GE Healthcare Camden Group Insights Blog

5 Keys To Successful Clinical Redesign

Posted by Matthew Smith on Jan 16, 2018 2:30:26 PM

By John Malone, MOD, Senior Manager, GE Healthcare Partners

Redesigning care and eliminating clinical variation are critical not only to ensuring patients receive the safest, highest-quality care, but also are integral components of reducing the overall cost of healthcare — on both the national and individual hospital level. But where should you begin? 

1. Engage The Medical Staff

Medical staff and executive leadership must formally and informally engage the medical staff to communicate their expectations, goals, measures, and accountability for the results of the clinical redesign effort. Hospital leadership must put processes in place that ensure physician-directed communications, listening, and real involvement in identifying, measuring, and reducing variation. This includes participation in interdisciplinary rapid design teams for high-volume DRGs or service lines to review data and understand current practice variation by physician. Trustworthy, risk-adjusted data analytics can provide insights relative to variation in resource use such as diagnostics, pharmaceuticals, and other professional resources. Administrators and medical staff leaders must partner in a style that is supportive and collaborative, creates the vision but is not directive, and rewards those who are engaged and achieve the required outcomes.

2. Ensure Accurate Data

Risk-adjusted, physician-specific clinical variation analytics form the foundation for engaging physicians to reduce clinical variation. Risk-adjusted analytics allow the design teams to understand the severity of illness of each practitioner’s patient population, thus removing the concern that one physician’s patients are more complex than others. Risk-adjusted analytics reduce physician resistance and further physician buy-in to study and reduce variation. It’s important that clinicians and the entire improvement team receive updated analytics on a frequent and predictable basis in order to see reductions in variation and support changes in behavior.

3. Redesign Care

When it comes to redesigning care, participants in the multi-disciplinary workgroup can vary depending on the patient population in scope and the type of initiative being implemented. We recommend beginning with high-volume, high-cost DRGs, and the physicians who provide care for those specific patient populations. The process should include the other key factor of where you think you will be successful to start. Additionally, we include representatives from those departments showing the greatest variation in care within the focused patient population. This often includes representatives from Nursing, Pharmacy, Imaging, Lab, and Case Management; however, it could include others depending on the patient population in focus and the types of clinical variation occurring. It’s also appropriate to include representatives from any existing groups responsible for developing clinical pathways, implementing quality initiatives or aligning treatment protocols with best practices. Equally important is how these protocols are developed and implemented throughout the organization.

4. Embed The Change With Protocols, Order Sets, And Pathways

An effective strategy to manage variation in practice includes the development and adoption of evidence-based protocols, related order sets, and/or pathways. Reviewing excess days per discharge, average cost per DRG, and strategic quality metrics by DRG and specialty will help target where to focus the efforts. Successful organizations engage key physician and nursing stakeholders, as well as representatives from pharmacy, therapy, and other experts, as needed, in the development of these protocols. Multi-disciplinary teams review cost and quality data to redesign care processes, reduce utilization, and reduce cost per DRG and physician. Protocols need to be reviewed annually and revised to reflect current best practice. Although these are very important tools in the effort to increase standardization and reduce variation, just having them is not enough. The process to develop, implement, maintain and update the protocols are important to organizational adoption. And measuring adherence is key. Impacted clinicians must believe that the evidence for the practice is valid, and that the organizational processes for implementing and updating them are timely and accurate. Only then can you expect clinicians to increase compliance.

5. Create A Culture Of Interdisciplinary Collaboration

To create a culture of interdisciplinary collaboration with an eye toward innovation, best-practice, and early adoption, organizations must build interdisciplinary teams that encourage cross-functional discovery of opportunities to improve patient care outcomes. Regulatory bodies, such as Centers for Medicare and Medicaid Services (CMS), the Agency for Healthcare Research and Quality (AHRQ), and the Health Resources and Services Administration (HRSA) are holding organizations and clinicians responsible for interdisciplinary collaboration with a goal of patient safety and clinical outcomes. Courageous leadership across all disciplines can ensure a culture of collaboration and the transparent flow of information. In clinical redesign, dimensions of transparency include communication and hand-offs between clinicians and patients, between clinicians themselves, healthcare organizations with the public, and healthcare organizations among themselves. Successful communication facilitates the timely progression of care and safe transitions to the least restrictive venue of care.


MaloneJ_Sq.jpgMr. Malone is a senior manager with GE Healthcare Partners with more than 25 years as a management consultant, executive coach, operations leader, and HR executive. He has significant experience leading change in the healthcare industry in both the United States and United Kingdom. In addition to his work in the healthcare industry, Mr. Malone has held leadership positions in human resources and operations in the professional services and insurance industries.

Topics: John Malone, Clinical Redesign

Care Coordination Best Practices: The Right Care At The Right Time

Posted by Matthew Smith on Jan 16, 2018 2:17:28 PM

Care coordination becomes critically important as the acuity of patients increases, and hospitals face financial challenges as a result of readmission penalties, declining reimbursement and higher costs. Care coordination ensures hospitals provide care in the right setting at the right time, and that they achieve clinical outcomes, patient/family engagement in planning, and safe and effective care transitions. For most healthcare organizations, case managers are seen as the guardians of the care progression and discharge plans – and these three essential best practices will help both case managers as well as hospital leaders to deliver the right care at the right time.

Best Practice #1: Hold Daily Interdisciplinary Care Coordination Rounds at the Bedside for All Patients, Including Those in Critical Care Areas

The value of daily transition of care rounds has been repeatedly discussed in current literature. Moving these rounds to the bedside offers the opportunity to establish clear communication with patients and family members. Rounds should typically include the patient’s physician, nurse, case manager and any other disciplines whose interventions contribute to the progression of the patient’s care. Bedside discussions should focus on what is keeping the patient in the Hospital, what has happened in the past 12-24 hours that impacts the transition plan, and what needs to be done in the next 24 hours to remove any barriers. Moving these rounds from hallway to bedside can be difficult for teams who often express concern that involving patients could prolong discussion and make the rounds too lengthy. To address this, caregivers should be coached on ways to keep the rounds on topic, with attention to how the leader can acknowledge the patient’s or family’s concerns while deferring the detailed discussions to another time. Statements like “It sounds as if you have a lot of questions. I will make sure Jane comes back this afternoon so that we have time to go over everything” keep rounds on topic and reassure the patient that their voice is important.

When setting up daily transition rounds, don’t forget to include critical care units. Rounds in these departments often take on a more medical focus, but should be adjusted to include discussion about the patient’s progress and plan of care. Keep in mind that the ICU is a costly setting and that patients are at risk for adverse events and outcomes, making the need for focused care coordination imperative. Because of the complexity of the care provided, patients and families are often confused. Daily care progression rounds provide an excellent forum for summarizing and clarifying the plan, as well as ensuring that best practices are in place for patient safety, sedation and weaning, nutritional support, and early mobilization. For those patients experiencing prolonged stays, rounds should be used to set up complex care meetings with family members, so that they understand the possible outcomes of the patient’s course and can begin to work with case managers or social workers evaluate options. Critical care rounds, when implemented in this way, serve to improve team communication and position everyone to effectively address patient/family questions and concerns.

Best Practice #2: Include Licensed Social Workers and Registered Nurses in Your Case Management Model, and Ensure Consistent Coverage Through the Week and Extending Through the Weekend

Consistent staffing of case managers and social workers is an imperative for hospitals today. While organizations have traditionally considered case management as a weekday operation, where planned and unplanned time off could be easily accommodated by adding to existing case loads, this is no longer true. The need for experienced case management to assess patients and families, coordinate complex services to expedite safe care transitions, address the risk of readmission, and provide post-discharge follow-up requires the specialized expertise of both nurses and social workers. Coverage needs to be maintained for each unit without compromising another by attempting to absorb additional work, and extend through the weekend and Holidays to support the implementation of more complex transition plans.

Best Practice #3: Create a Strong Case Management Presence in the Emergency Department and Other Points of Patient Access to the Organization

Effective care coordination practices begin with the assessment of appropriate care settings and necessity for hospitalization. Incorporating case management nurses and social workers at all access points is the most effective way to collaborate with physicians and other providers to determine the plan of care that best meets the needs of the patient and hospital. Case management oversight should be incorporated into any patient placement process so that bed requests from post-operative and post-procedure recovery areas, the emergency department, and all other direct admission and transfer sources are reviewed. This serves as a mechanism for the assessment of medical necessity and the opportunity to identify appropriate community services to support patients safely and avoid a hospital stay. With the proposed change in requirements by the Centers for Medicare and Medicaid Services calling for discharge plans to be in place for all patients (inpatient, observation, post-procedure), the inclusion of a case management professional at the point of entry will facilitate this initial assessment, offer an opportunity for patient/family discussion, and position the hospital and care team to be more successful in creating and sharing the transition plan.

In conclusion, the changing healthcare landscape has created challenges for hospitals as well as patients and their families. As a result of new and evolving regulations by government and private payers, increased incentives to avoid hospitalization, and penalties for failing to achieve quality and safety metrics, there is clear need for dedicated professionals to coordinate and oversee patient placement and daily care processes. The burden on physicians and clinical staff at the bedside is significant as a result of higher patient acuity, further emphasizing the need for strong care coordination professionals and processes to engage the multidisciplinary team and to ensure that the care provided is safe and effective and meets the needs of the patient, family and payer.

Topics: Care Management, Healthcare Transformation

The Smart Approach To Smart Technology: 3 Tips For Implementation

Posted by Matthew Smith on Jan 16, 2018 1:50:49 PM

By Don Martin, Senior Manager, GE Healthcare Partners

Introducing integrated smart infusion pump technology management into the clinical environment to drive medication safety measures is a strong step toward achieving – and sustaining – patient safety and quality outcomes.

In our case study “The Smart Approach to Smart Technology,” we discussed our collaboration with one of the nation’s largest non-for-profit healthcare systems to upgrade its aged fleet of Large Volume Infusion Pumps (LVIP) with newer generation units. These newer “smart” units are supported with medication safety software, orders integration, EMR documentation integration and RFID-aided asset management capabilities.

As the first healthcare organization in the nation to take a “Big Bang” approach to implementing this range of functionality and technology, the organization faced several challenges that required innovative and creative thinking – and a large dose of enthusiasm.

1. Begin with the end in mind

Create the vision and guiding principles that will drive your organization to the desired outcomes you want to achieve. Memorialize these principles in your project charter as well as in a multi-year strategic plan to guide implementation and post deployment optimization.

For our client, a guiding principle and desired outcome was to have metrics in place on Day One following activation supported by actionable data available to nursing staff to measure progress toward safer medication practices. This led to developing the integrated system, purchasing the appropriate software and ensuring the selected LVIP could support both. As a result, nursing managers now efficiently take high level compliance information and with the push of a few buttons, drill down to the actual instance and identifying the potential causes of the near miss. And they are able to trend the data and show compliance over time. This is one example of how beginning with the end in mind will lead to successful outcome.

Other insights gained from our experience include:

  • Senior leadership should revisit the project charter regularly with the project team and organizational stakeholders to avoid losing focus and footing as you proceed through implementation.
  • Take measures early in your pre-implementation planning activities to monitor and assess your organization’s willingness and readiness to embrace the clinical and operational changes this smart technology will bring to them. Continue to assess your team throughout activation and post-implementation.
  • Be careful not to misinterpret successful technical implementation progress as a sign your clinicians have made the transition to successful adoption. If you do not see the signs of growing pains among your staff as they prepare for this transition, it should raise a flag that they are not readily adopting the changes and opportunities this technology delivers.

2. Preparation is key

Every project manager will tell you that thorough preparation is the key to successful project execution as it moves from conceptual development to device deployment. In an ideal setting, preparation begins with establishing a solid governance structure and lines of accountability prior to establishing a selection committee for new devices, software and technical infrastructure.

One of the key milestones during the planning phase includes plans for a thorough impact analysis, which should be on file in advance, and leveraged during the early phases of the due diligence process. One lesson we learned first-hand is the importance of ensuring the project team engaged for the RFI process has access to key documents such as the project charter, business needs analysis and feasibility studies.

3. Mapping the implementation course

The formation and adoption of a clear implementation strategy at the project outset will provide the project team and key stakeholders with the necessary vision to successfully navigate a project of this scope and complexity. In this instance, our client’s leadership adopted the following strategic approaches at the project outset:

  • Map your implementation course to access organizational need and readiness with emphasis on safety and operational imperatives. In particular, investigate all areas of drug administration and look to expand the scope of pump integration to your entire line of infusion practices, including those that are done without technology (e.g., small volume, push, titration, free, flow).
  • Facilitate client and vendor collaboration with emphasis on total cost of ownership, impact on operational costs, and nurturing vendor partnerships aligned with broader sourcing strategies. Develop and foster broad, inter-disciplinary organizational engagement and commitment with focus on the drug library build and governance structures.
    MartinD.jpgMr. Martin is a senior manager with GE Healthcare Partners with more than 20 years of financial and clinical experience with operational responsibilities for patient care delivery, fiscal management, staff development and government, and regulatory compliance. His collaborative approach guides clients through the complex process of optimizing existing technology to meet healthcare’s Triple Aim: increase operational efficiency, improve the quality of patient care, and decrease the costs of care.

Topics: Pharmacy, Don Martin

New Year, New Tax Code: What the New Tax Cuts and Jobs Act Means for Healthcare

Posted by Matthew Smith on Jan 11, 2018 12:57:48 PM

By David DiLoreto, M.D., MBA, Senior Vice President, and Nicholas Malenka, MHA, CRCR, Senior Consultant, GE Healthcare Partners

Worried about political divisions and the uncertainty of the United States entering World War II, Winston Churchill famously said, “You can count on the Americans do to the right thing…after they have tried all the other solutions.” With federal and state governments now paying over one-half of all U.S. healthcare costs, helping shape public policy is an increasingly important charge for the health industry. The country’s political chasms are greater than ever, and as the recent Tax Cuts and Jobs Act of 2017 (TCJA) takes effect this month we examine how the new law might impact stakeholders in the healthcare ecosystem.

Corporate and Individual Tax Reductions

The big news in TCJA is the significant reduction of corporate tax and marginal rate reduction for most individuals. For the past decade, the United States has had the highest corporate tax rates among industrial nations. Pharmaceutical and medical technology companies stand to benefit significantly from the lowering of corporate rates from 37% to 21%. To judge whether the TCJA tax cuts increase the federal deficit by $1.5 trillion over the next decade (as predicted by the CBO) or stimulate economic growth, increase jobs, and lower the deficit by $600 billion (as predicted by the Treasury Department), watch for signs that the U.S market is becoming more competitive compared to its trading partners among industrialized nations. These signs include the repatriation of foreign profits, relocation of intellectual property, and manufacturing jobs returning to the U.S. This is particularly important for the U.S. life sciences and pharmaceutical industries. Due to the size, profits, and amount of taxes paid by these companies, there is much more at stake in the near term from tax reform than for other healthcare stakeholders. For example, many large pharmaceutical companies are headquartered in the U.S. but have complex global supply chains and international affiliates and use unrelated global suppliers. Re-investment by these firms at home could create a freer flow of capital in the U.S., increasing domestic research, capital equipment purchases, and job growth.

The TCJA keeps seven tax brackets for individuals and lowers marginal rates for all but the highest two. A significant change for individuals is the near doubling of the standard deduction and elimination of the personal exemption. For people who do itemize, the threshold for deducting unreimbursed medical expenses is lowered for the next two years from 10% to 7.5% of adjusted gross income (AGI). This should minimize the impact of higher out-of-pocket costs that individuals may face with their health plan policies.

Impact on Health Plans

The most significant change for health plans is the elimination of penalties associated with the Affordable Care Act’s (ACA) individual mandate beginning in 2019. ACA required individuals who forgo health insurance to pay a penalty of 2.5% of AGI or $695. While health plans and healthcare providers would rather have retained the mandate, it proved to be a weak incentive. The many statutory exemptions, multiple additional enrollment periods, and low levels of enforcement made it less effective than the architects had hoped. Since the ACA coverage requirements and subsidies remain in place, the impact from the elimination of the penalty is difficult to project and estimates vary widely. The CBO projects 4 million additional individuals will be without coverage in 2019 and 13 million more by 2027. Standard and Poor’s model predicts far less impact with no more than 3-5 million uninsured by 2027. While the projections may vary, health plans should factor some loss of healthy individuals from risk pools for plan years starting in 2019, and healthcare providers will do well to anticipate some impact on bad debt.

A counterweight to the elimination of the individual mandate penalty for health plans is the reduction of corporate rate to 21%. The reduced taxes could mitigate the rate of premium increases for consumers since the ACA medical loss rules still require at least 80% of premiums for coverage of individual and small group medical expenses. Even more helpful would be the passage of the Murray-Alexander Bill which aims to continue funding ACA’s cost-sharing subsidies. It would have the dual effects of stabilizing coverage for Americans earning less than 250% of the federal poverty line as well as signaling a bipartisan approach to solutions for fixing current problems in the U.S. healthcare system.

Impact on Hospitals and Providers

Whether TCJA’s lower corporate tax rates, lower marginal rates for most individuals, and the immediate expensing of capital expenditures results in positive gains for the U.S. economy is of critical importance to healthcare providers. If these fail and federal deficits increase, mandatory spending cuts are more likely to impact programs including Medicare, and additional entitlement reform affecting Medicaid becomes more likely. Currently half of all healthcare spending in the U.S. ($1.5 trillion a year) is government spending. This does not consider the value of the additional $400 billion that results from the tax deduction for employer-sponsored health insurance coverage. By comparison, the entire U.S. defense budget is $800 billion a year.

Should federal deficits increase, the Pay as You Go Act (PAYGO) requires automatic spending cuts. According to the CBO projections, TCJA will require a $150 annual billion annual federal budget cut to reduce the projected impact on the federal deficit. The largest of these cuts, $25 billion, would be to Medicare. Fortunately for providers, the TCJA bill includes a one-year waiver from the automatic PAYGO cuts in 2018. But mid-term elections in 2018 will heighten the focus on economic growth, the federal deficit, the looming automatic PAYGO cuts in 2019, and may result in additional debates in Congress over additional PAYGO waivers and potential Medicare and Medicaid entitlement reform.

For 2018 there are other real and tangible TCJA impacts on healthcare providers. Some non-profit systems pay tax on unrelated business income (UBI), which the IRS defines as income from a business, regularly carried on, that is not substantially related to the charitable, educational, or other purpose that is the basis of the organization's exemption. The TCJA now requires that health systems separate these activities and determine whether there is a UBI tax on each one. Previously, these could be grouped, and a tax was paid on net profits. The result for most health systems is likely an added non-recoverable cost burden. Additional tax deductions have been eliminated on certain employee benefits such as transit passes, parking, parking shuttles, bicycle commuting reimbursement, on-site gyms, and meals.

TCJA also includes a new 21% excise tax on compensation that exceeds $1 million per year for the five highest paid employees in not-for-profit and for-profit health systems. This change is a modification from the current rule which excluded performance-based pay and exempted the principal financial officer. Employees who are healthcare providers are exempt from the excise tax. For academic health centers, the law imposes a 1.4% excise tax on university endowments.

Assessing the impact from the tax treatment of UBI, employee benefit structures, the timing of employee compensation and severance payments for top earners, and the excise tax on university endowments should be high on the to-do list in 2018.

Looking Ahead

In recent years, healthcare related public policy discussions have been ACA-centric--and while that is likely to continue in 2018, the Tax Cut and Jobs Act of 2017 introduces new variables and solutions into the quest for viable healthcare reform. As Congress reconvenes in 2018, there will be more additional and crucial health reform solutions to consider and debate including the renewal of CHIP funding, Murray-Alexander cost-sharing, accelerating the move to value-based reimbursement, introducing more competition into pharmacy pricing, and entitlement reform. Competing for political attention and funding will be an infrastructure bill as well as the automatic 2019 PAYGO federal spending cuts if the projected economic gains from TCJA fail to materialize.

Churchill was prescient in his confidence that Americans arrive at the right solutions albeit after considerable debate and experimentation. Let’s hope it works for U.S. healthcare this time around too.

 Tax Cuts and Jobs Act


Source and Background Materials

Distributional Analysis of the Tax Cuts and Jobs Act, as Ordered Reported by the Senate Committee on Finance on November 16, 2017, Excluding the Effects of Eliminating the Individual Mandate Penalty https://www.cbo.gov/publication/53349

U.S Tax Reform: Repeal of the Health Insurance Mandate Will Save Less Than Expected, And Will Not Support the Current Insurance Market https://www.capitaliq.com

Repealing the Individual Health Insurance Mandate: An Updated Estimate on November 8, 2017 https://www.cbo.gov/publication/53300

Media Inquiry

Please contact Matthew Smith at msmith@ge.com to schedule an interview with the authors.


DiLoreto.png

David DiLoreto, M.D., MBA Dr. DiLoreto, senior vice president at GE Healthcare Partners, 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, quality improvement and patient safety, and data management and analytics. He may be reached at david.diloreto@ge.com.

Malenka.pngNicholas Malenka, MHA, CRCR Mr. Malenka is a senior consultant with GE Healthcare Partners and has more than six years of experience helping hospitals overcome strategic challenges. He has deep expertise in the impact of consumerism on hospital operations, as well as hospital revenue cycle optimization. Previously, Mr. Malenka worked at the University of Pittsburgh Medical Center where he worked with administration on key priorities, such as a Lean cost reduction effort that included service robots, building a retail pharmacy solution, and enhancing patient throughput for an outpatient respiratory department. He may be reached at nicholas.malenka@ge.com.

Topics: David DiLoreto, Nicholas Malenka, Tax Reform

2018 Healthcare Trends: Tough Challenges, Innovative Solutions

Posted by Matthew Smith on Jan 8, 2018 3:27:58 PM

New Opportunities to Control Costs, Improve Care, and Enhance the Patient Experience

By Laura Jacobs, MPH, Managing Principal, GE Healthcare Partners

Another year of unprecedented challenges lies ahead for the healthcare industry. Healthcare systems will grapple with continued financial performance pressures, while addressing an ongoing commitment to consumers and care delivery and experiencing opportunities to retool for the future.

Changing payer and consumer dynamics, along with an uncertain landscape will continue to present unprecedented challenges to the nation’s healthcare organizations. At the same time, innovation and technological advances present new approaches to tackle issues and move forward.

Trends and solutions expected to have greatest impact during 2018 include:

Financial Performance Pressures

Continued Payment Challenges. One of the greatest challenges to healthcare systems will continue into 2018: the unpredictability of health insurance and payment models. Uncertainty exists everywhere -- at the federal and state levels and with the Health Insurance Marketplace, as well as ways to fund Medicaid and manage Medicare costs. With rising prices and fewer products on the Exchange, some markets could experience a rise in the number of the uninsured. Additional dynamics, such as the high deductible plans and health savings accounts, mean that organizations need to carefully examine pricing practices and revenue cycle management processes. With 19 million people enrolled in Medicare Advantage programs (33 percent of total Medicare enrollment), the 8 percent growth experienced between 2016 and 2017 is expected to continue.

Evolving Payer Dynamics. Multiple factors will continue to put the squeeze on healthcare systems in the coming year:

  • The movement away from fee-for-service models will continue even though the Centers for Medicare and Medicare Services (CMS) has tapped the brakes on some value-based payment methods.
  • Pressure to reduce base rates on commercial contracts, coupled with success in Medicare’s value-based payment program, will require health systems to continue to find efficiencies through patient care redesign, utilizing high-value supplies and outsourced services, and considering performance-based contracts with vendors.
  • At the same time, many physicians will seek to participate in CMS alternative payment models, including ACOs, bundled payment and CPC+ that provide preferred treatment under the Medicare Access & CHIP Reauthorization Act of 2015 (“MACRA”).
  • The trend for health plans to utilize tiered provider networks will steer members to more cost-effective physician groups and hospitals.
  • Due to start-up costs and financial challenges, providers will be more cautious about starting their own health plans. Instead, they will seek co-branded health plan partnerships on insurance products to create greater consumer loyalty and market growth, and leverage the population health infrastructure of larger insurance companies.
  • As utilization is reduced, another consideration will move to the forefront: health systems can expect top-line revenue to decline unless a concerted effort is made to expand outpatient services and geographic presence.

Optimizing Capital Resources. Volume and price pressures will continue to strain operating margins and outstrip available resources due to organizations’ demands for capital to fund information and clinical technology, as well as expansion of outpatient facilities and replacement of aging facilities. Creative asset management could include evaluating leasing options, utilizing development partners and optimizing existing facilities. Additional solutions to explore:

  • Repurposing underutilized or older facilities to meet demand for post-acute, rehabilitation or behavioral health services.
  • Creating capacity command centers to leverage data and analytics to assure that health systems are effectively utilizing inpatient and outpatient facilities are becoming more common.
  • Using philanthropy to support capital needs for programs and facilities that may have minimal or no immediate financial returns, but are critical to improve health outcomes or provide a more patient-friendly environment.

Commitment to Consumers and Care Delivery

Focus on Seamless Patient Care. Managing transitions of care will continue to be a top priority for healthcare organizations in 2018. Rather than reviewing retrospective trends, there will be a move toward advanced analytics that predict potential disruptions in care delivery -- a journey that requires re-engineering and recalibrating the care team and the underlying support structure. Teams will be able to take real-time action to prevent issues and streamline the patient care experience. When properly executed, this results in a single care plan that follows the patient from ambulatory to inpatient setting; integrated care management systems to facilitate smooth transitions from the hospital to home or a post-acute venue; and next generation contact centers that assure that intra-health system referrals and transfers are efficient and user-friendly. In the end, patients truly become the focus of the healthcare delivery system.

Expanding Access through Technology. With companies like Apple, Google, and Amazon, as well as thousands of start-ups focused on innovative disruption, technology will continue to change the delivery of healthcare services and the way providers interact with patients. Virtual technology and telemedicine have made inroads, reducing the need for patients to be seen in a facility. Healthcare can now be provided at home, at work, across long distances and in traditional settings. These developments dovetail with consumer trends focused on mobile solutions, convenience, and on-demand services. To position organizations for future success and compete with emerging players, healthcare systems need to embrace innovation and consumer-centric service delivery and explore alliances with non-traditional partners.

Adopting the Next Wave of Technology. With robots, precision medicine, and 3-D printing coming of age, the future has arrived as these technologies leap from the academic environment into community healthcare settings. Robot-guided surgical procedures and bedside robots are no longer in the realm of science fiction. In addition, genetic advances are leading to precision or personalized medicine, based on an individual’s genetic profile. Targeted cancer therapy based on a tumor’s genetic make-up is increasingly available, and systems are expanding genetic profiling to provide early preventive treatment in a population health environment. An innovation in the manufacturing world, 3-D printing, is making headway into the healthcare arena through prosthetics and implants. While this innovation holds promise in the area of organ replacement, implementation is still remote.

Enhancing Community Connections. To produce better patient outcomes and gain greater control of utilization, health systems will look beyond the walls of their facilities into the communities they serve. There is increasing recognition that social determinants of health, such as socio-economic status, housing and nutrition, impact health status as much as or more than medical care for the general population. Behavioral health initiatives and forging relationships with community resources to help manage critical needs is becoming mandatory, particularly for organizations with high Medicaid and other underserved populations.

Opportunities to Retool for the Future

Continued Growth and Integration. With ongoing merger and acquisition activity expected through 2018, health systems will continue seeking ways to create greater efficiencies and demonstrate value to consumers. Solutions involve simplifying decision-making and governance, developing system-wide clinical operating structures, streamlining operations, and leveraging assets and information technology investments. Leaders will put mechanisms in place to instill best practices across the organization and management accountabilities will shift to emphasize system-wide performance. Many health systems will continue to coalesce the cultures, governance, and management of employed physician practices to create a more unified physician enterprise.

Optimizing Delivery through Digital Technology. Tremendous potential exists to optimize investments in digital technology. Organizations can leverage their digital ecosystem through advanced analytics and applications that can pull relevant, real-time, actionable data from all sources, leveraging it to make smart decisions about patient care and operational improvements. In addition, artificial intelligence and machine learning will provides ways to improve the productivity and focus of care teams. Continual innovation means that healthcare systems must determine where and how much to invest while maximizing applications across the enterprise.

Protecting People; Focusing on Joy. Unrelenting change creates stress for employees. To combat burnout and enhance recruitment and retention, organizations will focus on initiatives to provide support and demonstrate value to their most precious resource: the people who work for the system. Besides an integrated approach to recruitment, training/development, performance and productivity management, and cultural development, many organizations will redesign the roles of care teams to put “joy” back into the profession. Leadership development also will be crucial, particularly for clinical leaders to accelerate change and support succession planning.

2018 Healthcare Trends


Jacobs.jpgMs. Jacobs is managing principal at GE Healthcare Partners. She has more than 30 years of experience in the areas of integrated delivery system development, payer strategy, population health management, healthcare strategic and financial planning, transactions, and governance/ management systems. She is a noted speaker and industry resource on the impact of healthcare trends, most notably the requirements for success in value-based payment models, clinical integration, and creating successful integrated delivery systems. She may be reached at laura.jacobs@ge.com.

Topics: Trends, Laura Jacobs

Trends for Physician Practices in 2018

Posted by Matthew Smith on Jan 2, 2018 11:20:59 AM

By Marc Mertz, MHA, FACMPE, Vice President, GE Healthcare Partners

In last year's trends article for Physician's Practice, we highlighted several trends for 2017, including: payers will change the way that physicians are paid, patient expectations will reach an all-time high, hospitals will seek new ways to align, and physicians will face competition from new types of providers. Not only do each of these trends remain true as we approach 2018, but their impact is increasing in magnitude and pace. Two fundamental issues are driving these changes:

  • Healthcare remains too expensive.
  • Physician practices don't work nearly as well as they should.

To read this article in its entirety on the Physicians Practice site, please visit the following link: 

http://www.physicianspractice.com/blog/trends-physician-practices-2018 

The following login details may be used to access the site:

Login:       gehealthcarepartnersguest@gmail.com

Password:  physicianspractice2018

 

Topics: Trends, Marc Mertz

Lifespan, GE Healthcare Announce 6-Year Plan to Curb Costs by $182 Million

Posted by Matthew Smith on Dec 12, 2017 2:43:58 PM

Lifespan and GE Healthcare announced today a commitment to improving health care delivery in the Rhode Island region for patients, health care providers and the community. The goal of the collaboration is to increase capacity within the health system while reducing the cost of care. The agreement targets $182 million in organizational efficiencies for Lifespan over the next six years. Under the plan, GE Healthcare will assist Lifespan to improve patient flow, increase capacity for services, decrease wait times, pinpoint inefficiencies, and reduce costs.

“Our mission is Delivering health with care. Therefore, our patients and their families are at the center of every decision we make,” said Timothy J. Babineau, M.D., president and CEO of Lifespan. “Today, our hospitals are at capacity and the emergency departments are full of patients seeking high-quality care. This collaboration with GE Healthcare will help meet these challenges by providing our health system with unparalleled access to resources, expertise and digital tools. This means our patients will receive care in the most appropriate and efficient setting, even as our volume increases.”

The system-wide initiative includes a capacity management strategy that will better align departments and service lines, improve processes and optimize space. Lifespan and GE Healthcare will work together to assess Lifespan’s imaging needs and co-design a workforce management system that meets increasing patient demand. Ultimately, the two organizations will ensure the health system has access to the most cutting-edge data analytics and tools to help streamline the patient experience and reduce costs.

We are excited to collaborate with Lifespan, the leading provider in Rhode Island and a critical contributor to the state’s health care ecosystem,” said Helen Stewart, managing principal, GE Healthcare Partners.  “This innovative collaboration will reshape how and when patients are treated and help overcome the challenges that exist within many health systems today.”

Through a shared-risk model that aligns the interests of Lifespan with GE Healthcare, both organizations have agreed to outcomes that must be achieved throughout the six-year relationship. This partnership, a unique collaboration as opposed to a traditional transactional relationship, is GE Healthcare’s first risk-sharing model collaboration in Rhode Island and the fifth collaboration of its kind in the United States.

Topics: Healthcare Transformation, Lifespan

Humber River Hospital Breaks New Ground with the Opening of Canada’s First Hospital Command Centre

Posted by Matthew Smith on Nov 30, 2017 8:58:22 AM

November 30, 2017

Toronto, ON – Today Humber River Hospital (HRH) opens Canada’s first hospital Command Centre built in collaboration with GE Healthcare Partners (GEHC), addressing capacity, safety, quality and wait time issues that have preoccupied hospitals across Canada. The impact of the Command Centre will be felt immediately by patients, physicians and care providers.

“As North America’s first fully digital hospital with a commitment to high reliability care, our cutting-edge technology, insight-rich data and human expertise comes together through the Command Centre to create an excellent patient experience that is both timely and safe,” states Barbara Collins, President and CEO of HRH.

“Ontario is a place where today's innovative ideas are fast becoming tomorrow's world-renowned scientific, medical and technological breakthroughs,” said Reza Moridi, Minister of Research, Innovation and Science. “Congratulations to everyone at Humber River Hospital and GE Healthcare Partners for advancing innovation in Ontario, and for helping deliver the best in care to patients and their families.”

HRH began its digital transformation back in 2005 when planning started for the new site of the Humber River hospital, which opened October 2015. Since going fully digital, HRH has experienced a 20% increase in benefit and efficiency. Now, with the addition of HRH’s Command Centre, the hospital expects to double benefit and efficiency to 40%.

“Whether it be the flu season that brings with it an influx of patients to the emergency department every year, or the fact that Canada has an aging and growing population, there are always pressures, both expected and unexpected, in acute care hospitals,” says Collins. “The digital transformation and command centre are focal points of our strategy to deal with these pressures.”

“Over the next few months, the Command Centre will enable an increase in capacity equivalent to opening a small community hospital within our walls,” explains Collins.

The Command Centre includes a Wall of AnalyticsTM that provides advanced real-time and predictive insight, which triggers cross-functional staff co-located in the Command Centre to take action. This team works together to synchronize care delivery activities (e.g. patient discharge), eliminate delays in care and resolve patient flow bottlenecks (e.g. transferring patients from emergency to an inpatient bed) as soon as they are detected in the Command Centre. The alerts and actions that come to life daily in HRH’s Command Centre will also provide the basis for analysis and process re-engineering by staff throughout the hospital so that certain issues can be avoided altogether.

“Humber’s Quality Command Centre is all about action in support of care-teams and patients,” said Jeff Terry, Managing Principal of GEHC Partners. “It’s an honor to serve the Humber River Hospital team. Humber River is in the vanguard of a global command center ecosystem that is creating new tools and methods to improve quality and efficiency in healthcare.”

The Command Centre plan is a multi-generational roll-out that drives increased capacity, improvements to quality care, and a high reliability environment. Future phases will further enhance high reliability care and will allow the hospital to partner with the community so that more patients will be able to be cared for at home.  

Collins said “The Command Centre contributes to the HRH vision of working together to deliver innovative and compassionate health care in our community.”

Capacity Command Centers


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The Command Centre is located in a 4,500 square foot space. The Command Centre includes 20 workstations, 22 LED screens.


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Jane Casey, Command Centre Director at Humber River Hospital, stands before the Centre's Wall of Analytics.


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L-R Dr. Susan Tory, Command Centre Medical Director; Jane Casey, Command Centre Director
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 The Humber River Hospital Command Centre team monitoring real-time data from their work stations.

 All photos courtesy of Humber River Hospital

 

 

Topics: Command Center, Humber River Hospital

New Developments in the 340B Hospital Environment

Posted by Matthew Smith on Nov 3, 2017 3:14:07 PM

GE Healthcare Partners works with hospitals to implement, extend, and optimize participation in the 340B program. As you may have heard, new 340B guidelines were announced yesterday, November 1, 2017. Here is a brief summary of the changes which will be effective January 1, 2018.

On November 1, CMS issued its 2018 Outpatient Prospective Payment System (OPPS) Final Rule, which has finalized the Medicare Part B payment reduction for certain drugs acquired through the 340B Program for Disproportionate Share Hospitals and Rural Referral Centers.

The current rate for Medicare Part B payment is set at Average Sales Price (ASP) plus 6%. Effective January 1, 2018, the new payment rate for these affected 340B participants will be reduced to ASP minus 22.5%, which is nearly a 27% reduction in Medicare Part B reimbursement. It is also very important to note that commercial payer rates are often based on Medicare, so payment from these payers are likely to be reduced as well.

The final rule also establishes two modifiers to identify whether a drug was purchased under the 340B program—one for hospitals that are subject to the payment reduction and another for exempted hospitals that purchase drugs under the 340B program. The goal is to better track what drugs are being purchased under the program. Without that change, hospitals might have received a cut in reimbursement for drugs not purchased under the discount program.

To understand how this new payment rule may affect your organization, as well as to discuss strategies to lessen this negative impact to your outpatient revenue, please contact the GE Healthcare Partners team by clicking the button below. Our 340B experts will follow-up with you.

340B Final Rule

Topics: 340B

Humber River Hospital Opening State-of-the-Art Command Center

Posted by Matthew Smith on Oct 30, 2017 3:40:48 PM

Courtesy of InsideToronto.com

Staff at Humber River Hospital will soon be able to tell when a bed is free, if an area needs cleaning, or there is a delay in patient care.

North America’s first fully digital hospital will open its state-of-the-art, digitally-advanced Command Centre which uses complex algorithms, predictive analytics, and engineering to target improved clinical, operational and patient outcomes, Thursday, Nov. 30.

A first of its kind in a Canadian hospital, the 4,500 square-foot Command Centre, to be situated on the third floor of the Keele Street and Wilson Avenue hospital, will be made up of 26 screens and staffed by a team of 15 from various hospital departments.

Designed and built with GE Healthcare Partners, the site will include a GE Wall of Analytics processing real-time data from multiple source systems across hospital. The system applies advanced and predictive analytics and provides a continuous “read out” alerting staff to everything from delayed patient care activity to unbalanced physician and staff workload. This information provides real-time decision support so staff can prioritize patient care activities and discharges, make short-term staffing decisions, and mitigate potential bottlenecks before they occur.

The Command Centre will be funded through ongoing business investments, private donations, and efficiency savings.

For Barb Collins, the Command Centre has been 12 years in the making.

That’s when Humber River Hospital’s president and CEO met Michael Dell, founder of Dell Technologies, who explained the capability of monitoring computers based around the world.

She likened the hospital’s Command Centre to airport command centres, where flights are monitored in detail.

“We’ll know what’s going on throughout the hospital,” she said. “We’ll be looking at patient flows, what beds are available. Is a patient waiting two hours (for test results)? Why? Right now, there’s no global view of what’s happening. (Staff) have to phone or email each other. With the Command Centre, all they have to do is look at the screens. We are trying to eliminate delays.”

Collins said the hospital had to become fully digital before embarking on the Command Centre because “there was no way we could collect data before electronic hospital records became real. This is a dream come true.”

Topics: Command Center

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