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    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 stand head and shoulders above the competition.

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

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Embracing Change for Healthcare Transformation

Embracing Change for Health Care Transformation

With thousands flocking to Chicago for the annual ACHE Congress on Healthcare Leadership, many were interested in learning more about the strategic initiatives, aimed at delivering ‘high value’ healthcare, manifesting here, there…suddenly everywhere.  Speaking to the increased recognition and velocity for change, Sabrina Rodak highlights six key themes that were no doubt ubiquitous at this moment of metamorphosis for healthcare, and more to the point, the hospital industry.

Building on a recent article in Health Affairs, “Decline In Utilization Rates Signals A Change In The Inpatient Business Model”, Rodak notes that keeping patients healthy through preventive and primary care services, and out of acute care facilities whenever possible via population health management is the new mandate. By focusing on care delivery in the right place at the right time with the right quality, cost, and access, leaders in this new era will transform the health of the system, as well as the nation.

In order to succeed, six fundamental requirements have been defined:

1. Culture. Hospital leaders need to focus on delivering value rather than only acute-care services.  Proponents believe that happy, engaged providers and employees have a more positive impact on patient experience, versus those that do not.

2. Physicians and care delivery. Hospitals will need a strong physician platform to reduce utilization and cost and improve value. In concert with local, affiliated physicians and allied health providers, hospitals and health systems are moving closer to this goal through a variety of care coordination innovations.

3. Communication and HIT. Hospitals need to develop health IT systems to communicate with providers across the care continuum and analyze data to increase value. And with the onset of stage 2 meaningful use, having the tools to define and eradicate potential conflict between patient expectations and evidence-based medicine becomes tantamount.

4. Facilities. Hospital leaders should consider investing in outpatient settings instead of building costly hospital facilities.

5. Contracts. Hospital leaders need to encourage payors to participate in value-based initiatives to support providers who are delivering value. Nimble, forward thinking organizations are exploring a variety of collaborative measures in order to jointly address care delivery innovation.

6. Transformation. Hospitals need to start preparing for a value-based care model now by eliminating clinical variation, reorganizing services and reducing costs.  Checking out the ACHE Congress Management Innovations and Circle of Life winners gives you a small sample of the transformations en route and poised to come.

While measured steps are being taken for positive outcomes, critics of the Health Affairs article argue that this is meaningless activity for those lacking health insurance, mired in sub-optimal social health circumstances and facing a dangerous precipice with potential changes in Medicaid funding. Right, wrong or indifferent, there is one consistent theme – the time is ripe for change.  And as the outgoing ACHE Chairman, Gayle Capozzalo, points out – we, as healthcare leaders, are no strangers to change.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse PractitionerPhysician 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

Collaborating for Mobile Health Innovation

Collaborating for Mobile Health Innovation

As we begin to think about holidays, visions of sugar plum health related apps danced in the heads of the mHealth participants attending the 2012 summit, recently held in Washington, DC.  Billed as the largest event of its kind, the 4th annual mHealth Summit brought together leaders from across the mHealth ecosystem to advance collaboration in the use of wireless technology for improving health outcomes in the United States and abroad.  In efforts to differentiate itself from last year’s event, this summit contained a focus on mHealth research for the purpose of facilitating development and commercialization of empirically-supported solutions for specific disease states in addition to highlighting emerging best practices and sustainable business models for mobile health.

As part of the research track, Dr. Richard Pettigrew, National Institute of Biomedical Imaging and Bioengineering Director, moderated a session entitled, “State of the Science in Research on Mobile Health Technologies.”   During this presentation, Dr. Joseph Cafazzo, Senior Director at the University of Toronto’s University Health Network, stressed the need to streamline processes for mHealth app usability testing, which are often mired in funding and randomized clinical trial requirements.  And together with his co-panelist, Dr. Bonnie Spring, Professor in Preventive Medicine, Psychiatry and Behavioral Sciences at Northwestern University, his comments reinforced the need to establish the utility and value of mHealth technologies.

So, how do we cross this bureaucratic chasm, moving successful design to action?  Being a fan of collaborative innovation, I was delighted to see that George Washington University is already tackling this question.  With representatives from GW faculty in clinical medicine, public health, biostatistics, and engineering, the George Washington mHealth Collaborative has received grants from government, industry, and private foundations to develop and test mobile and electronic health applications for smoking cessation, hypertension, bipolar disorder, diabetes, peritoneal dialysis and prenatal health.  Together with their government and commercial partners, the GW mHealth Collaborative is engaging patients in the use of these solutions.

As so many have noted, physician alignment and leadership is integral to the successful delivery of mHealth.  In the video below, Dr. Joshua Cohen, Professor of Medicine and Director of Endocrinology at George Washington Hospital, aptly points out that the ultimate goal is for apps to be successfully integrated with one’s electronic health record in order to provide a comprehensive, detailed overview within a broader healthcare network.  In the absence of mHealth efficacy studies demonstrating the ability for real people to improve their health, better engage in their care, and enhance communication with their providers, much like the Nutcracker’s Clara, one has to wonder why haven’t we accelerated mHealth collaboration from dreams to reality?

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

Partnering Patients and Providers for Healthcare Technology Innovation

Partnering Patients and Providers for Health Care Technology Innovation

With the conclusion of the first vice presidential debate, the Los Angeles Times noted that discussions regarding healthcare turned prickly and personal.  Such heated rancor suggests that healthcare should become much more personal in the near future.  And speaking of making healthcare personal, the fall Health 2.0 conference commenced this week, debuting and highlighting new technology designed to improve cost transparency, patient engagement and provider workflow.  Having introduced more than 500 companies since its inception in 2007, Health 2.0 co-founders Indu Subaiya and Mathew Holt have helped to galvanize the revolution in healthcare delivery. Sufficiently impressed by several presentations, I will be watching a number of companies; however, my inner skeptic also wonders how many of these start-ups will successfully transcend the o-gap (operationalization), a term coined by Boston Children’s Hospital Chief Innovation Officer, Naomi Fried?

And by ‘operationalization’, I am referring to igniting both the attention and utilization of providers and patients alike.  Building on CryerHealth CEO, Donna Cryer’s definition, “patient engagement in action looks like shared responsibility between patients (and their families if applicable), health care practitioners (the entire team: surgeons, physicians, nurses) and healthcare administrators (providers of the infrastructure and payment models) to co-develop pathways to optimal individual, community and population health.  In order to succeed at this task, Paul Cerrato points out that tech tools alone, are not a magic bullet for patient engagement. Rather, an engaged, consumer driven provider, must also be part of the successful equation.  So, the better question becomes, what steps can be taken to foster this symbiotic relationship?

With a plethora of healthcare IT on the forefront, Rock Health, the first seed accelerator for digital health start-ups, has identified an immediate need for healthcare providers to partner with start-ups in order to verify clinical product efficacy and validity. Given President Obama’s recent legislation calling on HHS to report to Congress on an “appropriate, risk-based regulatory framework pertaining to health information technology, including mobile medical applications” and Rock Health’s interest in developing a formal collaboration process similar to the biotech industry’s clinical trial practice, it would be forward thinking to see academic, as well as, other healthcare providers with an Institutional Review Board (IRB) presence, engage in this activity.  Witnessing the extraordinary outcomes achieved by interdisciplinary teams of researchers, technology experts, clinicians and patients participating in the Robert Wood Johnson Foundation’s Project Health Design project for development of tools to be used by real people to improve their health, better engage in their care, and enhance communication with their providers, why can’t we accelerate this innovation two or three-fold?

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

Implementing Innovative Value-Based Purchasing and Readmission Reduction Strategies

Implementing Innovative Value-Based Purchasing and Readmission Reduction Strategies

No longer is the clock ticking; rather the alarm has sounded and value-based purchasing has commenced.  As this aptly titled article, “Medicare Rolls Out Carrots and Sticks for Hospital Quality”, the author points out that the Centers for Medicare & Medicaid Services (CMS) is now withholding 1 percent of its regular hospital payments and putting that money into a fund to reward hospitals that score well on 20 different quality measures.  Breaking that number down further reveals that seventy percent of a hospital’s score will be based on 12 measures that show how frequently hospitals performed recommended protocols, while the remaining 30 percent of a hospital’s value-based purchasing payment will be based on how it scored on patient surveys taken after they were discharged.

And as if that isn’t enough to contend with, CMS has also enacted the Readmissions Reduction Program, aimed at curtailing the number of patients that are sent back to the hospital.  With one in five Medicare patients typically being readmitted within one month, bringing this number down will help hospitals and healthcare systems avoid the 1% penalty looming in their future.  Some view the penalties as counterproductive since a patient’s behavior beyond the four walls of the hospital is simply beyond their control. And while medication adherence, diet, insurance and mental health status help drive many of these readmissions, CMS believes that hospital can significantly improve transitions and coordination of care.

In the face of two landmark program launches, what will your hospital’s valued-based purchasing and reductions readmission approach be?  According to Evolent Health, a joint venture between the University of Pittsburgh Medical Center system’s Insurance Division and the Advisory Board Company, a variety of paths can be taken based on a provider’s appetite for risk.  Ranging from individual programmatic efforts, to patient centered medical homes or accountable care organizations, providers must first review complex case management, condition management, and pharmacy utilization management to determine the right mix.

Specifically, Evolent Health believes that the following five key ingredients must exist in order to succeed at value-based purchasing:

  • Creating a Coherent View –organizations must integrate multiple sources of information, provide real-time alerts for ED admissions, and be able to transmit care manager notes to the appropriate providers
  • Prioritizing High-Risk Patients – entities must be able toassess patients over a discrete period of time by collecting data and processing it through a rules engine to create predictive models for readmission risks and risk scores
  • Providing the Right Intervention by Building a Targeted and Tiered Intervention Portfolio  – organizations must stratify patients into buckets and create menus of interventions and care management operations to address particular patients
  • Engaging at the Appropriate Intensity Level – depending on intensity, patients must be engaged in the appropriate format and/or forum

Given the current trend in healthcare spend, one would be hard pressed to argue the need for population health management, care coordination and home monitoring technology and processes.  And while large and medium size urban healthcare institutions have the ability to address these mandates head on, the question becomes – how will smaller entities in less well developed communities fare?  A first step in the innovation for value-based purchasing, according to Dr. Gregory Spencer, chief medical officer of Crystal Run Healthcare, is to develop internal processes and a registry for purposes of gaining a better understanding of your patient populations and identifying gaps in care.

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

Implementing Kaizen for a Lean Health Care Transformation

Implementing Kaizen for a Lean Healthcare Transformation

Having recently attended a meeting for the American College of Healthcare Executives, I had the chance to query a hospital CEO, who coincidentally happened to be a Toyota engineer in a former life, about healthcare Kaizen.  After mentioning that his team was currently engaged in a lean project, he, much to my surprise, confessed that he was not very familiar with the concept either.  Given my interest in continuous quality improvement, I decided to investigate further.

Kaizen is an ancient Japanese philosophy that strives to continually improve all aspects of a person’s life.  Recognizing the need for significant change in the late eighties, Dr. Don Berwick, former Administrator for CMS (Centers for Medicare & Medicaid Services) and Harvard Community Health Plan physician, illuminated the concept of Kaizen in an article in the New England Journal of Medicine.  As a potentially crucial concept for improving health care in the United States, Dr. Berwick writes that, “..in the discovery of imperfection lies the chance for processes to improve”.

With a variety of approaches available for organizational improvement, one may wonder, why choose Kaisen?  While Six Sigma is a mathematical process focused on eliminating statistically relevant defects, Kaizen seeks to improve all aspects of a business through process standardization, increased efficiency and waste elimination by focusing on seven core areas – overproduction, defects, unnecessary motion, inventory, space, transportation and waiting time.   Incremental and frequent improvements emanate from ‘Kaizen events’, which involve members from multiple functions and levels in the organization working together to address a problem or improve a particular process in a short time-frame.  By tackling process redesign, positive and immediate impacts can be found in the quality, cost and speed of service with corresponding results in improved customer satisfaction and patient experience.  And if you are still on the fence about the merits for your organization – be it inpatient or outpatient – you must see how the leaders at Salem Health felt about their journey to Japan to witness the Kaizen process first-hand.

Suspended in free fall – with another dismal jobs report sending the Dow careening, healthcare spending slowing, more Americans grappling with healthcare coverage/choices and the onset of value-based purchasing, the time seems ripe for the healthcare industry to usher Kaizen into their organizations.  With experts predicting that 10% of the workforce should be solely focused on working ON the business rather than IN the business, identifying the typical 30-60% of organizational effort that is waste, how will your organization bring this concept to reality for your own healthcare transformation?

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

Achieving Health Equity in the Community, as well as, the Healthcare System

Achieving Health Equity in the Community, as well as, the Health Care System

As we reach the final days of National Minority Health Month, one Healthcare Executive article recently caught my eye.  In John Buell’s, “Equity of Care”, the author stipulates that healthcare systems must focus on six key elements in order to truly achieve quality care.  In absence of efficiency, effectiveness, safety, timeliness, patient-centeredness or equity, Buell contends that institutions are not meeting the mark.  While progress is being made on the first five ingredients, equity is described as, “the last fundamental piece that many hospitals have struggled to achieve but one with which some clear progress is being made.”

According to the author, “equity is achieved by providing care that does not vary in quality on the basis of patients’ personal characteristics such as ethnicity, gender, geographic location and socioeconomic status.”   With the diabetes-related death rate of blacks in the U.S. almost twice that of whites, Dr. Joseph R. Betancourt, Associate Professor of Medicine at Harvard and Director, the Disparities Solutions Center at Massachusetts General Hospital, asserts that social determinants and access to care are the leading contributors to racial and ethnic disparities.  Dr. Betancourt also points out that, “hospitals are not purposefully treating patients differently, but it may mean that hospitals are not doing the extra things to meet the needs of the diverse populations.”

So, what can be done to reverse this trend?  The Disparities Solutions Center provides the following recommendations:

  • Create a disparities committee or task force – multidisciplinary team charged with what is being done to identify and address disparities, including whether or not patients’ race and ethnicity are being collected.
  • Build a foundation to address disparities, including data collection and stratification of quality measures
    • Develop medical policies
    • Finalize a strategic plan with one, three and five year goals
    • Assign leadership and raise awareness with internal and external constituencies
    • Create a dashboard for monitoring assigned measures and standardize processes
    • Develop pilots to address disparities
    • Evaluate, share and re-engineer

While not explicitly addressed at this level, it also remains critical to note that a multicultural workforce  provides a sense of community for prospective patients and resource for creative recommendations to better serve their brethren.  Engaging patients beyond the hospital walls to educate and empower them for better health also holds great promise.  With 45% of the fastest growing segment of the population owning smartphones, are we harnessing this engine to effectively reach Hispanics regarding their significant predisposition to diabetes…and the means to avoid it?  For that matter, is the U.S. taking serious note of the innovative preventive and service delivery measures that less developed countries are employing?  Last but not least, technology is merely an enabler and achieving true equity demands fundamental reassessment of ‘health’ in the community, as well as, the healthcare system.

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

Does Collaborative Continuous Quality Improvement + Technology Innovation = Improved Hospital Value-Based Purchasing Scores?

Does Collaborative Continuous Quality Improvement + Technology Innovation = Improved Hospital Value-Based Purchasing Scores?

Poised at the nexus of Supreme Court oral arguments for health care reform constitutionality and the close of the Centers for Medicare and Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) nine month performance period (July 2011-March 2012), hospitals eagerly anticipate news regarding their FY2013 Medicare reimbursement.  Beginning October 2012, CMS will reduce base operating diagnosis-related group (DRG) payment to all hospitals reimbursed under the inpatient prospective payment system (IPPS) model by 1 percent, with the amount gradually increasing to 2 percent by FY 2017.  Monies withheld will be used to create an incentive fund for future hospital performance based payment relative to identified domains of quality measures. Final determination of payment from the 1 percent withholding will be calculated as a linear function based on all participating entities, meaning that organizations must demonstrate continuous quality improvement in order not to fall behind their peers.

As outlined in the FY 2013HVBP final rule, an overall performance score will be calculated by assessing achievement and improvement for an institution’s Clinical Process of Care Measures and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient survey feedback.  In determining the final score, CMS will weigh the HCAHPS results at 30 percent and the Clinical Care Core Measures results at 70 percent.

For each of the 17 measures (12 identified for FY2013 shown below) included under the Clinical Process of Care Measures, CMS will use hospital data to calculate a performance score ranging from 0 to 10. A hospital earns an achievement score based on how well it did relative to a lower threshold and upper benchmark (generally 1.0 or 100%) calculated from all hospitals’ previous baseline scores, and an improvement score based on whether it beat its own performance during the baseline period. CMS uses the higher of these two scores for its official tally. In theory, a hospital could receive all 10 points if it beats the achievement benchmark, or 0 if it fails to meet the achievement threshold or better its own previous score.

Measure ID Clinical Process of Care Measure Description Threshold
AMI-7a Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival 0.6548
AMI-8a Primary PCI Received Within 90 Minutes of Hospital Arrival 0.9186
HF-1 Discharge Instructions 0.9077
PN-3b Blood Cultures Performed in the Emergency Department Prior to Antibiotic Received in Hospital 0.9643
PN-6 Initial Antibiotic Selection for CAP in Immunocompetent Patient 0.9277
SCIP-Inf-1 Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision 0.9735
SCIP-Inf-2 Prophylactic Antibiotic Selection for Surgical Patients 0.9766
SCIP-Inf-3 Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time 0.9507
SCIP-Inf-4 Cardiac Surgery Patients with Controlled 6AM Postoperative Serum Glucose 0.9428
SCIP-VTE1 Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered 0.95
SCIP-VTE2 Surgery Patients Receiving VTP w/I 24Hours Prior to Surgery to 24 Hours After Surgery 0.9307
SCIP-Card-2 Surgery Patients on a Beta Blocker Prior to Arrival Receiving a BB During the Perioperative Period 0.9399

Scoring remains relatively the same for the eight measures based on the HCAHPS patient surveys. Hospitals, however, also can earn up to 20 consistency points based on how well their single lowest score stacks up to the competition. Hospitals will receive a percentage grade based on how many points they scored out of the possible total.  CMS will post all scores on its Hospital Compare site and use the final performance score to determine the value-based incentive payment.

Domain Question Min 50th % Benchmk
Nursing Nurse courtesy and respect 38.98 75.18 84.7
Communication Nurse listens carefully
Nurse explanations are clear
Doctor Doctor courtesy and respect 51.51 79.42 88.95
Communication Doctor listens carefully
Doctor explanations are clear
Staff Did you need help in getting to bathroom? 30.25 61.82 77.69
Responsiveness Staff helped with bathroom needs
Call button answered
Pain Did you need medicine for pain? 34.76 68.75 77.9
Management Pain well controlled
Staff helped patient with pain
Medication Were you given any new meds? 29.27 59.28 70.42
Instructions Staff explained medicine
Staff clearly described side effects
Discharge Did you go to a home or another facility? 50.47 81.93 89.09
Information Staff discussed help needed post discharge?
Written symptom/health info provided
Cleanliness and Quietness Area around room quiet at night 36.88 62.8 77.64
Hospital Room and bathroom kept clean
Overall Rating Hospital rating question 29.32 66.02 82.52

While CMS’ Hospital Value-Based Purchasing Final Rule refers to Medicare patients only, private payers are quickly advancing towards a quality based reimbursement model as well.  As the bar continues to be raised in pursuit of improved quality and better value, how will your organization prepare for this challenge?  With less time to address the much more speculative HCHAPHS scores, does this provide the greatest area for improvement?  Since many enterprising organizations are currently engaged in this process, will innovative technology coupled with collaborative continuous quality improvement keep your institution in the race?

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

*Graphic courtesy of Triple Tree Research

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