GE Healthcare Camden Group Insights Blog

GE Healthcare Included in Fast Company's "Top 10 Innovative Companies in Health"

Posted by Matthew Smith on Feb 13, 2017 1:42:10 PM

GE Healthcare is featured as one of Fast Company's Top 10 Innovative Companies in Health of 2017. As part of the magazine's World's Most Innovative Companies ranking, the Fast Company reporting team reviewed thousands of enterprises searching for those that tap both "heartstrings and purse strings" and use the engine of commerce to make a difference in the world.

From Fast Company:

GE Healthcare works with partners ranging from the University of California San Francisco to Johns Hopkins to develop both hardware and software technologies that solve some of the most pressing problems in health care. Some are drawn from health systems; for example, UCSF needed a partner to develop machine learning algorithms for medical imaging, and Johns Hopkins needed a NASA-style command center to better manage patient flow in and around the hospital. Early results from Johns Hopkins have been promising: The hospital has reported a 60% improvement in the ability to accept patients with complex medical conditions from other hospitals around the region and country; its ambulances are able to get dispatched 63 minutes sooner to patients at outside hospitals; and its emergency department is assigning patients to beds 30% faster.


To learn more about The Johns Hopkins Capacity Command Center, watch this short video and click on the links to Modern Healthcare and Health Facilities Management, below.

 

To speak to the GE Healthcare team about Capacity Command Centers, please click the button below:

Capacity Command Centers

 

Topics: Hospitals, Hospital Operations, Command Center, Capacity Command Center, Capacity Management, Hospital Occupancy

NASA-like Command Centers are Coming to Hospitals

Posted by Matthew Smith on Jun 20, 2016 2:40:16 PM

By John Flannery, President and CEO at GE Healthcare

I often ask those who work in other fields how they view healthcare. Do they see an industry rife with cost challenges and complexity? Do they wonder why we want to be a part of it?

They wouldn’t be wrong, but I wouldn’t choose any other job.

Yes, the volume of patients needing care is rapidly increasing, but so is the data available to make decisions about that care. Resistant diseases are smarter, but advanced technology and medicines are outsmarting those diseases. Managing a hospital is more complex today, but building a digital and analytics infrastructure to manage these logistics is more possible than yesterday.

I saw this in action at The Johns Hopkins Hospital (JHH) this month. In the center of their campus in Baltimore, Maryland is a room with walls made of 22 high resolution screens. Numbers, charts and live video flash across them. The hospital staff flows in and out, scanning the screens and making quick decisions based on what they see. It’s what I imagine the inside of NASA might look like before a rocket launch – in fact, JHH calls it their Capacity Command Center. From here – the first predictive patient-experience control center – the staff is running their hospital with the help of a new source: predictive analytics.

One app on these screens uses a digital-twin of the hospital to predict patient activity for the next 48 hours. Another algorithm tells the staff which room turn or patient discharge would reduce wait time. Yet another senses when pressure on a unit is nearing a dangerous situation for patient care, a rare but critical measure.

When JHH, one of the leading health institutions, told the GE Healthcare Partners team that high demand was challenging their capacity to see more patients, we worked alongside the hospital staff to find a holistic solution. In this case, it was the Capacity Command Center, including GE custom-built software that could transform how they manage operations.

Back to my earlier questions: such transformations let a business like us seize the opportunity to be more than a technology provider. Because of our scale and reach, we work with healthcare providers of all shapes and sizes across the world, from Baltimore to Bangalore, to solve similar challenges. We have an obligation to use that vantage point to find and share solutions that work. To be a leading ideas provider.

For a 124-year old startup like GE, it’s an exciting time when we can adapt to what the world needs.

For patients, it promises to be a welcome improvement of less wait time and improved care. For clinicians, it can mean more time freed up to focus on those patients.

And if you ever want to meet people in healthcare who would never change what they do, speak with these clinicians, the care teams who work tirelessly, NASA-like Command Center or not, to help others get better.

Who wouldn’t want to be a part of that? That’s reason #2.


bio_Flannery.jpgJohn Flannery is the President and CEO of GE Healthcare, an $18 billion business unit of General Electric that provides transformational medical technologies and solutions to the global healthcare industry. GE Healthcare supports customers in over 100 countries with a broad range of services and systems, from diagnostic imaging and healthcare IT through to molecular diagnostics and life-sciences. John was appointed to his current role in October 2014.

 

Topics: Hospitals, Command Center, Hospital Command Center, Healthcare Transformation, John Flannery, Capacity Command Center

10 Emerging Characteristics of High-Performing Hospitals

Posted by Matthew Smith on Jun 8, 2015 9:01:02 AM

For decades, hospitals across the United States have operated within a challenging, rapidly changing, and fragmented healthcare system. Today, this environment is even more complex as healthcare reform and market forces transform the way healthcare is delivered and managed, shifting focus from fee-for-service to value-based care models. While healthcare providers are increasingly pressured to improve clinical quality at a lesser price, many have a long path of improvement to achieve sustainability in this post-healthcare reform era. Here are 10 emerging characteristics of high-performing hospitals in the value-based care environment.

1. Defined Strategic Vision

According to a 2014 global survey commissioned by the American Management Association and administered by the Institute for Corporate Productivity, the single largest gap between high-performing and low-performing organizations is whether organization-wide performance measures matched the overall strategy. The second largest gap between high- and low-performing organizations was due to whether organizations had clear and well thought out strategies to support the strategic plan1.

High-performing healthcare organizations have a strategic plan that sets a clear direction for the organization, and there is proper alignment between the strategies set forth and the organization’s goals, tactics, and measurable outcomes. Further, the strategic plan is hard-wired throughout the organization across all departments, engaging physicians, nurses, and staff in the process and making them accountable for achieving the organization’s overall goals.

2. Consistent Leadership

Leaders in high-performing healthcare organizations consistently demonstrate the mission, vision, and values, and ultimately drive the direction of the organization. These leaders are responsible for thinking strategically, allocating appropriate resources, building engagement, driving accountability, and achieving results – all in collaboration with very different stakeholders (physicians, nurses, staff, board members, and vendors).

Given that the healthcare industry overall faces an aging workforce, high-performing healthcare organizations have developed a pipeline of future leaders whose skills match their future needs. These organizations identify potential leaders, both clinical and non-clinical, and develop skills and competencies needed for the future. According to a survey of more than 5,000 executives conducted by The Boston Consulting Group and the World Federation of People Management Associations, high-performance companies fill 60 percent of top management roles with internal candidates, while low-performance companies fill only 13 percent internally2.

Lastly, high-performing healthcare organizations directly link leadership strategy to the organization’s overall strategic direction. Regardless of who the C-suite may be, operational execution takes place at the mid-level and supervisory levels of the organization, and involves engagement from physicians, nurses, and staff. High-performing healthcare organizations invest in their success, and actively monitor and work to strengthen their engagement and skills3.

3. Talent Management (don’t tolerate the low performers)

High-performing healthcare organizations focus on the development of their talent, managing people in the challenges of healthcare reform, strategic initiatives, and operational and performance improvement initiatives. These organizations are proactive in managing their talent and are quick to identify individuals that are not meeting performance targets, implementing necessary measures (e.g., talent replacement, mentoring, among others) to ensure that the organization’s performance remains on the projected path. According to a 2014 report published by the Project Management Institute (“PMI”), only nine percent of organizations surveyed rated themselves as excellent on successfully executing initiatives to deliver strategic results. Further, the PMI found that high-performing organizations successfully complete 89 percent of their projects, while low performers complete only 36 percent; high-performing organizations wasted nearly 12 times fewer resources than low performers4. Thus, high-performing healthcare organizations have more successful operations and waste fewer resources because they effectively align talent management to strategy.

4. Culture of Accountability

High-performing healthcare organizations are constantly looking for ways to improve the quality of care provided in order to achieve the Institute for Healthcare Improvement’s (“IHI”) Triple AimTM of: 1) improving the patient experience of care (including quality and satisfaction); 2) improving the health of populations; and 3) reducing the per capita cost of healthcare. In order to achieve these objectives, high-performing healthcare organizations have adopted and hard-wired a culture of accountability throughout the organization. A culture of accountability serves as a vehicle to reduce inappropriate utilization of healthcare resources; increase utilization of, and adherence to, clinical practice guidelines and evidence-based medicine; improve patient care outcomes; and ultimately create a continuous learning environment. As healthcare organizations seek to create a culture of accountability, it is critical that the following key factors become integral to the organization’s culture:

  • Provide consistent leadership and involve physicians
  • Focus on quality and the underlying processes required to sustain high levels of performance
  • Ensure customer service and patient satisfaction are forefront priorities across the organization
  • Regularly measure and monitor performance
  • Adopt and implement an infrastructure to support achievement of the organization’s objectives

5. Change Management and Adaptability

In this era of healthcare reform, high-performing healthcare organizations have the ability to rapidly adapt to changes in the marketplace and engage key stakeholders in the process. These changes include shifts in demographics, health status, and patient care needs; technological advancements; reimbursement changes; and transitions to emerging value-based care models. Not only are these organizations able to quickly adapt, but they have a disciplined approach to drive shifts in focus, strategy, direction, structure, and culture throughout the organization through innovation and by developing alternative approaches that maximize impact – usually through more cost-effective, higher quality of care. Further, high-performing healthcare organizations are prepared to respond to failures, and continually find new solutions, and their resilience and quick problem-solving prevents disasters.

6. Transparency

High-performing healthcare organizations drive organizational awareness and quality performance through improved communication and data sharing. These organizations provide sufficient, easy-to-access information to the right person at the right time for the right patient, facilitating evidence-based decision-making, and appropriate and timely measurement of quality and key performance indicators. Further, high-performing healthcare organizations are able to successfully align governance with the use of data and information to drive performance improvement. Comprehensive sharing of information and best practices means alignment between leadership and physicians, nurses, other clinicians and staff around strategic goals, data-driven decisions, transparent metric analysis, and timely reporting. This helps to ensure that patients receive consistent care while improving overall quality outcomes at lower costs.

7. Outcomes

The healthcare industry is becoming increasingly consumer-driven. Patients have greater decision-making power in managing their healthcare budgets, and the increased transparency of healthcare outcomes data allows patients to compare and select providers based on published reports. As competition intensifies, patient satisfaction, service quality, and efficient resource management have become the basis to measure patient, clinician, and organizational outcomes. High-performing healthcare organizations have developed a strategic quality plan that sets the direction for quality improvement by creating a strong patient focus and demonstrate continuous commitment to achieving the organization’s quality improvement goals. Further, these organizations have hard-wired evidence-based practices throughout the organization to ensure performance targets are met, and have engaged physicians, nurses, and staff in this process. This is particularly important, as shifts in payment models link reimbursement to quality outcomes. Thus, the benefits of high-performance are recognized in multiple areas:

  • Financial outcomes, through higher revenues and lower costs
  • Clinical outcomes, through higher quality of care and more efficient clinical resource utilization
  • Operational outcomes, through healthier patients at reduced costs and improved processes and workflows to manage information and enhance patient experience

8. Alignment with Physicians Through Clinical Integration

Healthcare reform initiatives are forcing all providers to reevaluate current partnership models in light of future accountability mandates. As reimbursement systems evolve, hospitals and physicians will share an increasing amount of joint accountability for the care they deliver, which will require a defined infrastructure to evaluate costs while delivering higher quality care. High-performing healthcare organizations have adopted a clinical integration strategy that allows both the hospital and its physicians to achieve these goals by jointly participating in value-based contracting models. This provides opportunities for both parties to collaborate through coordinated patient interventions, management of quality across the continuum of care, movement towards population health management, and pursuit of value-based contracting – all of which are key critical success factors in today’s age of healthcare reform.  

9. Patient Engagement

To build and maintain patient loyalty and engagement during a time when consumers can shop for the best value, healthcare organizations must not only provide quality care but also exceed patient expectations. Patient experience and emotional engagement have become critical factors to achieve improved health outcomes and lower costs, and research conducted by Gallup suggests that high levels of engagement among physicians, nurses, and staff are key to developing and maintaining these critical patient relationships. For example, engaged employees are enthusiastic and willing to go above and beyond the basic standards of performance, which makes them more likely to anticipate patients’ needs and create a positive patient experience5. High-performing healthcare organizations cultivate provider-patient relationships and apply strategies to build patient engagement, allowing patients to become more active participants in their care. These strategies include empowering employees to problem-solve down to the front-line levels, as well as deploying behavioral interviewing techniques to hire the right people for the right positions.

10. Innovation and Care Redesign

High-performing healthcare organizations adapting to transformational payment systems and payment reform have determined it is not business as usual. Many organizations cannot afford sophisticated benchmarking or best practice comparisons. A beginning strategy in care redesign for bundled payment and other payment reform initiatives includes comparisons to internal best practices in both cost and quality. Additionally, high-performing healthcare organizations have implemented systems such as Lean and Six Sigma to involve frontline staff and physicians in identifying unnecessary, non-value added testing and processes.  Competency in care redesign is a critical skill in an organization’s efforts to reduce costs, eliminate variation, and streamline transitions in care. High-performing healthcare organizations have learned how to enhance care transitions and move outside the walls of acute care hospitals and into post-acute settings to reduce readmission rates and potential complications.


  1.  American Management Association. “The Essentials of High Performance Organizations.” October 6, 2014. http://www.amanet.org/training/articles/The-Essentials-of-High-Performance-Organizations.aspx
  2. The Boston Consulting Group. “High-Performance Organizations: The Secrets of Their Success.” September 2011.
  3. The Boston Consulting Group. “High-Performance Organizations: The Secrets of Their Success.” September 2011.
  4. Project Management Institute. “The High Cost of Low Performance.” February 2014.
  5. Burger, Jeff. “Why Hospitals Must Surpass Patient Expectations.” Gallup Business Journal. May 1, 2014.

Topics: Clinical Integration, Hospitals, Patient Engagement, Strategy, Care Redesign, Hospital Pricing Transparency, Hospital Performance, Performance Improvement

What Hospitals, Health Systems, and ACOs Need to Understand about Post-Acute Care

Posted by Matthew Smith on May 26, 2015 2:26:00 PM

We spend a lot of money on post-acute care. Some pundits think we spend too much ($58.6 billion in 2012 according to Medicare Payment Advisory Commission’s [“MedPAC”] June 2014 Data Book), and they might be right. From a national perspective, 43 percent of Medicare discharges go to post-acute care, and given our fee-for-service traditions, there has been little call for hospitals and systems to understand, much less get to know, post-acute providers. A typical community hospital might refer patients to as many as 30 skilled nursing facilities (“SNFs”) and more than a dozen home health agencies with little regard for their capabilities or outcomes. In the shifting landscape of healthcare reform, post-acute plays a big role in shaping both outcomes and spending. To that end, here are three issues healthcare leaders should understand about post-acute care.

Post-Acute Spending is Highly Variable and Needs Better Control

In our fee-for-service mentality, we have never been really concerned about readmissions, nursing home length-of-stay (“LOS”), or patient perception of post-hospital care. By virtue of their reimbursement systems, post-acute has been left on its own with almost no controls around utilization or performance.

With the shift to fee-for-value, however, the impact of post-acute use and spending has come under newfound scrutiny. While long suspected, recent studies have established that post-acute care represents the single largest area of variability in Medicare spending. A 2011 MedPAC study confirmed post-acute spending can vary from $60 per member per month to nearly $450 per member per month, depending on geography. In 2013, the Institute of Medicine’s Committee on Geographic Variation found that 70 percent of variation in Medicare spending is attributed to post-acute use alone.

For hospital and systems, particularly those participating in an ACO or working towards the value-based paradigm, this post-acute variability represents an enormous Achilles heel. SNFs that “optimize” LOS, or home health agencies that repeatedly readmit to achieve greater revenues, can unnecessarily drive up Medicare Part A spending, and as a result, the total cost of care for a given beneficiary. As a handful of early ACOs and fee-for-value adopters have learned, getting to know your post-acute providers and developing formal relationship or networks is central to addressing these variations in use, and ultimately, spending and outcomes.

Post-Acute is Inherently Schizophrenic and Competitive

Many presume that post-acute care is just another kind of “continuum” – an interconnected sequence of services or settings that support post-hospital care. While post-acute service typically occurs after an acute inpatient stay, and there is sometimes a referral from one post-acute setting to another (i.e., SNF to home health), post-acute is highly disconnected within itself and has considerable overlap.

SNFs and home health agencies (which account for about 80 percent of all post-acute services nationally) are an excellent example. Post-acute care in SNFs evolved to address medically-complex patients requiring rehabilitative therapies while home health historically took on less complex patients with fewer needs. In the last 10 years, the lines between these two providers have blurred dramatically. Home health has ramped up its clinical skill to address complex wounds, congestive heart failure, and other patients who might have historically gone to a SNF. Many post-orthopedic procedure patients are now serviced by home health. As a result, SNFs have worked to take on more complex patients – those who might have gone to an inpatient rehabilitation facility (“IRF”) or even a long-term acute care hospital (“LTACH”). All of this has created both tension and increasing competition among different kinds of post-acute providers. The Centers for Medicare & Medicaid Services has worked to address some of these issues by redefining criteria for some settings (IRF and LTACH in particular) and suggesting site-neutral payment as one means, challenging the industry to sort out its differences. Bundled payment will also challenge traditional thinking as it gains more traction and becomes the dominant form of payment for post-acute services.

For a hospital or system seeking the “right” setting for a post-acute bound discharge, the prospects can be daunting. There is no uniform patient assessment tool for post-acute, and it is not unusual for patients to be placed in the wrong setting – sometimes at significant financial cost (e.g., $26,000 for a typical SNF-based episode vs. $64,000 for an LTACH episode). Understanding the differences among post-acute settings and determining appropriate settings for post-acute bound patients are critical for those organizations focused on the Triple AimTM. Providers need to re-engineer discharge planning, know how to pick the right partners, and improve communication both with and among post-acute providers.

Post-Acute is Eager to Partner and Adapt to the New World

Hospitals, health systems, and ACOs looking for the right post-acute organizations are often surprised by what they find. Most post-acute providers are willing and eager to engage. They understand the importance of a clinically integrated future, desire preferred relationships, and are facing their own value-based program expectations around quality reporting, readmissions, and payment.

Building the right kind of partnership, however, won’t just happen because you say so. Hospitals, health systems, and ACOs need to engage post-acute providers as active partners and treat them as equals in creating systems, tools, and networks to successfully treat and manage post-acute bound patients. There has been a lot of buzz about post-acute network development over the last 12-to-18 months, but much of that work has involved simply picking providers. Little of it has focused on actually engaging partners to fix the real problems – redesigning care, improving transitions, expanding physician coverage in post-acute settings, enhancing post-acute clinical skills, and creating measures of quality and performance that can drive long-term improvement. It is important to recognize that the hard work of change inside organizations must extend outside the walls or the historical view of the business.

The post-acute partnering pioneers of the past few years have seen tremendous results for their efforts – 20 to 50 percent drops in readmissions, impressive reductions in post-acute LOS, and dramatic shifts away from high-cost post-acute settings in favor of lower cost, comparably effective options. At the same time, patient satisfaction with improved acute/post-acute relationships hit an all-time high. For some, the approaches to post-acute partnering have even served as templates for partnership models addressing renal and behavioral health populations.

As we think about the next few years and the continued push towards greater integration and the goal of true population health management, post-acute care cannot be an afterthought or a minor footnote in any organization’s planning or thinking process. As post-acute continues to evolve, it will take on an ever-increasing role – shortening acute LOS, taking on unnecessary inpatient admissions, and managing the bulk of post-hospital care and service in a given episode. Now is the best time for hospitals, systems,and ACOs to step deeper into post-acute care, engage the right partners, and take the first steps towards a value-based acute/post-acute future.

Topics: ACO, Hospitals, Health Systems, Post-Acute Care, Post-Acute Spending

Hospitals: EHR Deadlines Approaching for 2014 Reporting

Posted by Matthew Smith on Nov 6, 2014 12:53:00 PM

CMS, EHR, Meaningful UseNovember 30, 2014 is an important date for the 2014 Medicare EHR Incentive Program for eligible hospitals and critical access hospitals (CAHs).

Attestation Deadline

Eligible hospitals and CAHs must successfully attest to demonstrating meaningful use by November 30 to receive a 2014 incentive payment. Hospitals participating in the Medicaid EHR Incentive Program need to refer to their state deadlines for attestation.

The CMS Attestation System is open and fully operational, and now includes the 2014 Certified EHR Technology (CEHRT) Flexibility Rule options. Medicare eligible hospitals can attest any time to 2014 data until 11:59 p.m. ET on November 30, 2014.

Reminder: Medicare eligible hospitals must attest to demonstrating meaningful use every year to receive an incentive and avoid a payment adjustment.

eCQM Submission Deadline

Eligible hospitals and CAHs who are electronically submitting clinical quality measures to qualify for that requirement of meaningful use must submit to qualify for that requirement of meaningful use must submit to Quality Net by November 30 to successfully meet the deadline to be evaluated for a 2014 incentive payment. Hospitals participating in the Medicaid EHR Incentive Program need to refer to their state deadlines.

2015 Hardship Exception Deadline

CMS reopened the submission period for hardship exception applications for eligible hospitals to avoid the 2015 Medicare payment adjustments for not demonstrating meaningful use of CEHRT. The new deadline is 11:59 PM ET November 30, 2014.

Eligible hospitals that have never met meaningful use before may apply during this reopened hardship exception application submission period if they were unable to attest by July 1, 2014 AND were unable to fully implement 2014 Edition CEHRT due to delays in 2014 Edition CEHRT availability.

2016 Payment Adjustments

Payment adjustments will be applied at the beginning of FY 2016 (October 1, 2015) for Medicare eligible hospitals that have not successfully demonstrated meaningful use in 2014. Read the eligible hospital payment adjustment tipsheet to learn more.

Note: CAHs have a different payment adjustment schedule. Review the CAH Payment Adjustment and Hardship Exception Tipsheet.

Resources
Attestation resources are available on the Educational Resources webpage of the EHR Incentives Programs website.

Topics: EHR, EMR, CMS, Hospitals, Electronic Health Record, Electronic Medical Record, Hardship Exception, eCQM

Funding Your Clinical Integration Project: 3 Important Considerations

Posted by Matthew Smith on Oct 29, 2014 1:05:00 PM
By Daniel J. Marino
President/CEO, Health Directions

Clinical Integration, Funding, Population healthHealthcare leaders are asking some serious questions about Clinical Integration. How much will it cost to develop a Clinically Integrated Network? How and when will the Clinically Integrated Network begin paying for itself?

Here are answers to three important questions about the economics of Clinical Integration.

Q. What Initial Investment Will Clinical Integration Require?

The upfront investment depends on the resources each participant can contribute to the network. The initial primary cost drivers of a Clinically Integrated Network are information technology, professional and legal support, and staffing. The good news is that all three cost components can usually be managed within the available resources of the hospital partner.

Based on the work Health Directions is doing with clients, new Clinically Integrated Networks typically require $500,000 to $3 million in investment capital. This money funds the network build and launch over a 2- to 3-year period.

Q. What is the Net Impact of Clinical Integration?

Leading organizations are developing Clinically Integrated Networks with the idea that they will not achieve true ROI until 2 or 3 years down the road. The sooner a Clinically Integrated Network can manage population health and build an organized system of care, the sooner it will realize a net positive return. Two areas are key:

Network impact

The Clinically Integrated Network as a whole should focus on securing incentive payments. These include incentives tied to reducing the cost of care and meeting/exceeding quality thresholds under value-based and risk-based contracts. Networks can also pursue employer contracts that provide care management fees and revenue from employee health outreach, wellness and prevention services.

Participant impact

Hospitals and physicians that participate in a Clinically Integrated Network can expect a positive impact within their separate operations.

  • As network-driven care matures, “leakage” of patients outside the Clinically Integrated Network should decrease by 10% to 15%. Hospitals will see their utilization increase, even though typical indicators such as length of stay and readmissions will decrease.
  • Many Clinically Integrated Networks begin by enrolling the hospital’s self-insured employed population. These hospitals will see a decrease in their variable employee costs and a decline in overall spending per employee per year.
  • Integration will also complement a hospital’s internal quality improvement initiatives. Hospitals that participate in a Clinically Integrated Network will have a greater ability to bend the cost curve, achieve quality targets and improve patient access.
  • Physicians have the opportunity to receive performance incentives in the form of shared savings distributions. Medical providers should also see a stabilization and eventual increase in their practice population, resulting in stronger practice revenue.

Q. What is the Financial Value of Clinical Integration?

Ultimately, Clinically Integrated Networks need to look beyond short-term incentives and start developing the ability to assume financial risk for groups of beneficiaries.

Payers are beginning to offer complementary insurance products that leverage population health management. These payers need high-performing Clinically Integrated Networks that:

  • Deliver a strong network of providers focused around organized care principles
  • Demonstrate the ability to drive down costs for high-risk population cohorts
  • Incorporate care coordination functions that result in high-quality care outcomes

Clinically Integrated Networks that can deliver on these points will build undisputed financial value, giving them a commanding position within emerging provider/payer partnerships.

Start with a financial model

Will your Clinically Integrated Network be economically viable? The answer depends on many variables, including market forces and assumptions inherent in population health management.

The first step for any new Clinically Integrated Network is careful financial modeling. Health Directions helps client Clinically Integrated Networks get a fast start by building sophisticated financial models that take into account changing conditions and sensitivity analyses. These models help Clinically Integrated Networks build strong provider networks, align participants with a population health vision, maximize their net economic impact and create true financial value. 

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Daniel J. Marino, CIN, Clinically Integrated Networks; As President/CEO of Health Directions, Daniel J. Marino shapes strategic initiatives for healthcare organizations and senior health care leaders in key areas such as population health management, clinical integration, physician alignment, and Health IT. With a broad background in all aspects of practice management and hospital/physician alignment, Dan is nationally recognized as a strategic leader in Accountable Care Organizations and clinical integration development. He frequently speaks at national conferences and regularly authors articles for the nation’s top healthcare industry publications related to current transformations in healthcare delivery. Dan may be reached via email at dmarino@healthdirections.com or by phone at 312-396-5400.

Topics: Clinical Integration, Population Health, Hospitals, Clinically Integrated Networks, Funding Clinical Integration, Daniel J. Marino

HD Download: Top Questions From Physicians About Clinical Integration

Posted by Matthew Smith on Aug 21, 2014 4:14:00 PM

FAQ, Clinical IntegrationClinical Integration programs unite physicians for the purpose of delivering higher quality health outcomes. Payers in certain markets reward systems with Clinical Integration programs due to the savings created by better population health management. Physicians are sometimes reluctant to join Clinical Integration programs and appropriately ask “What’s in it for me?” 

While our previous article, titled "5 Incentives for Enlisting Physicians in a Clinical Integration Program" examined the "What's in it for me" question, we received some great feedback asked for more answers to commonly received questions. This FAQ will help you communicate the value and details of clinical integration and a clinically integrated network to your physicians. If you're a physician, these questions and answers should help you with some recurring and nagging questions.

Top Questions Include:

  • What’s driving the movement toward clinical integration?
  • What is the purpose of the clinically integrated network?
  • What are the benefits of joining?
  • Who can join?
  • Do physicians join as individuals, or do all the physicians in a practice need to join?
  • What type of data is monitored?
  • How will clinicians submit data to the network?
  • What is the difference between a Clinically Integrated Network and an Accountable Care Organization (ACO)?
  • and more.

Do you have a question that is not included in the FAQ? Feel free to share your question in the comments section and we will address these in a follow-up document.

To download the FAQ, simply click on the button, below:

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Topics: ACO, Clinical Integration, Hospitals, Clinically Integrated Care, FAQ, Physicians

Expert Panel Recommends Sweeping Changes To Doctor Training System

Posted by Matthew Smith on Aug 1, 2014 9:51:00 AM
Courtesy of Kaiser Health News

Physician Training, HospitalsAn expert panel recommended Tuesday completely overhauling the way government pays for the training of doctors, saying the current $15 billion system is failing to produce the medical workforce the nation needs.

“We recognize we are recommending substantial change,” said health economist and former Medicare Administrator Gail Wilensky, co-chairwoman of the nonpartisanInstitute of Medicine panel that produced the report. “We think it’s key to justifying the continued use of public funds.”

The federal government, mostly via the Medicare program, currently provides more than $11 billion per year in payments to support the training of doctors who have graduated medical school. Most of that goes to the hospitals that sponsor interns and residents. States, through the Medicaid program, contribute nearly another $4 billion annually.

“The scale of government support for this phase of physician education is unlike that given to any other profession in the nation,” said the report, which was funded by a dozen foundations with the support of a bipartisan group of members of Congress.

But there are little data on how those funds are spent and how well they contribute to the preparation of a medical workforce needed for the 21st century. Despite a growing public investment in graduate medical education (GME) support, there are persistent problems with uneven geographic distribution of physicians, too many specialists and not enough primary care providers, and a lack of cultural diversity in the physician workforce, the report found.

Not only that, the authors note, “a variety of surveys indicate that recently trained physicians in some specialties cannot perform simple procedures often required in office-based practice and lack sufficient training and experience in care coordination, team-based care, and quality improvement.”

All of the changes proposed in the report would have to be made by Congress, because government support for graduate medical education is written into Medicare and other laws. The politics, however, are unclear because the changes would produce winners and losers among those programs currently training interns and residents. 

The Association of American Medical Colleges was sharply critical of the report. Its recommendations would “threaten the world’s best training programs for health professionals and jeopardize patients, particularly those who are the most medically vulnerable,” said AAMC President Darrell G. Kirch, whose group represents the nation’s top teaching hospitals.

“By proposing as much as a 35 percent reduction in payments to teaching hospitals, the IOM’s recommendations will slash funding for vital care and services available almost exclusively at teaching hospitals, including Level 1 trauma centers, pediatric intensive care units, burn centers, and access to clinical trials,” Kirch said. “In addition to hurting patient care, these cuts will limit critical training settings for future physicians, nurses, and other health professionals.”

The committee proposes a sweeping overhaul of the entire financing program for graduate medical education, with the goal of shifting the program “to a performance-based system,” rather than one that merely funnels money to any facility with an accredited training program.

The current Medicare medical education payment system would be phased out over 10 years. At the end of the phase-out, policymakers would reassess whether Medicare should continue to subsidize doctor training at all, and if so, to what extent.

The panel calls for spending the same overall funding from Medicare over the decade, adjusted for inflation. But it would be distributed much differently, with a declining share providing direct subsidies to teaching programs. An increasing share would go instead to a “GME transformation fund” that would finance new ways to provide and pay for training and fund training positions “in priority disciplines and geographic areas.”

The funds would still be distributed through the Medicare program, but a new “GME Policy Council” would be created under the office of the Secretary of Health and Human Services to oversee workforce issues and commission research on how well the federal dollars are being spent. The committee recommended that states impose similar requirements for Medicaid training funds.

Among those that would be most immediately affected are major teaching hospitals in the Northeast, which currently account for a disproportionate amount of Medicare medical education funding and number of doctors-in-training. The panel called for an end to the current system of payments that favor those hospitals, and instead for Medicare to make a flat “per resident” payment to training sponsors based on the national per-resident amount, adjusted for geography.

It’s time to close the open checkbook for teaching hospitals, the panel said. “The statutes governing Medicare’s GME financing were developed at a time when hospitals were the central – if not exclusive – site for physician training,” the report said. But by doing that, “the Medicare payment system discourages physician training outside the hospital, in clinical settings where most health care is delivered.”

Members stopped short, however, of recommending that Medicare stop funding graduate medical education altogether, at least for the near future.

The rapid evolution of the health care sector, said Wilensky, “was an important rationale for potentially using the leverage provided by government funding  to try to train the health care workforce we needed for a 21st century delivery system.”

But the panel also did not recommend lifting the current cap on the number of residencies that Medicare currently supports. That cap was imposed in the 1997 Balanced Budget Act.

“Increasing the number of physicians per se is not likely to solve important workforce issues,” Wilensky said, “particularly with regard to specialty distribution or geography.”

Topics: Medicare, Hospitals, Physician Training, Teaching Hospitals

Building the Four Pillars of Clinically Integrated Care

Posted by Matthew Smith on Jul 28, 2014 1:19:00 PM
By Daniel J. Marino,
President/CEO, Health Directions

4 Pillars of Clinical Integration

Government and private insurers are gradually moving away from encounter-based reimbursement and rapidly developing new payment models that reward coordination of care and population health management. How should healthcare leaders respond? As always, there are options.

The first option is to do nothing. Both hospitals and physicians can maintain current strategies based on fee-for-service payment, avoid the up-front costs of care coordination — and tolerate declining reimbursement. Physicians will take home less pay, and hospitals will see their margins shrink.

The next option for hospitals and physicians is to work on improving care coordination, but within their respective silos. A hospital could use quality methodologies and technological tools to improve coordination of inpatient care. A physician group could develop a medical home model to coordinate care within its practice population. "Siloed coordination" will enable each party to leverage gains in payor contracting. Hospitals will be able to point to cost reductions, and physicians will be able to tout better chronic disease outcomes. The problem is that neither the hospital nor the physicians will realize the benefits of fully coordinated patient care. Their opportunities for success under value-based contracting models will be limited.

That brings us to the last option: clinical integration between hospitals and physicians. Clinical integration offers both parties the opportunity to coordinate patient interventions, manage quality across the continuum of care, move toward population health management and pursue true value-based contracting.

Unfortunately, the path to clinical integration is far from clear. The best strategy is to build a platform for hospital-physician collaboration that is flexible enough to support a broad range of possible futures. Right now, leading healthcare organizations are creating this versatile platform by focusing on the four "pillars" of clinical integration.

Clinical Integration Collaboration1. Collaborative Leadership

The first pillar of clinical integration is a shared governance body with strong physician leadership. Getting governance right is critical for three reasons.

First, if a clinical integration initiative will include independent physicians, it needs to have a legal structure for contracting with payors and, in turn, paying physicians based on outcomes, not referrals. To be acceptable under Federal Trade Commission standards, a clinically integrated organization must be an independently governed entity with the objective of improving population health through coordinated programs and interventions.

Second, clinical integration requires collaboration on payor strategy. The scope goes beyond the typical Physician-Hospital Organization. The focus is on achieving clinical outcomes that can serve as value drivers within risk-based and pay-for-performance contracting models. Only a strong physician-led governance body will be able to create the clinical strategies required to pursue risk-based or value-based contracts with commercial payors, develop innovative care contracts with employers and take advantage of accountable care opportunities in the Medicare Shared Savings Program.

Third, clinical integration requires a strong physician-led governing structure for driving cultural change. For a clinically integrated organization to be successful, physicians must transition away from the fee-for-service mindset. This includes adopting new behaviors that align with outcomes-based reimbursement, such as collaborating across specialties, sharing information, managing utilization and providing proactive care. Educating providers on clinical integration concepts, including innovative care delivery models and tracking of clinical quality outcomes, is what allows community physician members to understand the value of participation.

2. Aligned Incentives

Hospitals and physicians share many goals, but their priorities often diverge. It is essential that clinically integrated organizations develop structures that align goals and incentives across the entire spectrum of providers.

Clearly, physician compensation is an important tool. Clinically integrated organizations must design incentive plans that not only encourage productivity, but reward physician efforts to achieve shared goals in care, quality and cost control.

But compensation design is not enough to ensure strong performance. Organizations need to create support structures to help physicians understand and work toward performance objectives:

Develop a plan for communicating strategies and decisions to the entire organization.
Assign staff and resources to physician education and office staff training.
Develop a provider scorecard that keeps physicians oriented toward improving clinical outcomes and controlling costs.

Supporting all of these efforts, leaders need to build a financial infrastructure to guide overall decision making. One key priority is to develop a risk-based cost model that links patient care costs to interventions and quality outcomes. Finance leaders will also need to begin engaging with payors to explore and negotiate risk-based contracts and develop a physician performance incentive fund.

3. Clinical Programs

The heart of clinical integration is care coordination. Greater coordination between providers will improve patient outcomes and wring costs out of the system by optimizing care transitions, reducing redundant testing and providing better management of patients with multiple complex co-morbidities and diagnoses.

To launch a care coordination strategy, begin by creating clinical programs that target major opportunities in care improvement. Initial areas of concentration may include:

High-risk patients (for example, diabetics with multiple co-morbidities such as hypertension or heart failure)
Cost-control opportunities (like generic prescribing and MRI utilization review)
Key public health initiatives (such as smoking cessation and depression screening)

The next step is to develop appropriate clinical performance measures. For example, an asthma care program could track asthma control rates, screening frequency and percentage of patients with an up-to-date asthma action plan. The program could also track cost measures such as drug expenses, physician visits and emergency room visits.

Clinical programs should also develop care plans that define care protocols for various conditions. Program leaders can use process mapping to create care pathways that encompass ambulatory, inpatient, post-acute and home health interventions. Care gaps reports can be created to identify opportunities to enhance delivery of patient care according to care protocols and measure clinical care performance by care setting.

Physicians who are used to encounter-based reimbursement need guidance on how to be successful within a clinically integrated initiative. Support should focus on helping physicians manage patients within care plans through the use of care coaches and care coordination tools. Many physicians will also need coaching on how to incorporate nurses, dietitians and other support providers into care efforts aimed at managing the patient outside the traditional office setting.

Proactive medicine is key. Traditionally, a physician knows that a patient has a problem only when the patient comes in for an appointment. The success of clinical integration will hinge on physicians' ability to anticipate and prevent patient problems. To do this, physicians will need to incorporate care gap reports into clinical care and adopt new processes — for example, assigning a nurse to call patients with high-risk diabetes to ensure hemoglobin A1C is reported according to the defined diabetic clinical treatment protocol.

4. Technology Infrastructure

New connectivity and point-of-care tools make hospital-physician collaboration more possible than ever. The risk is overspending on technology and under-delivering on functionality. The key to avoiding these problems is to create a focused IT investment strategy.

The first priority is to invest in technologies that support coordination of care. One approach is to develop a health information exchange that connects ambulatory electronic medical records (of both employed and independent physicians), the hospital EMR, pharmacy information systems, labs, etc. The goal is to create a patient longitudinal record that allows physicians, nurses and other providers across the care community to track patient care in every setting.

Next, begin investing in technologies that support population health management. A clinically integrated organization needs to be able to aggregate and analyze clinical data so it can identify performance shortfalls and strategize improvements. Stage 1 meaningful use data from the ambulatory EMR and Physician Quality Reporting System can serve as a starting point, but to achieve significant gains in quality and cost, the organization needs comprehensive clinical and claims data from disparate information systems. The solution is to create a disease registry, a database that enables an organization to capture information from various provider systems and sources. The key is to incorporate a tool that allows the clinically integrated organization to run performance analytics on clinical programs, care settings, provider performance and cost utilization.

Clinically integrated organizations should also invest in technologies for connecting patients. Patient electronic engagement — via patient portals and secure messaging — is a requirement under stage 2 meaningful use. Beyond the requirements, organizations should explore patient portal and personal health record technologies for involving patients more deeply in clinical programs.

Tying it all Together

The overall goal of the four-pillar platform is to link clinical outcomes to cost management with the aim of negotiating value-based payor contracts. In light of this goal, clinically integrated organizations need to be able to aggregate data for the entire network and compare outcomes to community performance.

For example, a clinically integrated organization might set the goal of reducing high-risk diabetic patients from 12 percent to 8 percent of its patient population, compared to a community-wide rate of 10 percent. If the organization can achieve this outcome and demonstrate it with valid data, it will be in a position to negotiate favorable risk-based or shared savings performance contracts that enhance revenue and drive patient volume.

Looking Ahead

While both hospitals and physicians have several options for taking advantage of new payment models, clinical integration represents the best opportunity for both parties. The key to success is a flexible strategy that emphasizes effective governance, aligned incentives, clinical programs and appropriate technology.

None of these pillars can be built overnight, but leading organizations are making steady headway in each area. Clinical integration is not a project with a defined endpoint, but an evolution that will require ongoing attention, quality improvement, resources and leadership.

 

Clinical Integration, Health Directions, Population Health

 

Daniel J. Marino, CIN, Clinically Integrated Networks; As President/CEO of Health Directions, Daniel J. Marino shapes strategic initiatives for healthcare organizations and senior health care leaders in key areas such as population health management, clinical integration, physician alignment, and Health IT. With a broad background in all aspects of practice management and hospital/ physician alignment, Dan is nationally recognized as a strategic leader in Accountable Care Organizations and clinical integration development. He frequently speaks at national conferences and regularly authors articles for the nation’s top healthcare industry publications related to current transformations in healthcare delivery. Dan may be reached via email at dmarino@healthdirections.com or by phone at 312-396-5400.

Topics: Clinical Integration, Hospitals, Clinically Integrated Care, Physicians

Infographic: The State of Hospital Readmissions

Posted by Matthew Smith on Jun 12, 2014 1:24:00 PM

Hospital, Long Term Care Readmissions, ReadmissionsSince the introduction of CMS readmissions penalties, many Healthcare Organizations have focused on preventing hospital readmissions. As a result, the national rate of CMS readmissions fell from 19.5% in 2011 to 18.5% in 2013, but still a long way from the CMS goal of reducing preventable hospital readmissions by 20%.

This new infographic from Vree Health compares readmissions rates by state and by condition.

For additional insight regarding readmissions, please see the following articles published by Health Directions in Hospitals & Health Networks magazine:

Reducing Long-Term Care Readmissions through Clinical Integration

Addressing the Human Factors Behind Readmissions


Reasmissions

The State of Readmissions: Hospital Readmissions by State, an Infographic by Vree Health.

Topics: Hospitals, LTC, LTC Readmissions, Long Term Care Readmissions

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