Innovating Healthcare System Strategy: Creating the Commercial ACO

Tick tock goes the clock….October 2012 will soon arrive and value-based payment will commence.  In order to prepare for this change, hospitals and healthcare systems are simultaneously improving quality and patient experience, reducing expense and crafting new strategies for growth.  While strategic planning efforts have traditionally focused on modifying or developing new service lines or delivery sites, one healthcare system has forged a different path, forming a commercial accountable care organization via a new payer partnership.

Though the concept of commercial ACOs is not new, the novel approach being taken by Aurora Healthcare, Aetna and Wellpoint subsidiary, Anthem Blue Cross and Blue Shield Wisconsin, is to offer a price guarantee – defined as a potential 10% reduction in cost – to small and mid-size businesses, which typically, are not target markets for insurers seeking large, self-insured groups.  Through the Accountable Care Network, Aurora Healthcare’s 1400+ providers will be poised to deliver care through its 15 hospitals and more than 160 clinics.  Not for the faint at heart, Aurora Healthcare’s new business model is supported by its 15+ years experience as one of the largest employers, with 48,000 covered lives, in the Wisconsin and surrounding area.

With extensive use of care managers for appointment scheduling, assistance connecting with physicians and follow-up for patients who have chronic or complex conditions, this group succeeded in reducing their per-member-per-month cost by 2.4% in 2010, while the national average rose more than 10%.  Coupling personalized care with its use of electronic medical records, claims reviews and advanced analytics, the Accountable Care Network is now confident that they can lower future members cost of care per diagnosis.  Bold statement, indeed.

Bold enough, in fact, to make me wonder…could this price guarantee be replicated for the Medicaid population?  With skyrocketing cost and rampant chronic illness, there exists no better petri dish for testing this hypothesis.  And, as Dr. Nick Turkal, Aurora Healthcare’s President & CEO mentions below, as a national quality and healthcare reform leader, they (and others) are beholden to share their knowledge regarding tools and processes developed to address these critical issues along the way.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

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Changing Behavior to Conquer Obesity

According to a recent Bipartisan Policy Center report, Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future, two-thirds of Americans are overweight or obese.  In addition, one in three children meet this definition, putting them at risk for chronic diseases such as diabetes, hypertension, asthma, heart disease and cancer.  With escalating health care costs now acting as the main driver of our spiraling national debt, obesity has become a preeminent public health issue.  Recognizing this plight, the Bipartisan Policy Center (BPC) launched its Nutrition and Physical Activity Initiative based in large part on concern about the national debt and the clear role that escalating healthcare costs play in our nation’s looming fiscal emergency.  As noted in the report, a number of recommendations must be implemented across individual, family and organizations in order for, “success (to be) possible if all these entities work together and bring creativity, innovation and focused commitment to the effort.”

In response to the report, Kaid Baifield highlighted a number of recommendations regarding how cities can help fight obesity.  Specifically, the author outlines ways in which the community can help prevent the situation:

1. Train health care professionals in nutrition and physical activity
2. Expand a “prevention-workforce” by providing training also to non-clinical, community health workers
3. Provide incentives for community health services such as diabetes or weight loss education
4. Improve menu options at large institutions, shifting food supply chains towards healthier options and better prices
5. Promote positive nutrition and fitness examples at public institutions
6. Use existing infrastructure assets to promote more local opportunities for physical activity
7. Make creative use of technology, such as games, pedometers, or apps locating walking and recreation spots
8. Incorporate physical activity and healthy transportation guidelines into construction codes and planning policies

As a wise mentor once taught me, our mission, as healthcare leaders, is to improve the health of the people in the communities we serve.  In reviewing the list above, there are a number of recommendations for interventions with health professionals and services that serve this purpose.  And while it is commendable to note these general statements about improving health, perhaps the real crux of the problem is how we influence individuals to change the way they think, and more importantly, act, about their health?  Further complicating the debate, researchers at the University of Florida have also noted that forty percent of rural residents, versus thirty percent of their urban counterparts, remain obese, underscoring the lack of access to health professionals and services continuing to fuel this potential epidemic.

Noting my previous interest in healthcare providers engaging their patients, I continue to believe this strategy offers a potential key to the solution.  First and foremost, providers must be given tools and reimbursed appropriately in order to succeed at this endeavor.  And by incorporating tools – concisely written ‘cue’ cards, texts, videos, apps (games, weight loss programs), pedometers, e-health visits, follow-up phone calls with traditional office visits, providers are able to reinforce their message via a variety of formats that are most relevant to the patient.  And it is through these channels – incorporating the use of ubiquitous technology, theory-informed, but user-relevant interventions, high degree of tailoring, and continuous interventions –  that Dr. Karen Calfas believes that healthcare providers can drive successful maintenance of behavior change.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Deploying Health IT and Patient-Centered Process Improvement for Innovation

Many have gathered in Washington, DC this week to celebrate National Health IT week.  With the goal of raising awareness regarding healthcare information technology, numerous organizations are highlighting the increasingly essential role it plays in delivering high-quality, patient-centered healthcare.  While few would dispute its pivotal nature, health IT fans must also be quick to acknowledge that in silo it will not render results, but must be strategically utilized in thoughtful, pragmatic processes that drive evidence-based outcomes.  And according to Dr. Andrew Litt, the need for clinical transformation – fundamentally altering the way care is delivered versus simply automating current processes – will be key, if we, as a nation, are to succeed in revolutionizing healthcare.

For the good news, there are multiple examples of innovative programs leading this charge.  One such enterprising example is the congestive heart failure clinic at the Johnson City Medical Center in Tennessee.  Founded by Nurse Practitioner, Julia Bates, this free clinic was established to help patients with education, medication reconciliation, healthcare access issues and disease management.  Having previously extolled the virtues of the nurse led clinic, it would be intriguing to measure the impact of a disease registry combined with population health management tools, striving to engage the patient in a variety of mediums, in this venue.  And better yet, providing access to this website through a patient portal would facilitate the search for appropriate and available health coverage, thereby  minimizing healthcare access issues.  But even with the potential to reduce emergency department re/admissions and generate significant cost savings, this clinic will, no doubt, continue to face many challenges validating this assumption under the auspices of value-based purchasing.

Knowing that they are not alone in this endeavor, with access to Essentia Health System’s pioneering work in their advance practice nurse led heart failure clinic, will prove, however, to be helpful.  As noted in the Agency for Healthcare Research & Quality’s (AHRQ) service delivery innovation brief, Heart Failure Disease Management Improves Outcomes and Reduces Costs, Essentia Health restructured outpatient care for heart failure patients by incorporating a combination of chronic care and disease management principles with home telemonitoring for high-risk patients to decrease medication use, improve outcomes and functional status and reduce readmission rates, length of stay, and overall costs of care for the health system.  Tune in to find out how health information technology and patient-centered process improvement, in concert, enabled this healthcare innovation.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Healthcare Innovation: Moving from Stewardship to Leadership

With the close of the subdued Democratic National Convention this week, there was noticeably scant mention of healthcare reform.  In light of the Supreme Court’s landmark ruling in favor of the Patient Protection and Affordable Care Act (PPACA), perhaps President Obama has checked this off his list.  Given the compelling need to drive cost out of the current bloated system, one might argue, however, that now – more than ever – healthcare reform should be a topic for discussion.  And as Alan Zuckerman, President of Health Strategies and Solutions, states, “(in this new era with new imperatives).. like many other industries, the call to action is how do we do more, or even the same, with less? And with the artificial prop of 5 to 10 percent increases in rates and spending no longer guaranteed, how do we maintain the vitality of our organizations?”

Living in a prosperous economy with profitable reimbursement rates, Zuckerman argues, shields healthcare companies, in particular, non-profit entities, from innovation.   In addition, he points out that the traditional terminology reserved for healthcare leadership – administrator – connotates stewardship versus active management.  In order to tackle this challenge head on, Zuckerman suggests, “busting the status quo, challenging long-held assumptions, envisioning the possibilities when uncertainty is converted to action and forging a new path – that’s what true innovation in healthcare could look like.”  While this can be a daunting charge, “healthcare executives must recognize that their organizations’ cultures are at odds with this new posture and work to reshape the cultures to make them more adaptable, flexible, risk-bearing and (centrally focused on innovation).”  Check out this previous post for more examples.

For organizations having ‘played between the lines’ in the past, how do they adopt this new mindset?  According to Zuckerman, “Peter Drucker’s Harvard Business Review article, “The Discipline of Innovation,” identifies seven sources of innovation, four that are internal — unexpected occurrences, incongruities, process needs, and industry and market changes — and three sources that are external — demographic changes, changes in perception and new knowledge. He suggests that “an innovation has to be simple, and it has to be focused. It should only do one thing…Above all, innovation is work rather than genius.”

Furthermore, he lays out the following five actions to launch the innovation journey:

• Rally senior leaders
• Reexamine and begin to modify your organization’s culture to be more risk-bearing by encouraging experiments and pilots and create a non-punitive environment
• Make innovation a theme of day-to-day operations
• Consider structural changes in the form of a Chief Innovation Officer or committee to support innovation
• Last but not least and my favorite – JUST DO IT!

A leader in the innovation movement, Kaiser Permanente has created a formal consultancy aimed at deploying design thinking to improve the care experience for both the patient and healthcare provider.  Listen in to find out more…

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website