fox, Vice President, GE Healthcare Camden Group

Has your hospital or health system struggled to reduce your Non-Labor expenses to meet budget demands? Is your organization finding it difficult to sustain previous expense reduction and find new opportunities? Here are 5 tips to help get your Non-Labor expenses and your supply chain back on budget – and keep it there.

1. Preparation Is Key To Engaging Physicians

If your hospital requires a value-analysis of products and medications used by physicians and other clinicians, it is essential that you engage with them to gain support for supply chain change initiatives. Before meeting with physicians, it is important to be prepared and do your homework. This includes performing a thorough review of relevant literature, researching product information and examining evidence about the impact of new supplies and treatments on the patient. Furthermore, it is essential to engage physicians in discussion to determine the quality of the clinical evidence with a focus on the clinical outcomes. By preparing for your physician meetings and having a plan for an open dialogue, you can make the most of your time with them and in turn, they will be more likely to consider and support initiatives to reduce supply chain inefficiencies and costs.

2. Effectively Communicate Supply Chain Changes

When considering supply chain changes, remember to include all stakeholders in the process. Consider all departments impacted by the potential change and include representation in meetings where changes are proposed. All communication should include information that describes the proposed or effective changes in sufficient detail to ensure clarity. It is also advisable that you include:

1. “before” and “after” scenarios for either product or process changes;

2. a reason for the change;

3. the expected implementation date; and

4. the contact person to call if there is a question.

Taking these steps will support a smooth transition to new products or processes.

Furthermore, it is critical to communicate to users when a product is on “back order” or “out of stock” for any reason. This communication should provide information about the plans to provide an interim substitute as well as expected date for re-stocking of the regular item. By doing so, you can ensure users will be able to accommodate the interim products during the time of a “stock out.”

3. Don’t Assume Supply Chain Parity

With respect to large integrated delivery networks (IDNs), there is a general expectation that standardized supply contract prices are loaded into materials management information systems and followed properly for all locations within a multi-hospital healthcare system. However, a review of these prices across the enterprise will very often identify fairly significant differences in pricing that contractually should not occur. This is particularly prevalent in large IDNs that have gone through recent mergers and acquisitions that required the consolidation of multiple items masters. Identifying these opportunities requires a review of not only prices for each item number at each location across an enterprise, but also conducting a review of the item master to identify duplicate item numbers for the same product. By identifying and resolving these price discrepancies, health systems can gain considerable savings.

4. Battling Extreme Drug Pricing Increases

Hospitals and health systems are experiencing an unprecedented escalation in the cost of older, commonplace drugs with new price increases. In these instances, drug manufacturers are not recouping the research and development cost of bringing a drug to market, but rather capitalizing on drugs that have entrenched use with little or no competition. Therefore, it is important to not accept these price-gouging practices without first exploring every effort to limit the use of these agents only to cases with no viable alternatives and to compound, dispense and administer in dosage forms designed to minimize waste.

Limiting the utilization of these old drugs with the new costly price tags will require the assistance and cooperation of the affected clinical departments. Often the clinicians ordering these agents have no idea that these commonplace drugs are now today’s pharmacy budget busters and educating them on this new reality will likely align them with the goal to seek alternatives when appropriate.

5. Monitor Medication Dosage Guidelines

Hospitals can limit the financial impact of drug price increases by closely monitoring and, when needed, adjusting medication dosage guidelines. In addition to limiting the utilization of medications when possible, the pharmacy department should review the actual dose utilized per case and determine if there is an opportunity to dispense in an amount that will minimize waste. This can be accomplished through internal pharmacy department compounding or through partnerships with custom IV compounding companies or 503B manufacturers.

Non-Labor Expense Reduction


TomFox_headshot.jpgMr. Fox is a Vice President with GE Healthcare Camden Group with more than twenty years of experience developing strategic vision with C-Suite executives, physicians, and department leaders to transform how healthcare organizations utilize their non-labor dollars. Mr. Fox works closely with clients across the country reduce non-labor costs and sustain those savings over the long-term. He works closely with clients to identify savings opportunities, obtain stakeholder support, and educate staff on utilization to maximize and sustain the savings. He may be reached at [email protected].

Topics: Non-Labor Expense Reduction, Supply Chain Management, Tom Fox

Population Health Support Organizations Serve as New Infrastructures for Today's Population Health Needs

Posted by Matthew Smith on Aug 21, 2017 11:43:35 AM

By Graham Brown, MPH, CRC, Vice President, GE Healthcare Camden Group

With the transition to value-based payment, medical practices are aligning with accountable care organizations (ACOs) and clinically integrated networks (CINs) as a way for providers to remain in independent practice, while joining with like-minded clinicians to improve the experience, clinical and cost outcomes for their patients.

CINs and ACOs as enabling business structures to bring large groups of providers together to address the healthcare needs of a particular population in a given geography—usually via patients’ common health insurance coverage. As a CIN or ACO enters into a contractual relationship with a payer, such as the Centers for Medicare and Medicaid Services (CMS), a managed care plan or even directly with an employer, its providers seek to understand the collective disease burden, access issues and care needs of that population. Core competencies must be developed if these providers are going to be successful in managing the cost, quality and their patient’s experience of care.

A true population health support organization (PHSO) is an ideal fit in this dynamically evolving delivery landscape. It can serve as the operations backbone through which providers might develop and deploy new program resources meeting the needs of its patient population with scale and greater impact than working alone on such efforts.

Strategically, a PHSO aims to integrate providers, hospitals, payers and services across a continuum of patient care. The interoperability between each of the entities reduces fragmented patient care and serves as a bridge between healthcare silos.

A PHSO is a key platform for helping providers transition into the new world of medicine by providing infrastructure for physicians to reshape and drive patient-centered care and engagement via efficient management of patient populations. It is a sound structure for those starting and maintaining a CIN, or simply for those managing medical practices that are evolving to meet the demands of a future delivery system. Much like management service organizations (MSOs) of the past, a well-designed PHSO may also support physicians who wish to remain and thrive in private practice but still collaborate with other providers across a continuum.

Setting the Performance Management Foundation

The key differences of a traditional MSO versus a new-era PHSO relate to the breadth of capabilities that are focused on managing clinical and cost needs of a defined population. Historically, a MSO would deliver common business services designed to help provider practices with administrative burden or provide scale effect for managing overhead costs. As a result, the scope of a MSO’s service offerings would be narrow and cover offerings such as group purchasing, credentialing, office management or centralized billing services.
The additional objectives of a PHSO are three-fold:

  1. Support physicians in quality improvement;
  2. Offer sound financial management; and
  3. Develop the infrastructure needed for population health.

These include moving the needle on quality measures and outcome performance, controlling total cost of care and providing improved patient access to medical care.

The goal is to improve patient loyalty and experience, ultimately keeping patients in an organized system of care. A PHSO also acts as an aggregator of key patient and administrative data so it might become the conduit for a transfer of knowledge critical to success in managing the health of populations.

Quality improvement initiatives must be grounded in a firm understanding of current performance by providers related to the key measures negotiated with managed care payers in a performance contract. Contracts that use shared savings, pay for performance, partial or capitated risk related to utilization and cost targets reward physicians and other providers only when specific measures can be calculated and action can be taken en-masse to have a positive impact on those measures.

Aggregating care delivery data across a network of participating providers is critical. A foundational capability of a PHSO must be deploying the information technology and analytics systems required to determine how care is currently delivered across a network. IT solutions that integrate claims-based data provide the first level of visibility regarding missing or over-utilized services. Such data could bring to light missing services and identify patients with complex or polychronic conditions who may benefit from additional care management.

Patient-centered care needs to augment this view of historical services with a forward-looking perspective to inform an individual plan of care. Care plans which truly engage patients will consolidate to the best extent possible, a whole-person view of the patient’s situation, integrating medical record data, diagnostic results, medications, procedures and clinical interventions into a longitudinal record. Each provider involved in caring for a patient needs to be able to see what other care is being provided to a patient in different care settings, and document the services they provided the patient, therefore, playing their role in furthering the objectives of a care plan.

Sound financial management of healthcare resources should be placed in the hands of clinicians; the historical adage regarding the power of the pen (i.e., a physician’s ability to prescribe, order services or procedures) is just as true and important today if healthcare costs are to be managed effectively.

The backbone of core services that a provider needs to manage healthcare costs must be informed by a holistic view of the cost associated with an individual’s care. In this context, the role of the PHSO is to present to the provider, at the point of care, key data elements to help ensure the best clinical decision is made for a patient, in the most cost-effective manner. A PHSO fills this role by pulling together data on care provided, aligning those elements to the patient’s care plan and then giving providers and patients relevant cost information to help support making the right decision.

Common examples of where integrating cost and clinical data points are essential if a provider hopes to serve the best interest of a patient and performance expectations of value-based contracting. They include forecasting an appropriate length of stay, understanding the appropriateness of prescribing a generic drug, preventing duplicative and expensiver diagnostic tests or directing a patient to a lower cost site of care, such as an ambulatory surgery or urgent care center.

The infrastructure developed through a PHSO should reflect current capability gaps of the providers to be served. The assessment of provider needs and existing methods to manage and report upon clinical and cost performance at network/ population and provider/patient levels serves as a baseline around which new common services should be developed.

In some organizations, understanding and providing visibility to the variability of how care is provided within a network now might be the most valuable information. For other organizations, the ability to stratify a population to identify those most in need of care management and care coordination might provide the best return. The unique needs of provider practices, hospitals and patients served by a network have to be the basis around which a PHSO’s infrastructure, staff, expertise, programs and technologies are scoped and designed over time.

The strategic vision for the infrastructure services should have a multi-year implementation and scalability plan to ensure financial investments are spread out and are prioritized based on goals of the network and its timing for moving into value-based payments for population health management.

PHSO vs. MSO

The PHSO is a vehicle to connect all the dots for a transformation from the old fee-for-service to the new value-based payment models. There are many benefits to organizing and operating a PHSO to support this transition, including:

  • Integrating physicians with an organized delivery system of care, which supports ACO and CIN initiatives.
  • Creating a mechanism to aggregate a holistic view of care provided to a patient across a continuum of care and integrating that view for all providers involved in a patient’s care
  • Coordinating the care management services across a continuum and managing transitions of care between settings.
  • Providing a contracting vehicle that allows and supports providers to assume risk and manage it effectively.
  • Being the collaborative forum for clinicians to develop care pathways, protocols and patient-centered care management programs to bring role clarity and coordination to the many individuals who might be involved in a patient’s care.
  • Enhancing system interoperability to exchange and share data among providers to support care delivery,
  • Improving financial performance and managing the complexities of practice management.
  • Ensuring compliance with CMS programs, such as MACRA, and avoiding payment reductions.
  • Supporting consumerism by creating a unified brand focused on consumer experience and loyalty.
  •  Managing revenue cycle and coding processes (i.e., diagnosis coding, chronic care management requirements, hierarchical condition categories/risk adjustment factor to support value-based contracts.
  • Providing education to physicians—both employed and independent—on topics, such as industry trends, leadership and care redesign.

Whether physicians are employed or independent, a PHSO can support them equally while providing a vehicle for improved operational and financial performance.

Where to Begin

Systems should begin by assessing their employed medical groups and conducting outreach to independent, affiliated practices to determine needs, timing of a value-based transition and identification of gaps. An existing CIN, ACO or MSO could evolve to become a PHSO.

The key to success is either designing a new or adapting an existing organization to fill identified gaps of support services necessary for success under changing reimbursement and care delivery models.

Lastly, a PHSO can be used to gain new relationships while strengthening existing ones with physicians. These partnerships will allow organizations to ultimately improve the health of populations they manage through joint investment in common infrastructure, technologies and staff resources.

The healthcare delivery system and corresponding reimbursement models are undergoing significant change that is unlikely to slow down. The old ways to practice medicine will no longer work in the world of a value-based payment system. A transformation of current practice structure, business strategy and partnerships along a continuum of care will play key roles in achieving success in the new healthcare delivery model.

PHSO, Population Health


BrownG.jpgMr. Brown is a vice president with GE Healthcare Camden Group and has over 25 years of experience in the areas of payer negotiations, program administration, and change management with healthcare provider, payer, government, and human service clients. He is an experienced leader in business planning and implementation for clinical integration and accountable care organization development across the U.S. He may be reached at [email protected].

 

 

Topics: Graham Brown, PHSO

Humber River Hospital in Toronto Turns to Advanced Analytics to Improve Patient Care

Posted by Matthew Smith on Jul 26, 2017 11:36:47 AM

As populations grow and age, many hospitals are being stretched past their limits. Rather than apply temporary or partial fixes to address the challenges that underlie this busy, acute care hospital, Toronto’s Humber River Hospital has chosen to implement a holistic, state-of-the-art hospital Command Center that will enable it to achieve radical gains in quality and efficiency.

The hospital partnered with GE Healthcare Partners to conceive, design, and build the new 4,500 square-foot Command Center, a cornerstone of which will be GE’s Wall of Analytics that processes real-time data from multiple source systems across the hospital. Using complex algorithms, predictive analytics and cutting-edge engineering, the hospital intends to do two seemingly contradictory things: improve quality of care and patient access while at the same time reducing costs.

That may sound like an out-sized ambition, but there’s a good precedent for such a radical increase in efficiency: airports. Air traffic control technology was a guiding inspiration as GE designed a better way to extend reliable healthcare to meet the needs of more patients.

Blue-Sky Thinking

The introduction of air traffic control technology in the 1960s allowed airports to swiftly transition from scheduling a few hundred flights a day to managing thousands. Whereas, the volumes of aircraft and flights have increased tenfold, they all vie for the same space. Many airports now see millions of passengers pass through every day.

Despite the vast complexity of such a logistical challenge, the airline industry became significantly safer and more efficient in the process. So it’s no surprise that when GE Healthcare began developing a comprehensive approach to enable hospitals to better manage congestion, they modelled their solution on air traffic control.

Adding a digital Command Center was a natural fit for Humber River Hospital, not only because it’s recognized as North America’s first fully digital hospital, but also because the busy facility must serve a region representing more than 850,000 people. 

The extremely high demand became quickly apparent. After construction of the new hospital was completed in 2015, the hospital was slated to reach full capacity in five years. Instead, they reached that point in just five months.

“We’re at full capacity and we’re only going to see more and more patients through our front door. How are we going to deal with that?” asks Peter Bak, the hospital’s CIO. “We can’t just say, Sorry, you’re going to wait longer. That’s not acceptable.”

Powered by Digital

Bak and his team have overseen the implementation of the many tools that earned the hospital its high-tech notoriety, from software that empowers patients to review their own health records, to fully automated robotic systems for delivering supplies and dispensing medication.

These digital systems offer incredible efficiency, quality and safety benefits. For example, a doctor at Humber River Hospital can expect the results from a lab test in under sixty minutes, guaranteed. In a traditional hospital, the same manual process can take up to four hours and is prone to labelling errors and other defects.

But even though Humber River Hospital’s digital approach has yielded great results, it has not yet been fully harnessed. What the Command Center will do is amplify the impact generated from digitized processes, work flow and information flow by offering a holistic real-time view of how the hospital is operating.

Seeing the Big Picture

“People work in their focus area, and so they don’t see the big picture,” Bak explains. “They’re not seeing what’s happening at the other end of the hospital, and how what they do might have a bearing on what’s happening somewhere else.”

The aim of the Command Center is to empower a team of co-located staff to monitor, prioritize and expedite activities with the goal of driving far greater efficiencies. At Humber River Hospital, those efficiencies are anticipated to enable the hospital to deliver care to more patients with the same number of beds its operates today, and avoid a projected shortfall of 40 or 50 medicine beds by the year 2021.

Increased capacity isn’t the only outcome that the hospital is anticipating from its new Command Center. Another is improved reliability. “We need to drive hospitals to a point where they don’t make errors,” says Bak. “The Command Center acts as a second set of eyes and allows us to reduce the potential for mistakes.” By integrating systems and applying analytics a small team can observe the “outliers” and intervene ensuring that delays will not go unidentified, resources will not go under-utilized and patient care actions are taken accordingly.

The Command Center will also enable much better integration across levels of care. “We want the hospital to be the hub of an ecosystem that drives health for the 850,000 people in our community,” Bak explains. “Instead of patients having to physically go to the hospital to access specialty services for diagnosing and monitoring a condition, in many instances the patient can remain in the community and be serviced remotely with the use of technology.” Someone in the Command Centre will be monitoring, intercepting risk and expediting action when it is required, using analytics powerful enough to monitor the status of thousands of people, and not just the ones in the physical building.

“There are plenty of digital tools to make healthcare better, but they’re less effective when they are working independently of one another,” explains Bak. “Humber River Hospital’s new Command Center provides the much-needed synthesis to make all those systems work together.” The outcome? Reliable, high-quality care for more people.

Topics: Command Center, Hospital Command Center, Wall of Analytics

GE Healthcare and Jefferson Health Launch Multi-Year Risk-Sharing Relationship

Posted by Matthew Smith on Jul 17, 2017 11:23:24 AM

PHILADELPHIA (July 17, 2017) — GE Healthcare and Jefferson Health have announced an eight-year, shared-risk relationship that will help Jefferson strategically transform healthcare delivery in the Philadelphia region for the benefit of patients and their families. The goal of this collaboration is to create a forward-looking, robust health system by removing redundancies and maximizing sourcing efficiencies. One of only five such long-term relationships in the U.S. and its largest, GE Healthcare and Jefferson have the potential to generate $500 million to $1 billion in efficiencies with Jefferson that can be directed toward services that best meet patient needs over the term of this relationship.

“We have a unique opportunity to become the region’s leader in delivering even greater value to our patients — offering them high-quality care at a lower cost, wrapped around an exceptional patient care experience — every time,” said Stephen K. Klasko, MD, MBA, President and CEO of Thomas Jefferson University and Jefferson Health. “With the industry knowledge and global expertise of GE Healthcare, we will gain significant efficiencies that will enable us to reinvest in initiatives that improve the lives of those we care for.”

During the course of the relationship, Jefferson Health and GE staff will work side-by-side in areas throughout Abington, Aria, and Jefferson to acquire a deep understanding of operations and processes. The teams will focus on strategic growth, operations, integration, and performance improvement opportunities, while leveraging technology to deliver best-in class, seamless care that is convenient and affordable for the patient.

“With the healthcare industry facing unprecedented levels of patient demand and increasing cost pressures, it’s great to see health systems like Jefferson seek new and innovative ways to improve better outcomes for patients,” said John Flannery, incoming CEO and Chairman elect of GE. “This collaboration, which is financially tied to our shared success, demonstrates the confidence we have to jointly deliver world-class health care for the community.”

Through a shared-risk model that aligns the economic interests of Jefferson Health with GE Healthcare, both organizations have agreed to critical milestones that must be achieved throughout the eight-year relationship. A portion of GE Healthcare’s fees are contingent upon the level of success both organizations have in reaching certain integration goals.

“To prepare for the launch of this multi-year relationship, some of GE Healthcare’s senior- most leaders have been onsite, working closely with us to ensure we’re doing all we can up front to position all of us for long-term success,” said Kathleen Kinslow, Jefferson Health’s Chief Integration Officer and leader for this comprehensive initiative. “They have become valued members of our extended team and their level of engagement has been exceptional.”

Nationwide, academic medical centers are facing a growing gap between the cost of their clinical missions and the available funding that threatens the future of those missions. New approaches to optimize health system performance, including improving the patient experience and the health of populations at a lower cost, are essential to ensure sustainability. The unique relationship with GE Healthcare presents an opportunity to proactively address today’s healthcare challenges.

“Together, Jefferson and GE Healthcare are charting a new course by taking the necessary steps today that will help shift the healthcare paradigm,” said Klasko. “My message is simple. We need to transform our industry, continue to be optimistic about our future, and embrace disruption, such as consumerism, to effectively change the way we deliver health care in this country.”

Topics: Healthcare Transformation, Jefferson Health

GE Healthcare Acquires Novia Strategies to Expand Clinical Consulting Capabilities

Posted by Matthew Smith on Jul 10, 2017 3:28:41 PM

July 10, 2017 – GE Healthcare (NYSE:GE) announced today it is expanding its U.S. healthcare consulting business with the acquisition of Novia Strategies, a 22-year-old healthcare consulting firm founded and led by clinicians with deep experience helping organizations transform while delivering critical outcomes. The acquisition helps GE Healthcare deliver on its commitment to be the leading provider of outcomes-based solutions and to help healthcare organizations meet the demand for increased access, enhanced quality and more affordable healthcare for their patients.

Novia Strategies will become part of GE Healthcare Camden Group, which has advised more than 2,400 hospitals and health systems on such critical issues as redesigning care delivery, accelerating health system integration, succeeding with population health management, and maximizing the use of resources. Terms of the transaction are not being disclosed.

Novia Strategies’ skills and experience are a strategic complement to GE Healthcare Camden Group in several key areas: care management transformation, workforce management, non-labor cost reduction, and sustaining operating performance improvement. “Over the past two decades, we’ve saved hospitals hundreds of millions of dollars, improved patient outcomes and redesigned delivery so they can care for patients for generations to come,” said Nancy Lakier, CEO of Novia Strategies. “We share GE’s vision to deliver impactful solutions, and look forward to leveraging the broader portfolio and deep analytical and activation capabilities unique to GE to enable breakthrough, sustainable outcomes for more healthcare organizations.”

Novia Strategies’ consultants bring proven methodologies and first-hand experience in hospital operations. “Their hands-on clinical and operational expertise in areas like care management, productivity management, compensation and benefits, pharmacy, and non-labor cost reduction will broaden our ability to help clients tackle their most complex challenges,” said Laura Jacobs, President of GE Healthcare Camden Group.

The acquisition furthers GE Healthcare Camden Group’s vision to be a strategic transformation partner to leaders in healthcare and enable organizations to become best-in-class, high performing health systems. “Our two organizations are culturally aligned and share a passion for solving client challenges,” said Geoff Martin, COO of GE Healthcare Camden Group. “We both begin with the challenge, work side-by-side with clients to identify, shape, and activate solutions, and focus on measurable outcomes and return on investment.”

In particular, Novia Strategies’ capabilities will help accelerate the activation of large-scale health system transformations including implementing Command Centers and redesigning care across the continuum.

Topics: Acquisitions, Clinical Consulting, Novia

Clinical Strategies Not Producing Results? Take a Good Look at Your Operating Model

Posted by Matthew Smith on Jul 7, 2017 10:30:11 AM

By David DiLoreto, M.D., MBA, Senior Vice President, GE Healthcare Camden Group

Empowered consumers/patients; outcomes-based reimbursement; quality, safety, and cost concerns; unwarranted clinical variation; and new digital technologies have all created conditions in which health systems confront a need to re-evaluate their clinical strategies and execution skills. Successful organizations realize that effective responses include not only the creation of new strategies and the development of new execution skills but then need to challenge existing mind-sets as well.

Bridging the gaps between strategy, execution, and culture often require evolving the clinical operating model. Our experience at GE Healthcare Camden Group proves that addressing operating model structures may be one of the smartest investments that an organization can make to achieve success.

The competitive advantage created by effectively matching strategy and operating models is well-recognized in many industries.1 Operating model assessments and re-design are important during periods when greater organizational clarity is needed, i.e. after mergers and major acquisitions, when entering new market segments, when new revenue models are introduced or during major changes in operations like digital transformation. Healthcare organizations finding themselves in these circumstances may carefully evaluate and design new operating models for non-clinical functions such as Finance, HR, and IT, but are often less likely or slower to effectively address operating models for their clinical services and clinical support services.

Clinical Operating Model.png

Too often health systems make one of two missteps. Some fail to evolve their clinical operations quickly enough to match a strategy shift. Consider the health system that entered a new market with new ambulatory service offerings including retail, urgent care, and mobile health but stifled growth by keeping clinical services highly integrated with their existing core acute care business which starved it of the resources, management focus, and flexibility needed to launch effectively.

Another misstep is to move ahead with a new organizational design that does not match how the organization will create value. A newly merged health system too quickly moved from multiple ambulatory physician groups to a more integrated model to encourage cost reduction and centralized patient scheduling. Centralizing so quickly to realize a modest opportunity underestimated how much front-line staff accountability would be lost, added complexity, slowed decision making, increased patient complaints, and distracted the organization from major growth opportunities in the individual physician groups.

So how do health systems avoid these mistakes and create stronger linkages between clinical strategy and clinical operating models? We have found that the following six steps enable an organization to articulate clear and specific design principles to serve as guardrails for the senior team as it evaluates clinical operating model options.

  1. Define What is Most Important: The first design principle is whether to assess the entire organization, a specific business unit, or an individual function specifying which clinical strategies are most important for the operating model to support. Most likely, a combination of clinical and business priorities will be identified. Often previous strategies which address the same issues may have been implemented with mixed results. It is important to discuss ways in which the organization must adapt to win. Identifying key operating model principles, sequencing priorities, and pacing their implementation depend on more than just organizational structure. All elements of the operating model—structure, governance, decision rights, behaviors, processes, and technology—will need to be considered when selecting the appropriate clinical operating model.
  2. Decide How Value Will Be Created: A U.S. health system realized that the growth of Medicare Advantage plans in its largest markets was occurring at the same time commercial insurers had successfully resisted increases in hospital reimbursement rates. It established clinical operating model design principles to "focus on the delivery of clinically effective ambulatory care for seniors" and "reduce unwarranted clinical variation in acute care" to "achieve Medicare break-even margins." The operating model it designed integrated key clinical support services, many clinical services, and its clinical leadership into regions that effectively served multiple hospitals. Increasing the span of control and standardizing key processes produced annual operating savings of 12 percent while improving key measures of clinical quality, physician satisfaction, and patient loyalty.
  3. Streamline Decision Rights: Once the key clinical strategies are identified, the right operating model should catalyze faster and more effective decisions. The design principles should point to the types of decisions that will be needed. Engaging key stakeholders and front-line leaders to pro-actively assign responsibility and accountability for key decisions as well as identifying who will serve as collaborators and who needs to be informed creates role clarity and sets performance expectations. A health system that integrated outpatient care management for its clinically integrated network and accountable care companies established a principle that "Operation decisions regarding staffing ratios and promotion decisions should be regionalized." This led to the selection of an operating model for care management that clarified the roles and responsibilities of hospital care managers, transition care managers, and key service lines as well as fostering a more collaborative environment.
  4. Establish and Communicate Boundaries: Operating models should be designed so that customer-facing best practices and capabilities-sharing processes are widely and quickly disseminated across organizational boundaries. As health systems provide more services further from their acute-care hospital core such as retail, post-acute care, mobile health and telemedicine, they need to carefully determine how clinical support services such as quality improvement, risk management, infection control, and care management will be designed and integrated into new operating models.
  5. Assess and Bolster Necessary Capabilities: Achieving growth targets requires clinical operating models that are designed using principles that must balance customer requirements, available capital, and technical capabilities. Managing commercially insured individuals, low-income persons, and seniors under risk contracts require different patient engagement, care management, and medical management processes and expertise. Operating model design principles for a clinically integrated network such as "Contracting, claims, network development, legal, and risk management will be managed globally" while "Beneficiary engagement, customer insight, care management, and medical management will be managed along insurance product-lines" points to adopting an operating model in which the hurdle for centralizing clinical support services across product lines is high, but capital investments and specialized non-clinical expertise can be leveraged across multiple patient populations.
  6. Be Clear About What Will Be Preserved: Among the clinical operating model design principles expressed by a health system that was rapidly acquiring established physician practices was "How we go to market and acquire will make it easy for our physicians to do business with us." Strong physician relations were a hallmark and competitive differentiator for the health system, and they wanted to preserve it as they deployed the new strategy. This statement guided many key elements of the new clinical operating model.

Putting it All Together

Our experience proves that using these six design principles greatly facilitates the creation and adoption of effective and sustainable clinical operating models. They provide fact-based context and key observations that are important solvents in what can be a charged process. They are specific enough to allow leaders to recognize and make trade-offs between competing priorities and decisions such as what functions to centralize and what should remain local. Ultimately they serve as a beacon for clinicians and employees as to what choices leaders have made about implementing the strategic priorities that matter most to the organization.

1. Enterprise Architecture as Strategy: Creating a foundation for business execution. Jean W Ross, Peter Weil and David C. Robertson. 2006. Harvard University Press


DiLoreto.pngDavid DiLoreto, M.D., MBA Dr. DiLoreto, senior vice president at GE Healthcare Camden Group, is a physician-executive who is highly experienced in executive management, strategy and operations of healthcare delivery systems, and managed care companies. He has deep management expertise in community-based and academic health systems, large group medical practices, hospitals, and managed care organizations. His areas of specialty include clinical transformation, population health, business process improvement, leadership development, medical informatics, and data management and analytics. He may be reached at [email protected]

Topics: David DiLoreto, Clinical Operating Model

Building a Value Model for Population Health Management

Posted by Matthew Smith on Jun 16, 2017 10:40:18 AM

By Daniel J. Marino, MBA, MHA, Executive Vice President, GE Healthcare Camden Group

Most healthcare leaders understand the importance of managing the health of their patient populations. Building the tools for effective patient population management is key to improving outcomes while “bending the cost curve” in U.S. healthcare.

At the same time, executives are concerned about the cost of population health initiatives. What level of investment is needed to effect change? What is the right pace for transitioning from fee-for-service (FFS) to value-based payment? Finance leaders, in particular, are concerned about preserving margins during the transition.

How can a healthcare organization maintain profitability as spending increases on population health initiatives while FFS revenue decreases?The only way to answer these questions is to use a data-driven “value model” to predict and manage the total financial impact of the population health initiatives.

An ideal value model will accomplish three goals:

  1. Quantify the output of population health interventions, including shifts in utilization and changes in cost of care.
  2. Help identify population health investments that will move the organization forward while retaining margin.
  3. Allow finance leaders to support value-based contracting with predictions of costs and the quality of outcomes.

 To continue reading this article, please click on the button below to download a PDF.

Value Model, Population Health

Topics: Value-Based Care, Population Health, Value-Based Contracting, Daniel J. Marino, Value Model

Healthcare Transformation Complexities Broaden Leadership Development

Posted by Matthew Smith on Jun 12, 2017 11:24:44 AM

By Darryl Greene, MS, Vice President, and Alexander M. Pinto, Ed.D., FACHE, Manager, GE Healthcare Camden Group

Complexity and change are not new terms or realities to manage, yet in healthcare it is the pace and extent of change that is often the topic of conversation, as we all seek solutions to address this new normal. 

This is an environment in which the complexity of day-to-day care delivery and operations now places tremendous demands on leaders and their staff, often causing them to overextend while trying to keep up. This tsunami-like type of change in healthcare can often be characterized by leaders as a sought-after future state without a clear destination and without a pathway for organizations to adapt, thereby compelling them to pursue significant numbers of internal transformations, often simultaneously.

Consider New Roles and Responsibilities

The external drivers, such as new policies, new regulatory requirements, new consumer expectations, and new business models, are driving internal actions like new operating models, new strategic initiatives, new information management needs, new technology, and new processes. The necessary internal changes do not end here; a significant human component exists that also requires consideration of new roles and responsibilities, new skills, new behaviors, and new ways of working together. This degree of change even impacts organizations’ cultures to the point where leaders and their staffs are attempting to develop strategies to refuel the passion and joy they once experienced in practicing medicine.

GE Healthcare Camden Group believes this wave of change can and has flooded the functional capacity of most healthcare organizations, their teams, and their individuals. Adding resources is rarely an available or right option--thus a pause with purpose is needed. A new way of leading must be contemplated while asking fundamental questions such as:

  1. How do we impact the human side of change and create capacity for our leaders and our teams, improving their ability to deal with the complexity and volatility of their current reality? 
  2. How do we design systems of care that embrace a culture of problem-solving and collaboration, in the face of evolving change, growing ambiguity, and our patients’ quest for best-in-class outcomes?
  3. How do we cultivate a new leadership mindset instilling cognitive, behavioral changes in our leaders that advance our relationship building skills, our culture of collaboration, and embraces a new healthcare landscape comprised of interdependent care delivery and systems-based, patient centered care?

Synergistic Leadership Development

We believe the answers begin with individual leadership development, supporting leaders to become more self-aware, while also broadening their perspective-taking skills, and teaching them to engage their teams in methods to co-create solutions relative to existing issues. Additionally, focus is needed on the healthcare leadership team emphasizing unambiguous roles and responsibilities fostered by a collaborative yet interdependent nature of sharing work and accountability amongst clinical (physician, nursing, and allied health), operational, financial, and strategic leaders. Because your leaders’ performances and impact on the organization doesn’t happen in a vacuum, there must also be support for them by advancing and implementing systems and structures in the organization for effective and sustained delivery towards balanced measures and goals. The emphasis on leadership development across three areas we refer to as synergistic leadership development (Figure 1).


Figure1_Greene.png


At the core of our leadership development, a systems and structures framework is needed that supports leaders and teams in strategy to activation efforts. The Culture Driven Performance Management model (Figure 2) provides such a framework. Through implementation of this framework model, the organization’s leaders benefit from the development of individual and team competencies and skills, while working collaboratively in setting the direction for their organization, aligning the organization’s strategic goals, and executing to achieve targets. This empowers active involvement of leaders in a customized curriculum to expand their competencies while immediately integrating those skills in their work. Integrating an experiential learning approach both advances the value proposition to leaders and advances the culture of performance to achieve organizational goals (Figure 3).


Figure2_Greene.png


Figure3_Greene.png


New Leadership for the New Normal

This new norm of transformational change in healthcare requires a new leadership development approach for institutions to thrive--an approach like synergistic leadership development, that is focused on advancing the capacity of individuals and teams, while fostering interdependent functions, maximizing their impact as they leverage supporting management systems. The task ahead of us is:

  1. Assess the current state of organizations relative to a framework with this filter.
  2. Create a tailored roadmap of leadership development (individual, team, and management systems/structures) to capitalize on the greatest leverage or impact areas.
  3. Support our teams and organization through cultural advancement while empowering cognitive, behavioral change at an individual level.
  4. Collaborate to advance these organizations amidst complexity and change to provide even better care delivery to patients.

d.Greene-1.jpgMr. Greene is a vice president for the strategy and leadership practice at GE Healthcare Camden Group. He has more than 18 years of strategy to execution consulting experience, including 11 years in healthcare. He has significant expertise in strategic planning, business management systems implementation, talent management, performance improvement, leadership, and leading and executing transformational and culture change. He may be reached at [email protected]. 

 

Pinto.pngMr. Pinto is a manager with GE Healthcare Camden Group, with more than 15 years of healthcare industry experience spanning allied health provider, health system, and healthcare consulting roles. His experience includes system leadership, performance improvement, and advisory/design roles. Additionally, he has a strong and diverse academic background in adult learning, organizational design, and the development of leadership and engagement programs. He may be reached at [email protected]. 

 

 

Topics: Healthcare Transformation, Darryl Greene, Leadership Development, Synergistic Leadership Development, Alexander Pinto

Top 10 Reasons to Integrate Your Inpatient Case Management with Your Population Health Initiatives

Posted by Matthew Smith on May 30, 2017 10:42:24 AM

By Mark Krivopal, MD, MBA, Vice President, & Tara Tesch, MHSA, Senior Manager, GE Healthcare Camden Group

Most hospitals understand the importance of inpatient case management. Yet, when asked how care managers are coordinating care for the inpatient population, most responses are focused on discharge planning tactics or utilization management strategies. The patient’s care is not truly being managed – just their length of stay (“LOS”), inpatient progress, and planning for discharge to avoid a readmission.

As the focus on value-based care is increasing, and more care is shifting into the ambulatory space while the U.S. population continues to age, a higher proportion of vulnerable ambulatory patients find themselves in need of holistic supportive care. Health systems are realizing the importance of ambulatory care management as a crucial foundation to managing populations across the care continuum by delivering high quality and patient-centric care while keeping in check avoidable costs. High performing organizations have implemented integrated care management programs focused on managing patients across care settings that include deciphering patients’ various medications, coordinating the many care directives from multiple providers, ensuring safe transitions of care from a post-acute care setting to the home, and helping patients with transportation difficulties or other social barriers to seeking care at the right time and at the right place.

The challenge though, is that many organizations are still thinking about delivering care within silos rather than integrating and aligning the initiatives within a patient-centric care delivery model. Outlined below are 10 reasons you should consider integrating your care management across the care continuum to support your population health initiatives.

1. Integrated care management addresses inefficiencies in managing the high risk populations and addresses LOS challenges and shifts in utilization to support the most effective care resource model.

The shift to value-based care delivery and the strengthened incentives for advancing value-based reimbursement will lead health systems and providers to renew their focus on adopting care models to support management of high-risk, high-cost patients, complex, and chronic care patients, in addition to disease-specific management programs. This will require new approaches to expanding patient access to lower cost sites of care and providing patients a more effective and simpler approach to navigating their care. The integrated care management model supports organizations and providers in developing innovative models (see graphic below) focused on reducing inefficiencies, managing medical spend, and improving patient access. Integration of targeted, evidence-based programs such as post-discharge transitions, complex care management, disease-specific, and episodic care pathways, as well as proactively connecting patients with behavioral health needs to appropriate care management and community services are just some of the strategies that have proven success.

For full-size image, click here.

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2. Duplication of care management services causes competing priorities and operational inefficiencies and redundant costs.

An integrated care management model provides a seamless patient experience across the continuum of care when there exists one aligned team to care for the patient. For organizations to achieve an integrated care management model requires not only effective communication channels and standardized care processes, but the analytics and information technology systems to support these care processes. Duplication typically occurs because barriers in technology and lack of standardization of workflow processes limit the ability of care managers to share information as the patient moves across different sites of care. Due to the limitation in electronically aggregating the necessary clinical information, care managers are not able to coordinate their efforts and spend significant time manually gathering information from providers. As a result, time is spent on manual documentation and patient management that could be automated, and more staff is typically added to ensure such information is captured, verified, and reported. The development and implementation of a shared care plan (and tools that will house the care plan) that follows the patient and is accessible by the care team, along with electronically aggregating important clinical information, are key requirements to reduce staff duplication, inefficiencies, and redundant costs.

3. One quarter of patients consume three quarters of resources, many of whom are unmanaged and lack community-based resources.

Integrated care management and coordination is a person-centered, collaborative, and multi-disciplinary process that uses population based risk-stratification and evidence-based interventions to promote optimal outcomes in a value-driven environment. By incorporating tools that allow organizations to understand the health risk level of the populations served, organizations can build more prescribed programs to track and manage high risk (and typically high cost patients), and to help prevent potentially avoidable higher-acuity, higher cost care. As organizations become more proficient in understanding the risk factors of their populations, integrated care management programs will increasingly rely on partnerships and linkages with community-based services and organizations and community health workers to help coordinate care and meet patient needs — driving the most optimal results.

4. Integrated care management addresses suboptimal transitions across the care the continuum.

The most vulnerable time for the patient is when he/she leaves the acute care setting or transitions from a skilled nursing facility back into the community. Today more patients are transitioned out of acute and rehabilitation care settings earlier than even just a few years ago. This is because more services and treatments are deemed safe to be administered in an outpatient setting. Yet, many patients are limited in their ability to thrive when one considers social determinants of health such as ability to afford medications, transportation to providers, or simply required competency level to manage their health. These factors, although likely present before the admission, are not properly addressed as part of the traditional coordinated discharge treatment plan. As a result, providers only come across these social determinants when medical errors occur, important medications are erroneously discontinued, tests are not followed up, or patients end up back in the emergency department after being discharged. Implementing patient-centric integrated care management across the continuum of care that incorporates providers expanding their discharge care plan to include social determinant evaluations helps avoid “fumbled handoffs.”

5. Integrated care management helps providers meet increased expectations around quality, cost, productivity, and patient satisfaction, critical to population health management.

The pressures on and expectations of providers (particularly primary care physicians) are immense. Physicians themselves cannot (nor should they) assume that they can address quality of care, cost, and patient satisfaction on their own. An integrated care management approach provides support to primary care practices by managing these increased expectations and helps the entire risk-bearing organization achieve success. The key is to redesign the care model to incorporate a physician-led and team-driven best practice approach. This should include integrated care plans, coordinated protocols, and outcome tracking. Providers benefit from pre-visit planning to identify complex, chronic, and high risk patients, making practice operations run more efficiently. This, in turn, leads to a more focused care plan, better managed patient flow within the practice, enhanced patient and provider satisfaction, and more coordinated overall care. By incorporating a care model that includes a significant preparatory assessment, chart reviews, and checklists to ensure preventative screening is performed and documented, providers are well-positioned to enhance the quality of care delivered and see real results within their quality performance outcomes. Those organizations that embrace an integrated care management approach find themselves better positioned to meet ever increasing demands on their expertise, time, and resources, and are better able to maximize opportunities within a value-driven healthcare world.

6. Overlap and lack of clarity in roles and responsibilities create staff dissatisfaction that can be ameliorated with integrated care management.

Over the last several years, many healthcare systems have invested substantial resources and efforts into deploying and retraining inpatient case managers to address preventable hospital LOS. As these organizations take on financial risk by participating in value-based contracting, they embed care managers in the primary care physicians’ offices to assist with managing complex patients, help with their social and behavioral needs, and improve communication around transitions of care. However, some providers are not as satisfied with this approach as one might expect. There is significant role confusion and frustration among various healthcare professionals, resulting in multiple calls to patients, for example, from home health, the care manager assigned to them by their payer, a hospital social worker, and an ambulatory care manager. Physicians are then also confused as they receive mixed messages from various care managers, which is exacerbated by lack of clarity around who they should contact in order to address some of the issues. Is it the responsibility of the hospital discharge planner to communicate important information to the ambulatory care manager, or is the ambulatory care manager responsible for contacting the hospital to get this information? Who is truly empowered and accountable for care managing the patient along the entire continuum? This can all be resolved by a single, clearly identified integrated care manager who has the responsibility to work on the patient’s behalf and serve as the single source of truth for the patient and all treating providers. Clarity around care managers’ role designation and empowerment will increase overall provider satisfaction and significantly enhance quality of care delivered to patients.

7. Integrated care management helps improve patient engagement and activation in their care.

Organizations are frequently struggling with getting patients to engage in their health in a proactive way. For many patients, active engagement in creating (and understanding) their care plan is a key to improving their health outcomes and conditions. Education and engagement with the caregivers as well as the patient is an important element in ensuring proper activation of the care plan. The integrated care manager’s care plan should include education and clear instructions to not only the patient but to care giver to ensure a common thread is formed along the complex continuum of care that bridges factors affecting patient motivation, care compliance, and the ability to activate a safe, cost-efficient, and truly patient-centric model of care.

8. Fragmented and uncoordinated care creates a poor patient experience and confusion.

When patients are battling a healthcare issue, the last thing they or their families/caregivers are thinking about is how to navigate the healthcare system. Yet, healthcare providers often overlook the basic coordination needs of patients beyond the actual treatment provided. Integrated care management is designed to ensure a positive experience for the patient and improve satisfaction in how care is provided by understanding the patient’s journey across the care continuum. Thoughtful, coordinated, and patient-centric design ensures patients remain the focus in defining processes for warm handoffs between providers and care settings, eliminating the need for the patients to repeat information or fill out duplicate forms. It provides added clarity in roles of contact with the patient, ensuring the patient/caregiver has one person to contact with questions or for support, and influences how patient materials are created and deployed (e.g., use of pictures and graphics in teaching self-care concepts, use of lay terminology rather than clinical jargon, use of teach-back and follow-up demonstrations, etc.) to reduce confusion and provide a trusted resource for patients and caregivers to access.

9. Implementing optimal integrated care management across the continuum requires support from an analytics strategy, which aligns with population health initiatives.

As organizations continue to expand their systems of clinically integrated care, building an analytics strategy that connects data from disparate IT systems will create opportunity to allow providers to act more quickly on the information. The ability to effectively aggregate data and translate that data into actionable information available at the right time, and at the point of care, should be an ever-striving goal of organizations and the foundation for effective care management. Successful integrated care management uses real time data that is turned into actionable information allowing care managers to quickly identify high risk patients and apply interventions. Gathering the right data and analyzing it correctly requires a combination of skills involving clinical knowledge, medical informatics, and technology capabilities. The analytic strategy begins with creating a culture of transparency requiring diligence in making information accessible, accurate, and easily transferrable to providers within their clinical workflow.

10. Health systems are missing opportunities to partner with payers in redesigning care delivery.

The adoption of an integrated approach to care management that is aligned with health system contracting and population health initiatives provides new revenue opportunities, when implemented successfully. By demonstrating the organization’s ability to deliver high quality, affordable care to various populations, health systems can leverage their value-based performance outcomes to engage in innovative contractual arrangements with employers and payers that align incentives across the system. Since investing in new care models and integrated care management program can be costly, it is most effective when both the providers and payers share in the investment costs and are appropriately aligned on the potential outcomes and medical cost savings. Some of this share investment occurs through innovative provider-payer partnership arrangements where the payer pays providers care coordination fees or reimbursement that is directly tied to care management services across the continuum. This will require a shared philosophy of managing care between the payer and provider as well as integrated approaches around data sharing, alignment in clinical protocols, and resource collaboration. In addition, the coordination of the care management network staff and providers aimed at promoting, maintaining, and/or restoring health will ensure a patient-centric model of care that truly spans the care continuum.

By creating a focused approach around integrated care management operations and breaking down communication barriers, organizations and providers can fundamentally transform how to deliver patient-centric care management in an integrated fashion to achieve the most optimal results possible. Well designed and properly executed integrated care management is of foundational importance for any organization aiming to achieve success within their value-based contracts. Successful implementation of an integrated care management model will empower patients and their care givers to navigate through our complex healthcare systems that lead to better quality outcomes, reduced avoidable medical costs, and improved patient and provider experience.


krivopal_M-963748-edited.jpgDr. Krivopal is a vice president with GEHC Camden Group and an accomplished senior physician-executive with 19 years of healthcare experience across the continuum of care. Dr. Krivopal is responsible for developing and leading innovative, value-based programs addressing client needs in healthcare organizations, hospitals, and physician practices focusing on transformational system integration strategies, service line optimization, throughput and clinical leadership development. He may be reached at [email protected]

 

Tesch_T_headshot.pngMs. Tesch is a senior manager with GE Healthcare Camden Group with more than 18 years of experience as a healthcare leader and strategist. Ms. Tesch specializes in value-based care delivery strategic planning, CIN development and implementation for commercial, Medicare, and Medicaid populations, health information technology data governance and analytics strategy, as well as care management strategy, design, and implementation. She may be reached at [email protected]

Topics: Population Health, Care Management, Tara Tesch, Mark Krivopal

House of Cards: Using Process Simulation Modeling As the Glue for Practice Transformation

Posted by Matthew Smith on May 26, 2017 9:42:32 AM

Adapting to the current healthcare environment for most medical groups may feel like a house of cards, each card representing a different initiative precariously stacked, one on top of the other, with the slightest slip causing the pieces to crumble.

Medical groups are scrambling to understand changing reimbursement structures, to establish new systems of care and to integrate with larger health systems to manage populations of patients, all while trying to maintain patient and provider satisfaction. With all of these factors competing for attention and change fatigue rampant among providers and staff, it can be difficult to implement the necessary changes to help achieve a vision for practice transformation.

Because of this fragility, practices often fear that the change itself will be their undoing. However, successful change can be achieved with thoughtful planning, the necessary tools and stakeholder engagement to motivate commitment. Simulation modeling is one tool that can assist practices in modifying practice patterns with minimal disruption to operations, resulting in better outcomes.

To read this article in its entirety, please click the button, below, to download a PDF version of this article.

Practice Transformation

Topics: Medical Practice, Practice Transformation, Simulation Modeling

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