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Real Issues : Real Solutions

SEP/OCT 2013

Cornerstone Health Care Building A Physician-Led, Value-Driven Organization

HEALTHCARE EXECUTIVE EXCHANGE MAGAZINE | www.healthcareix.com


Real Issues : Real Solutions

CONTENTS

04 Cornerstone Health Care

IN-FOCUS STORIES 10 Dallas Medical Center 12 Dental Health Associates, P.A. 16 Consulting Radiologists, Ltd. 20 Camillus House 24 New York Gracie Square Hospital 26 Molina Healthcare, Inc 30 Schneider Regional Medical Center 33 Smartlinx Solutions, LLC 36 Plus One Health Management

Grace E. Terrell, MD, President and Chief Executive Officer

HCE EXCHANGE

39 The Innovation Institute, LLC 42 Queens Boulevard Extended Care Facility, Inc. 46 Richmond University Medical Center

SEP/OCT

2013


Focus for Today, Vision for the Future “It’s crucial to pick a solid product but even more important to have a company behind the product that’s going to listen to you, adapt and create new solutions. We have found that with Allscripts.” – Grace Terrell, M.D. Chief Executive Officer, Cornerstone Healthcare

www.allscripts.com

Allscripts Allscripts is the leading provider of healthcare technology that empowers caregivers and healthcare organizations to deliver better patient outcomes. Through our clinical, revenue cycle, connectivity and information solutions, Allscripts works with physicians, hospitals and post-acute organizations across the world­—including Cornerstone Health Care—to advance population health.

CORNERSTONE HEALTH CARE As the healthcare landscape changes, more physicians are considering either hospital employment or other avenues that will allow them to focus less on running an office and more on providing quality care to patients. One multispecialty physician practice in North Carolina offers a unique model for physicians to practice under, in addition to pioneering new models for care delivery.

Learn about how Allscripts is building an Open, Connected Community of Health™. www.allscripts.com

BUILDING A PHYSICIAN-LED, VALUE-DRIVEN ORGANIZATION Cornerstone Health Care is physician-owned and led, not just by virtue of its president and chief executive officer Grace E. Terrell, MD, being a physician, but also in how physicians play a role in decision-making. Physicians run the board, they serve on committees, and some even become shareholders. Cornerstone was formed in 1995, when many healthcare organizations were expecting to see some iteration of government reform. Terrell specialized in internal medicine and was working for her in-laws’ medical practice at the time. She and a group of physicians from 15 practices in and around High Point, N.C., met together to discuss primary care and where the healthcare industry may be headed. After 18 months, the senior partners in these 15 practices decided to merge together to form a multispecialty physician group. Now, the practice spans a two-hour driving geographic range,

HCE EXCHANGE MAGAZINE

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15 hospitals, and 375 physicians and advanced-

tion and came up with protocols that are now being

practice, which has then tracked the differences in

practice providers.

integrated into the EMR.”

terms of controlling the disease.

The first few years of the organization were

BETTER CARE. BETTER HEALTH. LOWER COSTS. MedCost salutes Cornerstone Health Care for being an innovator in the industry. As a trusted advisor for employer self-funded health plans, MedCost embraces this same vision of improved health, quality patient experience, and affordability. We support this by: • Working closely with clients to customize benefit solutions for each unique population. • Managing costs effectively through highly successful clinical health programs. • Improving health outcomes and a plan’s bottom line with a commitment to physical and fiscal health. Together, we bring value to employers and health plan members alike. www.medcost.com 800-433-9178

IT investment has also been key to quality initia-

This practice has also expanded to other pre-

spent learning to become positive business leaders,

tives, as physicians have analytic and predictive

ventive and management services such as screen-

growing the practice, and adding specialties. By

modeling tools. Patient-care advocates, oncology

ings.

2005, the group began to expand, adding electronic

patient navigators, and advanced-practice providers

medical records and building a 100,000-square-foot

are also heavily used at Cornerstone.

ambulatory clinic. But then, the recession hit in 2008, local un-

“We are all having challenges with the short-

Furthermore, many service lines are taking a team-based approach to providing care, particularly in oncology and the heart-function clinic.

age of primary-care physicians,” Terrell said. “We

Terrell said the group is seeing remarkable results

employment rose, and fees were cut. Cornerstone

have a lot of mid-range providers, and we try to

with the sickest patients. She credits the success

looked for a way to contain costs and increase

make sure we are using everyone to the full extent

of many of these programs to the fact that the

value. Terrell said the organization immediately

of their licensure. That is a mindset change for a lot

physicians are designing and putting them together.

chose to implement a value-based model, and by

of people and requires training. The things we are

Everyone has a vested interest and those closest to

2012, the group had renegotiated all managed-care

doing are a lot of hard work, and we face competi-

the patients are the ones developing the solutions.

contracts to be value-based rather than fee-for-

tion as there is a lot of consolidation in the market,

service.

but as long as we keep making sure we’re doing the

about Cornerstone’s role in the marketplace as

right thing for patients, that usually gets us where

healthcare faces monumental changes.

“We had to make substantial investments in information technology and change the way we practice medicine,” she explained. “We are seeing year-over-year improvement now in our Medicare claims, plus improvement in cost, quality, and patient satisfaction.” As part of being a value-driven organization,

we want to go.”

TRANSITIONING TO POPULATION HEALTH MANAGEMENT With reform now in place and a greater focus

Cornerstone is recognized as a National Commit-

on managing chronic conditions throughout the

tee for Quality Assurance Level 3 Patient-Centered

healthcare industry, Cornerstone is also looking at

Medical Home.

ways to “morph from a traditional multispecialty

IMPLEMENTING PATIENTCENTERED QUALITY INITIATIVES

no reason why we shouldn’t work on it. We will continue to innovate and change to meet what the market needs.” BY PATRICIA CHANEY

Current investments for the group include informatics tools and new facilities, including a concierge practice for dual-eligible patients and a facility for an extensivist who is seeing the one

reorganized physicians into service lines rather

percent sickest patients.

“Our physicians meet together and pick the

pensive and of lower quality,” she said. “There’s

ment company,” Terrell said.

tives to manage chronic conditions. They have also

improve quality in their services.

“Many people believe healthcare is too ex-

medical practice into a true population manage-

Cornerstone’s physicians are developing initia-

than practices, where physicians work together to

As a result, she is excited about the future and

In managing patients with diabetes, Cornerstone uses analytics tools to identify patients who haven’t been seen by a primary-care provider in the

top three things in their service lines where they

previous six months and suffer from A1C, hemoglo-

can make the most impact on quality or cost,” she

bin, blood pressure, or cholesterol that is uncon-

said. “For example, our neurology group looked at

trolled by standard definitions. Medical assistants

migraine management throughout the organiza-

then call those patients to invite them back to the

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

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02 | DALLAS MEDICAL CENTER

Allied Telesis Allied Telesis partnered with Dallas Medical Center to deliver a modern network with managed services, designed to optimize the performance of new, integrated systems including EMR/EHR, PACS, pharmacology, OR scheduling, automated back-up and a HIS that simplified new patient admissions. To learn more about Allied Telesis and advanced IT network and data center solutions that drive better patient outcomes, visit alliedtelesis.com/healthcare.

INDUSTRY PARTNERS Criticare Nurse Staffing Agency www.criticare.net

DALLAS MEDICAL CENTER

REGAINING THE TRUST OF STAFF AND PHYSICIANS With a background in hospital turnarounds, Raji’s first priority was to involve herself in the day-today operations of the physicians and staff, making

Nearly four years ago, Dallas Medical Center, a 155-bed hospital with four medical plazas located in the suburb of Farmers Branch just north of Dallas, Texas, was struggling to stay alive. It was losing money at a rate of $2 million a month and was on the brink of closing its doors.

herself accessible to them and working with both to facilitate a plan that would refocus the organization’s mission. She said their input on what was working and what was not working in the past was invaluable in accomplishing her first goal of stabilizing the workforce and attracting physicians back to the hospital.

Raji Kumar, President and Chief Executive Officer

In late 2009, a private investor, determining the hospital was too valuable an asset for the community to lose, brought in a management company, PSG, to orchestrate a major turnaround of the facility. This turnaround, led by Raji Kumar, president and chief executive officer, would transform Dallas Medical Center into an efficient, quality-driven healthcare organization.

“A hospital turnaround is not a sequential pro-

John Beall, chief nursing officer, someone she said exemplified the qualities desired in her leadership

cess,” she said. “You have to have many irons in the

team from his first interview. For one thing, Beall

fire. But first is visibility. People need to know they

had grown up in the community and as a result,

have a leader, that you have a plan, and that we can

took the hospital’s quality of care personally.

get out of this, but we have to work together.” In three years, she has recruited more than

“This is my community’s hospital. I live just up the street, so if I were to become ill, this would

100 physicians, including program directors with

be where I would be taken,” he said. “And I want

a reputation for quality. Recently Raji brought on

to make sure, if for no other reason than a selfish

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

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one, that good care is provided here. I have a vested interest in this hospital’s success.” With individuals like Beall on her team, Raji had confidence about Dallas Medical Center’s future. “It was great to know that we had a team motivated to see this place survive,” she said.

REDEFINING THE HOSPITAL’S PLACE IN THE COMMUNITY In addition to stabilizing the workforce, an integral part of Raji’s strategy was the reevaluation of service lines. Dallas Medical Center had been seeing abysmal census numbers, maintaining an average census of 17 and performing only 50 to 70 surgeries each month. A decision was made to institute three new service lines: spine, orthopedic surgery, and a workers’ compensation program. These new service lines led to a significant increase in volume, and the hospital now performs nearly 400 surgeries a month. Rebranding and renaming the facility was another crucial step, not only in determining who

REDUCING COSTS AND IMPROVING ALIGNMENT Dallas Medical Center had several major issues that led to its financial struggles, Raji recalled. For example, the real estate had been owned by Metrocrest Hospital Authority for more than 30 years, but the operations of the hospital had been leased by several different companies that were not really interested in the physical plant. “The land was owned by a different entity; operations were owned by yet another entity, and when they decided they were not going to renew their leases, there was no more investing in infrastructure,” she said. “A lot of things slipped through the cracks as a result of those two interests not aligning.” Since coming aboard, Raji has made huge strides in reducing overall costs and has renegotiated all managed-care contracts, which is something that had previously been pushed aside. Raji also knew that partnering with a larger health system

the hospital was, but also in reintroducing it to the

was going to be key to the hospital’s long-term

“Making every decision in the best interest of the

survival.

patient is the key,” Beall said. “It’s somewhat of a

“I knew six months into the job that we were go-

community. “The hospital had gone through an identity crisis, so we had to rebrand,” Raji said. “It has taken about three years for people locally to call it Dallas Medical Center.”

ing to need to be part of a bigger system,” she said.

overemphasized. We really have to stay focused

Dallas Medical Center approached many larger sys-

on what is right for our patients and that means

tems, and in late 2012, Prime Healthcare Services

having the right people providing the care, the

acquired the hospital.

right leaders overseeing those who are provid-

According to Raji, “Prime Healthcare picked

Another important component to her strategy was community outreach. Beall said the medical center has cultivated a presence at most community events, including functions held in neighboring “We are involved in the Chamber of Commerce [and] on boards of civic organizations,” he said. “We have connectivity with ambulance services and

that involves that patient’s experience needs to be

shown we are survivors, as well as examining the

centered around what is in the best interest of the

market and seeing that we have a future here.”

patient.”

ship with a nearby nursing school. Connectivity with the community is integral to the hospital’s success.

was recently recognized as one of the 120 Women

“growth mode.” Raji said the past year has been

Hospital and Health System Leaders to Know by

spent recruiting talent and assembling a unified

Becker’s Review. “We need to run the hospital right to stay alive

finding the proper balance between quality and cost

for the community,” Raji stated. “If we are not

effectiveness.

responsible business leaders, we can’t take care of

Looking forward, the organization plans to

We’re going to expound on that even more. ”

For her efforts at Dallas Medical Center, Raji

is now moving beyond “survival mode” and into

team for moving forward, as well as focusing on

paramedics, and we are about to forge a relation-

ing the care, and the right equipment. Everything

us up based on the efforts of our team and we’ve

With the acquisition, Dallas Medical Center

cities.

buzzword in our industry to say that, but it can’t be

invest about $16 million into updating infrastructure and equipment.

the community and patients, because we won’t be there for them.” BY PATRICIA CHANEY AND PETE FERNBAUGH

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

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03 | DENTAL HEALTH ASSOCIATES, P.A.

REACHING AN EXPANDING MEDICAID BASE Dental Health Associates, P.A.’s current patient base is a mixture of Medicaid, capitation, PPOs, and full fee-for-service. Over the last five years, with the economy in a tailspin, Dental Health Associates, P.A., has undergone a rotational shift to increase its outreach to the NJ Medicaid and Family Care populations, the state’s version of the nationwide CHIP program.

Edison Equities is a real estate firm focused on the purchase and development of commercial property in the tri-state area for over 25 years. We have had a successful 10 year relationship with Dental Health Associates as our tenant in Livingston Plaza in North Brunswick, NJ and look forward to continuing it. We would welcome DHA in any of our upcoming projects.

In New Jersey, it is unusual for a provider to deliberately look to expand its presence among this patient base, but the program is gaining traction, Lisman said, with “significant hurdles” still existing “that deter the vast majority of providers from

We congratulate Dr. Lisman on his achievements and selection to be interviewed by HCE Exchange.

entering into the system.” While this is a net positive for Dental Health Associates, P.A., it also presents a challenge both in

DENTAL HEALTH ASSOCIATES, P.A.

educating this patient base on receiving the care they need and understanding and following federal and state regulations pertaining to documentation, claim submissions, and reimbursements.

Based in New Jersey, Dental Health Associates, P.A., is spread across nine locations in the Garden State, with each location featuring full- and part-time general dentists, dental hygienists, and specialists who deliver a wide-ranging catalog of services, from episodic emergency care to boutique dentistry, to a patient base that ranges from infants to geriatrics.

Clifford G. Lisman, D.M.D., President and Chief Executive Officer

In spite of having nurtured a significant infrastructure platform from which to grow, Clifford G. Lisman, D.M.D., president and chief executive officer, who founded Dental Health Associates, P.A., in 1986 after buying out his father’s practice, said he is “never satisfied and never happy” with remaining in one place as an organization or as an individual. Having graduated from Rutgers University in 1975, he is again a full-time student at the university, where he is pursuing an MBA; professionally, Lisman has positioned Dental Health Associates, P.A., to carry on his father’s legacy into the healthcare reform era. “Yes, the company is stable,” he said, “but also always evolving and changing. Stable should not be equated with static.”

EMPOWERMENT THROUGH EDUCATION Lisman said there is one pervasive factor that makes the education of Dental Health Associates, P.A.’s patient base difficult: “Unfortunately, most patients have the attitude that if it isn‘t covered by their insurance, it’s not necessary.” As a result, Dental Health Associates, P.A., has to demonstrate the value of the services it provides and recommends, emphasizing the necessity of taking one’s care into their own hands, rather than allowing the insurance companies to determine their overall dental health and medical wellbeing.

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309 B South Main St. Phillipsburg, NJ 08865 Phone: (908) 777-3700 | Fax: (908) 777-3702 Email: info@jpglv.com Real Issues : Real Solutions


Therefore, he said, “empowering providers, staff,

tient satisfaction scores are fast becoming a priority

and patients through education is a significant

of the industry.

and ongoing project to have everyone understand

Dental Health Associates, P.A., is currently es-

the value of the services that we recommend and

tablishing a system wherein “providers’ compensa-

provide.”

tion will also have a component tied into patient sat-

The company’s efforts include multiple com-

isfaction, quality of care, compliance with protocols,

munity outreach programs. Its marketing director

and interaction among other staff members within

and community coordinator spends a great deal of

the practice to enhance and further those types of

time in schools and at health fairs. Dental Health

behaviors that we’re looking for and to be ahead of

Associates, P.A., itself has put on major health fairs

the curve as to what’s coming down the pike.”

over the past years where they attracted over 1,000 people on average.

In many ways, Lisman added, he has an advantage in that he is intricately connected and

“We have providers from different offices come

networked with HMO and state officials, giving his

down, and we do dental screenings for people that

organization an inside track on what’s happening

come by,” Lisman said. “Last year, we opened it up,

and a multi-dimensional understanding of the rules

and we were providing free dental care for preg-

and regulations that exist for the NJ FamilyCare

nant women as a means of spreading the word that

population, as well as for other payers.

pregnant women should undergo dental care on a

Lisman is also involved with the New Jersey

routine basis and also to help educate and stimu-

Dental Association, the state Medicaid committee,

late our providers that this is what they should be

and the New Jersey Oral Health Coalition. He serves

routinely doing as well.”

on the quality management committee for United

REVAMPING PROVIDER INCENTIVES FOR A CHANGING MARKET

Healthcare and is a co-state leader for the Office of Head Start, helping to ensure that every head-start child is placed in a dental home. “Many of the insurance companies often will call

As with the rest of healthcare, compensation within

me or interact with me on protocols,” he said. When

dentistry has been based upon production as op-

they don’t get it right, he is forced to correct them

posed to patient satisfaction.

or in some cases, take them to court to legally de-

However, Lisman explained the oversight, moni-

mand compliance with federal and state mandates.

toring, and measuring of procedures by third-party

One company in particular, he said, has “now

payers and federal entities has become just as in-

corrected most of the issues that I have alleged in

tense within dental care as in the rest of healthcare,

the lawsuit that were problematic, but I am still go-

and the need to root out fraud, waste, and abuse is

ing after them for damages.”

being heavily emphasized now. Furthermore, pa-

LISMAN SAID HIS COMPANY’S MISSION STATEMENT “IS TO ACHIEVE 100 PERCENT PATIENT SATISFACTION.”

COMMITTED TO CORE VALUES Lisman said his company’s mission statement “is to achieve 100 percent patient satisfaction.” Its three core focus values are achieving patient satisfaction and quality care; achieving employee satisfaction, growth, and development; and achieving practice growth and profitability. “We must have all three in order to be successful and most fortunately all three work in a very symbiotic relationship with each other and they enhance each other,” he said. “Every once in a while, there is a conflict between one or the other, and if there is a conflict, we always resolve the conflict by one superseding two and two superseding three. And that’s how I make my business decisions and clinical decisions on a routine and daily basis.” BY PETE FERNBAUGH

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

15


04 | CONSULTING RADIOLOGISTS, LTD.

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RESTROOM SUPPLIES

CLEANING CHEMICALS

We take care of the details, so you can focus on your business. Our company has been delivering superior customer service to businesses throughout North America for nearly 125 years, and the secret to our sustainability is our ability to evolve over time. We are a strategic business partner that delivers relevant solutions that respond to our customers’ ever changing needs. Our quality and service is unmatched in the industry and our innovative technology and attentive team ensures your order is on time, every time. For a clean you can count on, from people you can count on, go to

www.ameripride.com or call us at

612.362.0306

CONSULTING RADIOLOGISTS, LTD.

Consulting Radiologists, Ltd., has been around for over 80 years, growing into an expansive subspecialized radiology practice that offers telemedicine and onsite services, along with a multitude of procedures, such as neurointerventional radiology, body interventional radiology, and basic musculoskeletal radiology. With 83 board-certified radiologists, CRL is spread across five states at over 100 sites, approximately 60 of which feature telemedicine and 40 of which feature both on-site service and telemedicine. With a sophisticated IT infrastructure that enables the easy transfer of images, PACS, and reports, CRL provides 24/7 read coverage to its clients. The company is heavily focused on tertiary hospitals and clinics in the metropolitan areas of Minneapolis and St. Paul, as well as large hospitals in smaller, more rural areas, such as North Dakota, South Dakota, Iowa, and Wisconsin.

AN INNOVATIVE PRODUCT LINE One of the cornerstones of CRL’s product line is its voice-to-text service, a specialized voice-translation interface programmed specifically for radiologists

Relying on traditional advertising, a traveling sales force, and word-of-mouth testimonials from referring practices and hospital systems, CRL has seen its business grow even in challenging economic

and the vocabulary, templates, and order sets they

times.

use to write reports.

A TRIPLE-AIM COMPETITIVE STRATEGY

Instead of dictating into a system where a transcriptionist then types it up and sends it back to the radiologist for editing, CRL’s interface processes it immediately, eliminating the transcription middleman, and allowing radiologists to get their final report to their patients with little delay. CRL is in the process of preparing this interface for other specialties. The practice also offers independently owned freestanding outpatient imaging centers to its clients.

What keeps CRL competitive with larger systems is its triple-aim focus on service quality, clinical quality, and value. For example, in the area of service, with its voice-to-text interface, CRL offers a first-rate turnaround time for readings, not to mention 24/7 phone consultation for any provider with questions about those reads. These consultations involve

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17


are being bought up by larger systems already in possession of highly sophisticated radiological capabilities. These systems tend to employ their physicians as well. Despite the attraction inherent in the employee model, however, a partnership with CRL, which is completely physician-owned and led, carries additional incentives. Recently, CRL aligned itself with a hospital that had two aging doctors on site who lacked surgical capabilities. As a result, the hospital, a regional referral center, was limited in the level of care it could provide to the surrounding rural community. Once CRL launched its service at the site, it spent a couple of weeks training the hospital’s radiological technologists on procedures they might have learned in medical school, but had not been able to practice in recent years because the hospital didn’t have those procedures. By building these relationships, this hospital will be able to use its partnership with CRL to provide radiological coverage and telemedicine services to well-trained, highly subspecialized radiologists

cians rereading them and rating the accuracy of the

its clients, clearing the pathway for a higher level of

who provide one-on-one assistance in 10 different

original read.

care, growing volumes, and a more fulfilling work

subspecialties.

If a reading is less than perfect, CRL follows up

This is better than relying on those on-call and in-house to read a CT, CRL believes, especially

with the specialist to see if they understand what they missed.

if those on-call are of another specialty. When a

CRL also sees the need for value in a climate of

environment for its physicians. CRL believes this kind of collaboration is something for which the larger, more sophisticated hospital systems are still searching.

specialist tries to read a CT that isn’t in their realm

alignment and declining reimbursements, where

In fact, it’s CRL’s sophisticated on-site cover-

of expertise, the result can lessen the rate of ac-

physicians and hospitals are unable to survive on

age, procedural capability, and involvement in its

curacy.

quality alone.

clients’ medical staff community that gives this

CRL also integrates itself with clients’ medi-

CRL is determined to help its clients identify

cal staffs, participating in meetings and decisions

alternative sources of revenue and develop a diver-

around how the institution wants to handle clinical

sified portfolio that keeps them from being depen-

care and physician relationships.

dent on one or two revenue streams. CRL wants its

CRL says none of its competitors provide this type of integrative compatibility to the extent that it does.

carried out aggressively and enthusiastically.

at the country’s leading institutions. CRL is also studious about its internal quality improvement

The greatest challenge facing CRL right now is the

program, which involves peer reviews of a majority

acquisition trend in healthcare, in which many of the

of the reads that are processed, with other physi-

hospitals and practices that would need its services

cians are well-trained and board-certified, educated

healthcare marketplace.

clients to grow a culture in which the triple aim is

PROVIDING PERSONALIZED, RELATIONSHIP-BASED SERVICES

In terms of clinical quality, all of CRL’s physi-

veteran company a competitive advantage in the

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05 | CAMILLUS HOUSE

Coastal Construction Company

CAMILLUS HOUSE

In 1960, a Roman Catholic ministry, Little Brothers of the Good Shepherd, opened a soup kitchen in Miami-Dade County, Florida, to provide food and beverages to Cuban men living in public spaces near downtown Miami’s Freedom Tower. Eventually, Brother Mathias Barrett was also able to open a small shelter and offer beds at a rented house.

Dr. Paul R. Ahr, President and Chief Executive Officer

Since then, Brother Mathias’ operation, Camillus House, has grown to 16 locations throughout the county that provide comprehensive, compassionate care to the neediest among Miami’s homeless population.

In 1988, Chairman & CEO, Thomas P. Murphy, Jr., incorporated Coastal Construction Company. Today, as one of the leading construction management companies in Florida, Coastal’s divisions include hospitality, commercial, residential, educational, and institutional. Coastal’s passion for excellence extends beyond the job site. Among our core values of Integrity, Safety, and Quality, is our emphasis on being a trusted community member.

PROVIDING SERVICES FOR THE NEEDIEST INDIVIDUALS Camillus House’s mission at its most basic is to fulfill the Catholic Church’s Works of Mercy, which include feeding the hungry, clothing the poor, and sheltering those without homes. The organization provides emergency, transitional, and permanent housing; substance abuse and mental-health treatment; basic healthcare and dental care through its sister organization, Camillus Health; and hospitality services including food, showers, clothing, case management, and rent assistance. Camillus House cares for people who meet the definition of persons who are chronically homeless -- defined as someone who is homeless for a year or longer or experiencing four episodes of homelessness in three years -- and have a disabling condition such as mental illness, substance abuse,

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

21


There is a commissary, a larger kitchen and

He added that the medical conditions afflicting most

dining space, an 80-unit apartment building that

of these individuals are the same as those found in

provides low-rent housing, a 128-bed treatment

the general population, including diabetes, coronary

center, a 48-bed overnight shelter for men and

artery disease, and hypertension.

women, a 64-bed job readiness center, a 20-bed medical respite unit, isolation rooms, and medical

those who are chronically homeless and struggling

outpatient clinics. Persons who are homeless can

the most to get off the streets to overcome disabili-

shower three days a week, and Camillus House is

ties or illness and to become productive members

the only place in the county where women who are

of the general population. Ahr said through the work

homeless have access to a shower. Individuals off

of other organizations that serve individuals who

the street can also receive barbershop services,

experience temporary episodes of homelessness,

use the Post Office, and visit a nondenominational

Camillus can help end chronic homelessness.

chapel. During the next few years, Camillus will add

called Camillus Health to provide basic healthcare

This is a smaller niche within the homeless popula-

services to more than 5,000 patients a year.

tion, but one in desperate need of Camillus’ services. “Many people we see at Camillus House who are

Miami-Dade County levies a one percent tax on food and beverages sold at establishments is administered to civic organizations through the

get on with their lives,” said Dr. Paul Ahr, presi-

Miami-Dade County Homeless Trust.

people becoming homeless who don’t have dis-

pus.

abling conditions, we are able to keep our focus on

ment grants, many of which are administered by the

injuries, and those who are chronically homeless

Homeless Trust, fees paid by those using services

usually have substance abuse, untreated mental ill-

such as transitional housing, healthcare, and treat-

ness, or some form of a criminal record as well.”

ment programs support Camillus House’s mis-

The organization serves as a blessing to many

we will nearly eliminate chronic homelessness in the county, and I hope that in the future we will be

Camillus House has grown from one substance

dealing with people in the early stages of homeless-

abuse program eight years ago to five programs

ness.”

for mental illness or substance abuse. “We are evolving as a treatment entity to deal

BY PATRICIA CHANEY

with the issues our population has,” Ahr said.

sion. Residents in transitional housing must hold a job and pay monthly program fees. Residents in

“Some people spend their lives on the street,

permanent apartments must contribute 30 percent

but we reach out to them and are able to put them in

of their incomes to program fees and participate in

permanent housing where they are able to live with

supportive services to gain independence and move

dignity and peace,” Ahr said.

on to unsupported housing.

EXPANDING CARE TO MEET BASIC NEEDS

that population. I believe in seven or eight years,

In addition to private philanthropy and govern-

persons who are homeless have traumatic brain

individuals who find Camillus late in life.

he said. “Through their good work to intercept

with incomes over $400,000 a year. This revenue

homeless have a narrow range of choices on how to dent and chief executive officer. “A large portion of

“We have a lot of other agencies in the county,”

more office space and a Catholic Church on cam-

OUT OF ONE PROGRAM CAME MANY a chronic medical illness, or a physical condition.

Overall, Camillus House’s mission is to help

In 2008, after many years of planning, Camillus began an $84 million construction project to bring more services to one campus. The expanded

Camillus houses about 900 people a night and

campus will have seven buildings, four of which are

serves 350,000 free meals a year. The Brothers of

already built and operational, and will be able to

the Good Shepherd who sponsor Camillus House

house 340 individuals a night.

also operate a separate nonprofit organization

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

23


06 | NEW YORK GRACIE SQUARE HOSPITAL NouvMedAdFinalRev:Layout 1

NEW YORK GRACIE SQUARE HOSPITAL

5/23/08

3:43 PM

Page 1

INSTITUTIONAL

“When I look at [potential hires], I make sure they

New York Gracie Square Hospital has been a fixture within the Greater New York Metropolitan Area since 1959. A member of The New York Presbyterian Healthcare Network, this 157-bed inpatient facility provides psychiatric and Dual Focus care to mentally ill and chemically addicted adult and geriatric patients.

have the passion for their role as the leader,” he stated. “I make sure they really like what they’re doing, really like being challenged with responsibility, and set an example to the staff members.” He also wants his leadership team to not fear possible failure but to embrace it head-on, always moving forward.

Johnny Kuo, Chief Operating Officer

New York Gracie Square is especially focused on the Asian community; however, Johnny Kuo, chief operating officer, was quick to clarify that New York Gracie Square’s patient population is actually quite diverse. Kuo also said many people aren’t aware of the extent of care New York Gracie Square provides to its patients. “It’s a basic need of the community,” he explained. “There are not many psychiatric facilities around Manhattan.” The last few years of economic turmoil have made New York Gracie Square’s operations even more important to its area, and the hospital is expanding its patient floors from seven beds to 27 beds. It is also in the process of upgrading to electronic medical records.

“That to me is considered passion,” he concluded.

PATIENT SAFETY IS THE AGENDA

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Kuo strives to channel this passion into patient safety. “That’s a key element for people to know,” he

Nouveau realizes that each elevator in our care is critical to your operation. So we train our staff to learn the special needs of every business in every industry we serve. When you choose Nouveau, you’ve chosen the highest level of pro-active care available. At Nouveau, we’re raising New York.

said. “We are focused heavily on patient safety. No matter the agenda in any type of meeting that we

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have, patient safety is always the highest on the

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agenda.” He added, “We don’t play around with the patient safety at the facility, so [family members] know that we have highly skilled and trained pro-

PROVIDING CARE TO VICTIMS OF A BAD ECONOMY

credential requirements,” Kuo explained. “Being properly informed of the prerequisites is necessary

Kuo said this expansion has come about largely

for efficient management.”

because of the bad economy.

QUALITY DRIVEN BY PASSION

“Within the last four to five years, the economy has really hit a lot of family members, the people without a job,” he related. “We see a lot of these types of patients. They did really well in their careers, but they lost their job. A lot of these patients come to us.” Most patients tend to stay for a short period of time, seven to 14 days, because they need counseling, reassurance, courage, and the motivation “to get their feet back on track.” It’s important, then, he said, that his team is not only dynamic in the leadership and care they provide, but also knowledgeable. “I think that the executive healthcare manager needs to be knowledgeable of the current guidelines and regulations, professional standards and

fessionals above taking care of patients.”

INDUSTRY PARTNERS

The hospital is currently transitioning to the

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Six Sigma model of care, another way in which he wants to test his team’s abilities and limits until

Kuo himself has an established role within the community, having been COO since August 2000.

they’re top-notch professionals. “We are developing people at all positions to

He refuses to settle for “merely acceptable” service

Kuo has also emphasized evolving education

and keeps raising expectations for the quality of the

since the earliest days of his tenure, when he re-

care and services New York Gracie Square pro-

quired all of his therapists to be licensed in clinical

vides.

care.

During his time at New York Gracie Square,

“We have to provide the latest education at the

he has forged a tightly knit team, he said, one that

facility where the people are if we expect to remain

contributes to the hospital’s quality, something re-

the top program,” he said. “The hospital has to

flected in the fact that they have met or surpassed

improve process, customer service, and quality of

all of CMS’ core measures and standards.

care.”

So high are his team’s expectations of what

Matco Service Corp. www.matcoservice.com

achieve excellence,” he said.

In fact, his team represents the advice he gives to all healthcare professionals. “Be focused on what you’re doing. Be good at what you’re doing. And be faithful at what you’re doing.” BY PETE FERNBAUGH

His staff is very creative in coming up with

New York Gracie Square can and should do, that

ideas that challenge and expand the program, he

Kuo really focuses on one solitary, but vital element

added. They are the action plan for New York Gra-

when recruiting new leaders: “Their passion.”

cie Square’s future.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

25


07 | MOLINA HEALTHCARE, INC

MOLINA HEALTHCARE, INC

Thirty years ago, Molina Healthcare was founded by a gentleman with the foresight to know that providing financially vulnerable patient populations with care in the emergency room would ultimately tax the healthcare system to the point of breaking.

Terry P. Bayer, J.D., M.P.H., Chief Operating Officer,

Gloria Calderon, Vice President

To reach out to this population, many of whom were uninsured, nonEnglish speaking, and dependent on government assistance and services, Dr. C. David Molina founded a medical home focused on preventive care provided by a physician who would be intimately acquainted with each of these individuals’ specific needs. Dr. Molina’s family now carries on that work, and Molina Healthcare, Inc., has grown into a powerful $6-billion healthcare force across the nation, with a presence in 16 states, over 6,000 employees, and a provision of services to over 4.5 million people. “All of our work is focused on folks with limited or uncoordinated access to care,” Terry P. Bayer, J.D., M.P.H., chief operating officer, said. “And our goal is to really provide high-quality healthcare that is cost effective, and where we have government funding our services, be good stewards of the public funds.”

FOCUSING ON DUAL ELIGIBLES Molina Healthcare is always in the process of identifying new markets in which to expand. As Bayer explained, the company has three components to its business line. The largest segment of Molina’s business includes managed-care organizations, which are state-licensed HMOs designed to serve Medicaid, CHIP, and Medicare patients, specifically dual eligibles who qualify for both Medicaid and Medicare. Molina participates in each state’s Medicaid managed-care program as well as CMS’ Medicare Advantage Special Needs Program (SNP), also with

been selected to participate in Duals Demonstration Programs that fully integrate Medicare and Medicaid in Ohio, Illinois, and California. This is estimated to begin in 2014. Molina Medicaid Solutions provides the second

Dr. Molina began his career with a small medi-

component of Molina’s business line. Acquired from

cal clinic in Wilmington, Calif. The clinics are now

Unisys Corporation three years ago, Molina Med-

owned by Dr. Molina’s son, Dr. J. Mario Molina, who

icaid Solutions builds, operates, and administrates

administers them through one payer source, Molina

IT systems for Medicaid agencies in five states that

Healthcare.

are designed to better serve their fee-for-service populations. Molina’s third and final business line is direct delivery through its primary-care clinics.

a focus on dual eligibles. In addition, Molina has

According to Gloria Calderon, vice president

INDUSTRY PARTNERS ICoviant Software Corp. www.coviantsoftware.com

in Florida, New Mexico, Northern and Southern

MANAGING THE COST CURVE WHILE COORDINATING CARE

California, and Washington and “are basically there

Healthcare reform has emphasized the need to

to care for Molina members and other low-income

continuously improve execution on strategies for

individuals and families.”

controlling costs, Bayer said. However, she added,

of Molina Medical Group, these clinics are located

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

27


“We look at managing the cost curve as going handin-hand with providing high-quality services.” Molina believes “that by providing high quality, which means appropriate care, the right care at the right time with the right provider,” cost reductions often follow as a result. To that end, Molina centers its operations on patient-centered care management and coordination with the goal of improving outcomes and reducing unnecessary expense. “We know that people also have not only physi-

ers and ancillary practitioners and making sure

ing, or food banks. Calderon said Molina wants its

cal health problems but mental health issues,” she

people have the tools that they need to get healthy

members and patients to receive the full services

explained. “They also face social problems related

and not simply end up in the emergency room.”

they need.

to their housing or their transportation needs.

nal mission, Bayer explained, and is representative

cracks.”

with babies to include the aging, blind, and disabled

of the commitment that characterizes the physi-

(ABD) population in their delivery of care.

cians and healthcare professionals Molina hires.

comprehensive quality care targeting these three areas of need.

PROVIDING SUPPORT FOR ALL OF A PATIENT’S NEEDS Molina has embarked on a biopsychosocial model of care for its members, a model that recognizes a

www.cisco.com/go/healthcare

“You’re looking at a set of patients that really

stayed close to its mission for over 32 years now,”

multiple chronic conditions, they also have signifi-

she said. “The majority of the folks in management

cant mental issues, and so our waiting rooms are

and throughout our organization at Molina are

comprised of probably 25 to 30 percent of this ABD

committed to making a difference in the healthcare

patient population.”

delivery system, and they’re committed to increas-

Since these patients are in need of other services when they come in, Calderon has hired more

lems.

internists and social workers for the clinics. “Rather than take the physicians’ or nurse

model of care that is what we call Higher Touch,

practitioners’ time with that, we get those patients

meaning more face time with our patients in the

over to the social worker so that they can help them

home setting and not always with a licensed medi-

maneuver through the bureaucracy that is known as

cal provider, but often with a community health

mental healthcare.”

worker or a caregiver through a home-care pro-

“We have a fantastic organization that has really

need a higher level of care,” she said. “They have

person’s needs may extend beyond physical prob“With this population, we have migrated to a ©2013 Cisco Systems, Inc. All rights reserved.

This is completely in line with Dr. Molina’s origi-

model, moving beyond children and young moms

The solution, Bayer said, is found in providing

Cisco healthcare solutions help streamline workflows, facilitate BYOD, enable care-at-a-distance, and improve the patient experience

Calderon said the clinics have also adopted this

These are the folks that have fallen between the

ing access and quality to healthcare services and government programs.” BY PETE FERNBAUGH

Furthermore, Calderon has brought patient

gram,” Bayer said. “So we’re really broadening the

access coordinators (PACS) onboard who are there

definition of the kind of healthcare we deliver and

to supply members with services they need outside

really supporting that with community health work-

of the clinics, whether it be transportation, hous-

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

29


08 | SCHNEIDER REGIONAL MEDICAL CENTER

SCHNEIDER REGIONAL MEDICAL CENTER ™

The plight of rural healthcare in the United States is frequently and rightfully discussed. What’s often missing from the conversation, however, are hospitals that are classified as urban facilities, but are actually serving a patient population whose make-up is more rural. A good case in point is Schneider Regional Medical Center, a three-facility system that provides healthcare to the residents of the U.S. Virgin Islands and the Caribbean. Its facilities include the 169-bed Joint Commission-certified acute-care Roy Lester Schneider

Angela Rennalls-Atkinson, Hospital, the Charlotte Kimelman Cancer Institute in St. Thomas, and its ambulatory care facility, Interim Chief Executive the Myrah Keating Smith Community Health Center, on St. John. Officer and Chief Operating Officer In discussing the difficulties Schneider has in keeping pace with the changing healthcare paradigm, Angela Rennalls-Atkinson, interim chief executive officer and chief operating officer, emphasized two characteristics of Schneider’s care team: its genuinely united teamwork and its focus on patient care.

You’ll never see packs the same again. Organized. Efficient. Simple. For more information, contact Medline at +1-847-643-3292 or international@medline.com www.medline.com

system’s payroll. Its gross patient revenue is about $140 million, but expenses are, not surprisingly, quite high.

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Since the hospital is on a TEFRA payment structure, Medicare reimbursement rates are stuck in the 1980s, when the hospital was built. Simply put, additional funding is needed to meet

A COLLABORATION OF CARE

Fundraising, unfortunately, decreased in the last

expenses. The rub is, Schneider could get additional

Schneider Regional Medical Center works in close

year, as the decline in the U.S. economy affected

funding if it were considered a rural facility.

collaboration with the local Department of Health

some of Schneider’s key supporters. This is a blow

and Human Services and other government entities

to the organization, since Schneider is faced with

urban or rural status requires a population density

to ensure that the services the system is providing

IT requirements to comply with Meaningful Use

of fewer than 1,000 residents per square mile. The

are as comprehensive as possible.

standards.

density in St. Thomas per 2010 census data is 1,652

“Our medical records are not fully electronic

With its partners, Schneider takes into account

residents per square mile.

throughout the center,” she said. “A portion of the

This high population density affects the catego-

afford care. At the forefront of discussions is how to

medical record is in paper format, which is some-

rization of a rural locale, limiting access to some of

manage those patients.

thing we know we have to improve to meet CMS

the available grant funding that is readily adminis-

requirements.”

tered to other islands or territories.

Schneider has started Meaningful Use Stage

facing two challenges that directly affect these

In the absence of additional funding, Renalls-

INDUSTRY PARTNERS CalMed, Inc. www.calmedvi.com

discussions: financial constraints and aging infra-

1 and is rushing to complete it in order to avoid

Atkinson said Schneider is forced to prioritize

structure.

penalties, but without capital funds, the system

expenditures that will best help her team coordinate

ALWAYS FOCUSED ON THE PATIENTS

must utilize its operating budget to deal with capital

patient care.

No matter what an organization’s challenges may

“We really don’t have capital to meet all infrastructure upgrades and the regulatory require-

expenditures.

“With expenses being so high we are really

be, in healthcare, Rennalls-Atkinson said, it’s

As a semi-autonomous government facility,

running a deficit, so it’s very difficult,” she said. “It’s

always about the patients and creating solutions

equipment in excellent working condition to help

Schneider receives a certain amount of funds from

prioritizing so that we can meet the urgent needs of

for those challenges that also ensure continued

decrease unnecessary capital expenditures.”

the local government, but it’s less than half of the

our patients.”

improvement.

ments for affordable care,” she said. “We maintain

6/10/13 9:39 AM

However, one of the criteria used to determine

the many patients in its service areas who cannot

Rennalls-Atkinson said Schneider is currently

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HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

31


09 | SMARTLINX SOLUTIONS, LLC

VCPI is the premier provider of business technology solutions exclusively for postacute healthcare. We help you reduce costs, increase capabilities and solve problems so you can focus on your core business...providing quality care.

“Yes, it’s difficult to run a facility that is unrealistically categorized,” she said, “however, we are meeting and exceeding in our composite scores for core quality measures.” This is why Schneider continues to look to the future, investing in spite of the obstacles. Right

Since then, SmartLinx has expanded its labor

now, the organization is planning on upgrading

management suite to include the applications Time

its gastroenterology and urology services, along

& Attendance, Employee Self Service, Payroll,

with other offerings. New specialists are joining

Human Resources, and Corporate Planning and

the care team, and the organization is utilizing

Control, along with manufacturing biometric time

evidence-based practices. All of these investments

clocks.

are centered on patient safety, which is Schnei-

Mark B. Tomzak, chief executive officer, joined the company in 2007 and firmly believes that

der’s highest priority.

SmartLinx is positioned to help long-term care

Why?

BECAUSE IT’S ALWAYS ABOUT THE PATIENTS. “Regardless of our designation, urban or rural, we make attempts to remove obstacles that negatively impact patient care and continue to strive

facilities in the era of healthcare reform. After all, the reimbursement cuts aren’t anything new, he pointed out. Long-term care actually has a history

www.vcpi.com 1-877-908-VCPI

of recurring cuts. “When your top line is getting cut to make sure that your company is still viable and in business,

to decrease expenses and increase our revenue,” Renalls-Atkinson said. Schneider is the only safety-net hospital that provides care to patients in the St. Thomas/St. John district. It has to exist for the community and

SMARTLINX SOLUTIONS, LLC

for the area’s visitors. “We’re here for our patients,” she said. “As healthcare providers we are focused on our mis-

SmartLinx Solutions is a unique player in the healthcare market. With clients in 49 states, the company has grown rapidly since its founding in 2000.

sion to be able to provide that quality comprehensive care that the residents and visitors expect and need. “Clinical excellence is not an option; it is a requirement.” BY PETE FERNBAUGH

Mark B. Tomzak, Chief Executive Officer

Specializing in labor management software for long-term healthcare facilities, the seed of its products was planted in the mid-1990s when two of the company’s founders were owners and operators of long-term care facilities in the New York City area. Each of them was bothered by the difficulty in managing their labor expenses, which accounted for 60 to 70 percent of their overall budgets. Together, they developed an application called Staff Scheduling that would become SmartLinx’s flagship product. Staff Scheduling enabled an organization to manage overtime, shift assignments, and other operational matters across the entire facility, tracking where the spending was and where the expenses were going.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

33


or the owner to the mid-level regional VP directors

“I’m a true believer of one-place data entry and

to the specific centers to the specific employee-

whether it be in somebody else’s application as a

-everybody has the information they need to make

system of record or whether it be in our applica-

the right decision,” Tomzak said.

tion, if it’s needed somewhere else, I don’t want

Value must be provided to the users themselves because they’re the ones driving data into

EHRs have information that is important to

ability to access all levels. They also appreciate the

schedule against, and those products run on basi-

texting element of the software.

cally the same principles as SmartLinx’s products. Tomzak said. “Because they want to better serve

calling attention to the problem. In fact, fixing

their clients and we want to better serve our cli-

problems before they occur is a chief function of

ents, by working together we’re doing that.”

SmartLinx’s software. Open shifts will prompt a

It’s this kind of out-of-the-box thinking that

system text to be sent out, offering it to the first

has given SmartLinx 99.9 percent client retention,

person who texts back.

and Tomzak said the company is poised to be the

“It takes the manual effort of trying to fill things itself,” he said.

WORKING ALONGSIDE EHR

towards your bottom line, and we’ve been able to

market, it really doesn’t work very well for this

help people manage that labor expense and liter-

market,” Tomzak said. “There are a lot of la-

ally eliminate any unnecessary labor expense so

bor management tools out there and software

they can strive and thrive as a business,” he said.

programs, but there’s only a handful that really

“So with negatives from one side, we’ve been able

service this industry based on the logic, the knowl-

to offer a positive solution from the other.”

edge, and the workflow that’s needed.”

MAKING LABOR MANAGEMENT HEALTHCARE-SPECIFIC

Many software programs, he added, struggle to focus on what the client needs, rather than what said, people want their programs to be cool, and

there. Every industry in which people punch in and

software programmers feel the need to oblige.

next few years. “Our goal is to continue to ask: What are the things out there that maybe people are using that they’re trying to retrofit from other verticals? We

SmartLinx’s labor management suite does not

want to put that together, while understanding

compete with an organization’s EHR either; in-

our client’s workflow, understanding our client’s

stead, the company seeks to partner with the clini-

outcomes and objectives, and really building our

cal and financial software companies behind most

applications for how they would do work.”

EHR platforms. Tomzak said SmartLinx interfaces with every

BY PETE FERNBAUGH

single clinical and financial vendor within longterm care, incorporating all of the information relevant to labor management from the EHR into its software.

SmartLinx, however, wants to make sure the

from the light industry to gas stations to Target,

cool things are providing a value and a function.

Tomzak said. “The interesting thing about health-

Just because a person thinks an application is

care is there’s no consistent shift-start time that is

cool doesn’t mean they’ll ever use it, he said. One

mandated on an ongoing basis. Those are vari-

simply has to look at the many untouched apps on

able.”

their smartphones to understand this.

In other words, your labor management

dominant player in long-term healthcare over the

is attractive to the client. In the technology age, he

There are many labor-management tools out punch out based on scheduled shifts needs them,

“With that integration, it’s a natural thing,”

area, for example, the system will send out a text,

out and builds efficiencies within the application

“Unless your application is built for this specific

four spots,” he said.

the system, and he said their clients appreciate the

If overtime goes above six percent in a certain

you have to look somewhere and you have to look

people to manually do that in one, two, three, or

SmartLinx’s clients need to have software that

software must be built to accommodate how your

is vital to their success, especially since many of its

people do work. Furthermore, there are certain

clients are enterprise clients, servicing anywhere

nuances for which the software must account, such

from 10 to 100 sites across multiple states.

as unions, agencies, pay policies, conditional shift

“We want to make sure that at all levels of that or-

differentials for bonus work, etc.

ganization--whether it be the CEO or the president

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

35


09 | PLUS ONE HEALTH MANAGEMENT

GROWING HEALTHY BEHAVIORS AMONG EMPLOYEES Plus One Health Management provides personalized solutions to improve the health and effectiveness of an organization’s employees. Plus One offers on-site health and wellness programs, as well as online programs to supplement the personal touch. President and Chief Executive Officer Chris Ciatto said Plus One will first perform an assessment to determine the organization’s goals, demographics, and available resources. Then, Plus One clinicians develop a plan that involves individual assessment, education, intervention, and engagement “We assess the organization to see where they are currently, whether they are pursuing health management already and need a change, or if they are starting from scratch,” he said. “We have the tools to work with companies at all different start-

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ing points.”

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With a plan in place, Plus One will perform health assessments of employees who choose to participate, including questionnaires and biometric screenings. Education is also a large component of the program, allowing employees to understand their numbers, their risk level, and which programs are available. This can be done online, in

PLUS ONE HEALTH MANAGEMENT

person, or through other communication avenues used in the organization. “Once employees get a basic understanding of where they are in the risk spectrum, we give them means to get better,” Ciatto said. “This includes

Most businesses struggle to provide employees with affordable healthcare, especially as the workforce mirrors the U.S. population with high rates of obesity and chronic conditions related to poor lifestyle habits.

physical activity, nutrition, and ergonomic interventions. We can assemble physical-activity programs through a commercial gym, an on-site facility, or simple walking programs. We also offer weightmanagement challenges, with calorie-tracking tools.”

Chris Ciatto, President and Chief Executive Officer

Hospital employees in particular are found to be even less healthy than the general workforce and have higher healthcare costs. With hospitals promoting preventive care and population management to patients combined with shrinking budgets and rising employee healthcare costs, finding ways to increase the health of staff should be a top priority.

As with individual organizations, employees are at varying levels of readiness to accept wellness programs. Because Plus One operates on-site, clinicians are able to speak personally with employees who are reluctant to start a challenge or who have questions. “We will have conversations with people at

cerns and encourage them to join one of our health management programs,” Ciatto said. “Our clinicians listen closely and find the right starting point for each individual.” In addition to the personal touch, technology is heavily utilized to deliver Plus One’s solutions. This allows Plus One to reach remote employees, those at different branches of the organization, or spouses who are often significant contributors to rising healthcare expenses. “We have a robust wellness portal and apps for our programs, allowing participants to conveniently record metrics such as steps or weight for many challenges,” Ciatto said. “It has to be convenient and have some reward for people to participate. Unfortunately, many people are not willing to participate solely for the health benefits.”

their cubicle to understand their barriers or con-

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

37


10 | THE INNOVATION INSTITUTE, LLC

“We must find new ways to operate and focus on

FACING AN UPHILL BATTLE

solutions. Plus One offers health and wellness pro-

Although the need for solutions like Plus One’s is

grams; on-site fitness-center, recreation and spa

clear, the company faces an uphill battle in indi-

management; design and development services for

vidual adoption and overcoming the environment

fitness facilities; and technology solutions. Wellness

in which employees are operating. Plus One not

programs for organizations are comprehensive and

only works with hospitals, but also corporations

include health assessments, biometric screenings,

and universities. Most workplaces, especially in

wellness coaching, nutrition consultations, ergo-

these settings, are designed to be sedentary, and

nomic programming, physical-activity program-

overcoming that environment to increase physical

ming, general wellness, and health-management

activity is a challenge.

promotion.

People also have a biological preference for

“We have a suite of programs that are people-

salt, sugar, and fat, as well as ingesting vast

led but technology-enabled,” Ciatto said. “They are

amounts of marketing that urge them to consume

fun, but also clinically sound and customized for

products high in those ingredients.

each individual client.”

“We are trying to reverse many years of poor lifestyle choices,” Ciatto said. Plus One works closely with food-service vendors--specifically their partner, Compass Group,

With more emphasis on healthy lifestyles for patients, now is an optimal time for healthcare organizations to focus on the wellness of their employees. “Healthcare organizations need to be authentic

and Compass’ healthcare division, Morrison Man-

in what they do,” Ciatto said. “They have every clini-

agement Specialists--to provide healthier food op-

cal resource within the organization and just need a

tions and educate client populations about nutrition.

catalyst.”

“The cafeteria and fitness center are two prominent access points to promote a wellness agenda

BY PATRICIA CHANEY

within an organization,” Ciatto said. “We work

transformational innovation rather than incremental change,” Randolph said. “Our existing system is broken, and we need to think differently to move forward. The same thinking that created our broken system will not result in solutions needed to fix it. We need a collaborative model that allows us to tap into the creativity of our employees, physicians, and business partners. “Oftentimes, innovation occurs when there’s a burning platform, and I think the healthcare reform issue provided that burning platform that calls for change,” he continued. “Hospitals and health

INDUSTRY PARTNERS

systems, for good reason, are very risk averse. They

Tech Knowledge Associates Clinical Engineering Services

focus on standardization and incremental change. In order to focus on transformational innovation, you really need to be separate and distinct, so you

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have the ability to be nimble, take risks, and not get bogged down in day-to-day operations.”

AN INDUSTRY-WIDE NEED FOR INNOVATION

with its initial funding of $40 million and with the

The Innovation Institute was launched by St. Joseph

blessing of the St. Joseph Board and the full back-

Health, where Randolph had been serving as chief

ing and support of the system’s chief executive

operations officer. St. Joseph provided the Institute

officer, Deborah Proctor.

closely with them to devise compelling, integrated programs with joint marketing, programming, and technology to create a seamless participant experi-

THE INNOVATION INSTITUTE, LLC

ence.” He also said it’s important to make healthy choices the standard in food offerings. If people have to ask for the less healthy option, they are more likely to accept what is offered. For example,

As healthcare in the United States undergoes a transformation from fee-for-service to value-based care, the need for innovation and unconventional thinking has never been greater.

if all sandwiches are on wheat bread, a person would have to go through the extra effort of asking for white bread, and Ciatto said that is often enough to increase adoption rates of the food program.

SERVING AS A CATALYST TO WELLNESS Plus One Health Management began 26 years ago as a personal training studio and has since ex-

Joseph Randolph, President and Chief Executive Officer

panded to a large provider of health management

In January 2013, The Innovation Institute was launched with the express purpose of being a central node for creative, groundbreaking thought. Joseph Randolph, president and chief executive officer, said the idea for the Institute was sparked by the realization that his colleagues at different health systems around the country were facing the same challenges under reform, mainly oriented around cutting 20 percent out of their cost structures.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

39


A THREE-PRONGED APPROACH TO INNOVATION This model devised by Randolph and his team consists of three elements. The first element is the Innovation Lab, which isn’t anything like a traditional laboratory. “It’s not a lab with microscopes or a wet lab,” he explained. “It’s an incubator where we can grow the most promising ideas from our employees, physicians, and business partners.” Researching other innovation labs across the country led the Institute team to the Cleveland Clinic, which had the best track record, Randolph said, in the commercialization of new products and new ideas. To harness this, The Innovation Institute signed an alliance agreement with the Cleveland Clinic to manage the concept to prototype to endproduct process. Randolph said his team plans to work with the employees and physicians at each of the memberowner health systems to commercialize their ideas and concepts. They also plan to use social ideation and crowdsourcing to collaborate on challenges and solutions. These ideas will provide new revenue sources,

property. We will showcase their products and innovations in the Lab.” Furthermore, the Institute plans to establish a nonprofit foundation that will essentially serve

centers around the country devoted to innovation,

as “member owners.”

and most of these centers were focused internally.

Since launching in January, Randolph has been

Therefore, the mission for The Innovation Insti-

in dialogue with several system leaders across the

tute is to focus on innovation in collaboration with

country who are interested in the Institute’s three-

others, doing more with less, for more people.

pronged model. The Institute should be closing with

The vision of The Innovation Institute is to be a

its second health system in early October.

vehicle that fosters innovation and growth for the

sharing the service among several hospitals. The Innovation Institute has three service companies presently in the EDG division, including Tech Knowledge Associates (biomedical engineering), Petra (construction management), and Healthcare Design and Construction (hospital construction). Management is also looking at several other tuck-in acquisitions to enhance the portfolio. These three companies were previously either cost centers for St. Joseph or a purchased outsource service. Now these companies sell services to others and are revenue centers. Through these companies, The Innovation Institute is profitable and is ahead of its financial projections after only six months. The third element is the Growth Fund, which will enable the Institute to channel money raised from private investors into companies with innovative product ideas that will provide returns. The Institute has seeded the fund with about $10 million and is in the process of raising the balance

A COLLABORATIVE MODEL FOR INNOVATION

and the ability to partner with us on intellectual

model is intended to have seven non-profit systems

pany and share in cost savings from scaling and

tute, the investors, and the inventors.

the lab,” he said. “They’ll have marketing rights

he discovered there were fewer than two dozen

that otherwise would go to the outsourced com-

of the capital with outside private investors.

that are interested in becoming underwriters of

member-owners and investors. To that end, the

Institute, the member-owners can capture margin

not just for those systems, but also for the Insti“We’re going to tap into technology companies

As Randolph researched his idea for the Institute,

By purchasing the service from The Innovation

as a development company to raise philanthropic support to pioneer innovative products for underserved communities. The second element, the Enterprise Development Group, is focused on making the Institute itself financially viable during its early years. The Enterprise Development Group is a portfolio of service companies that allow for best-practice sharing and cost savings. These are

Ultimately, Randolph and the Institute envision this three-pronged model as providing fuel for collaboration and communication within the healthcare community. The Innovation Institute believes a unity of ideas will inspire the solutions demanded by healthcare reform. “Bringing people together to collaborate rather than having them work in silos could be a great benefit of the model that we’ve put together,” he said. “I’m hopeful that we’ll be able to change the industry from the inside rather than having others outside the industry dictate what the changes need to be.” BY PETE FERNBAUGH

overhead-type services that most health systems either provide in-house or purchase as an outsourced service.

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41


11 | QUEENS BOULEVARD EXTENDED CARE FACILITY, INC.

QUEENS BOULEVARD EXTENDED CARE FACILITY, INC.

Dr. Jonathan Mawere started his career at Queens Boulevard Extended Care Facility in 1999 as the head of the Rehabilitation Department. Then, in 2008, he was appointed Administrator and Chief Operating Officer.

Patient Care Associates, Inc.

INDUSTRY PARTNERS

Patient Care Associates, Inc. is open 7 days a week, 365 days a year to coordinate portable diagnostic testing and communicate interpretations for patients in New York, New Jersey, Pennsylvania and Connecticut. PCA performs X-Rays, EKG’s, Echocardiograms, Sonograms, Doppler Studies, Holter Monitoring and Pacemaker Checks as onsite services.

CHE Senior Psychological Services, P.C. www.cheservices.com

only at Queens Boulevard for a short period of time, anywhere from one to four weeks, usually following strokes or joint-replacement surgeries. Because of the short-term nature of these services, one of Queens Boulevard’s greatest challenges has been lowering rehospitalization rates. “The subacute population has become extreme-

He brings to the C-suite an extensive educational background, including doctorates in both physical therapy and medicine, as well as a license in administration, all of which equips him to serve a complex patient population.

Dr. Jonathan Mawere, Administrator and Chief Operating Officer

Located about 15 minutes from Manhattan, Queens Boulevard’s patient population is both ethnically and generationally diverse.

ly complicated,” Mawere said. “Due to the medical complexities of some sub-acute patients, reducing This 280-bed skilled-nursing facility treats patients

rehospitalizations has become a hurdle and a chal-

of all backgrounds, including Hispanic, Irish, Asian,

lenge we are meeting head-on.”

Italian, Greek, Indian, Russian, and Polish. Almost

Rehospitalizations lead to penalties and reduc-

50 percent of the patients are sent to the facility for

tion in reimbursements for hospitals, and care

sub-acute rehabilitation services, meaning they’re

facilities like Queens Boulevard have had to find

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

43


ways to avoid sending patients to another stage in

“This program, we think, is a huge complement to

able to innovate and adapt is a true measure of

the continuum of care, keeping them at the facil-

what we already provide in the sub-acute rehab

success in the healthcare arena.”

ity when medically possible, and stabilizing their

program,” Mawere said.

condition in-house.

In addition to the new outpatient services,

Thankfully, Mawere said, Queens Boulevard

Queens Boulevard has established an Adult Day

He added, “That’s why we have remained one of the most sought-after facilities in the New York metropolitan area.”

has been successful in reducing rehospitaliza-

Health Care Program over the last decade, provid-

tion rates, thanks in no small part to its affiliation

ing specialized medical monitoring for patients

where it is today without the partnerships that

with the North Shore-Long Island Jewish Health

who are well enough to live at home, but have

have been developed and without the willingness

System.

chronic medical conditions such as diabetes, heart

to invest in technology. Realizing that no organi-

failure, or Alzheimer’s Disease, to name a few.

zation can survive in isolation anymore, Queens

This demand, however, is merely representative of how extended-care facilities have been

The ADHC Program participants come into

Mawere said Queens Boulevard would not be

Boulevard has branched out, forming relation-

affected by healthcare reform and of how they, too,

Queens Boulevard for a five-hour period of time

ships with Patient Care Associates for radiology

have had to adjust their care-delivery models in

during which they have the opportunity to socialize,

and working with North Shore-LIJ Labs to reduce

order to accommodate a changing marketplace.

participate in recreational activities, and receive

turnaround times for test results. Furthermore,

medical monitoring from doctors and nurses who

Queens Boulevard has adopted evidence-based

see them on-site.

practices in delivering care.

UPGRADING SERVICES TO ENHANCE THE QUALITY OF CARE

Since CMS began rating nursing homes,

Without real alignment of best services and

Queens Boulevard has been five-star rated and is

without implementing proven methods of providing

There is a second group of patients to whom

on the U.S. News and World Report’s Honor Roll

best care, Mawere doesn’t think Queens Boulevard

Queens Boulevard delivers care: long-term resi-

for America’s Best Nursing Homes.

would be able to survive.

dents who reside in the facility for as long as their

“The accolades we receive are accomplished

“I am pleased to say that, as an organization,

life expectancy allows. This group comprises the

through doing things correctly,” Mawere said. “We

the entire team here has embraced what works

other 50 percent of its patient population.

are able to showcase these achievements through

and we have learned to work with fewer resources

a demonstrated proficiency in delivering care in

and be successful,” he said. “Queens Boulevard

the best way that it can be provided.”

remains an organization that is dedicated and

Keeping patients out of the hospital also means keeping the long-term residents out of the hospital, too, Mawere said. As a result, Queens

committed to providing the best care. We are a

ability to treat chronic conditions, pneumonia, and

ADAPTING TO CHANGE BY EMBRACING IT

other ailments at the facility. Queens Boulevard

Like most healthcare facilities, Mawere said,

The community can count on us to be there in the

also does most of its testing in-house and has

Queens Boulevard has “had to endure a barrage of

future because we are looking forward.”

radiology and laboratory services available on-site.

regulatory changes” and a rapidly evolving reim-

Boulevard has upgraded its services, improving its

Recently, Queens Boulevard unveiled an out-

bursement environment.

smart organization and a great organization that is on its way to becoming greater and smarter.

BY PETE FERNBAUGH

“Adapting to those changes is challenging for

patient rehabilitation program for patients within the community who may need treatment without

any organization,” he said. “We’ve been able to

an inpatient stay or after their sub-acute rehabili-

embrace changes and look at them as opportuni-

tation has been completed.

ties. To capitalize on these opportunities and be

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

45


12 | RICHMOND UNIVERSITY MEDICAL CENTER

Crothall Healthcare

“There’s a certain mindset change in terms of focusing on quality, physician alignment, and expansion as opposed to reporting numbers and looking

Proud to serve at Richmond University Medical Center

at budgets and in trying to realign my thinking to be more strategic in nature as opposed to financial,” Breslin said. He began making regular rounds within the units—environmental rounds, patient-safety rounds, patient-satisfaction rounds—allowing himself to be present on the floors and available to the patients and staff. “In the finance role, you’re trying to put together reports and you’re analyzing data and you’re reporting to department heads, but probably not doing patient and physician interaction to the level

Environmental Services • Facilities Management • Laundry & Linen Patient Transportation • Clinical Equipment Solutions

a CEO is,” Breslin said. “It was just making sure I was more available and interacting more with our stakeholders.” What he discovered was an organization confident in the care it provides and in its role as one of

www.crothall.com | 877-4-CROTHALL

only two hospitals on Staten Island, which has over 500,000 residents, no public hospital, and is the only New York City borough to have no health and hospital enterprise in the area.

RICHMOND UNIVERSITY MEDICAL CENTER

Richmond University Medical Center, therefore, plays a pivotal role within its community. “There’s an absolute need and there’s a whole

Michael Breslin has been serving as Richmond University Medical Center’s chief executive officer for over a year, having become the organization’s acting CEO last September, then accepting the role of permanent CEO earlier this year. He had previously served Richmond as executive vice president and chief financial officer, roles that left him acquainted with the business side of running a 510-bed organization, but not necessarily acquainted with the practical side of care delivery.

Michael Breslin, Chief Executive Officer

For this reason, when he was appointed CEO, he made it his chief goal to step away from the financial functions of the organization and become more familiar with its day-to-day functions.

county of patients that otherwise may have been

Island seem to be unaware of the latter’s presence,

serviced by the public hospital and other boroughs,”

Breslin said, so Richmond is consulting with physi-

Breslin said. “We want to make sure they are get-

cians and other medical professionals on ways to

ting the world-class care they deserve.”

aggressively market the program. U.S. News and World Report recognized

MAKING EXPANSION AND INVESTMENTS TOP PRIORITIES

Richmond’s state-designated stroke center for the

Richmond University Medical Center is looking to

mond has added more monitoring equipment in its

expand in all areas. The organization has added

ER, as well as designating more beds for stroke and

capacity to its sleep center and is striving to be a

epilepsy.

pulmonary center of excellence by making its pul-

Breslin said the center opened its new cath lab

monary offerings more cohesive.

in October of this year, and the organization was

Its pain-management center is first-rate, as is its wound-care center, but most people on the

outstanding outcomes it has produced, and Rich-

prepared to focus on asthma, diabetes, and cardiac care in the near future.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

47


Furthermore, its clinical affiliation with Mount Sinai

aware of outcomes and preventable quality indica-

alone hospitals will not be the ideal model for the

Hospital is helping Richmond grow these and other

tors.

reform era.

programs, and the center is hoping to harness

As they await the best fit, Breslin said he and

“I think that’s a long overdue focus of hos-

Mount Sinai’s clinical prowess to great benefit on

pitals,” he said. “It’s got us looking outwards as

his team are continually improving both the admin-

the Island.

opposed to inwards.”

istrative and patient sides of the house. He wants

Richmond has also made major investments in

to evolve into an institution that’s reflective of an

Richmond has partnered with local federally

IT infrastructure and has met Meaningful Use Stage

qualified health centers to see what they can do

environment in which populations are managed

1 and anticipates Stage 2 certification in late 2013.

together to ensure community needs are being met.

more effectively and more diligently.

In April, Richmond went live with computerized

The Affordable Care Act has increased the commu-

physician order entry (CPOE), and a partnership

nication between hospital executives and medical

a presence in the community and especially an

with Meditech has yielded a proficient IT platform

professionals as both strive to understand the fac-

institution that provides services in the areas where

within the center, while eClinicalWorks has linked

tors behind readmissions and certain outcomes.

right now the objective measures would suggest

its physician offices and outpatient clinics.

“We want to be more of an institution that has

“For the first time in a while, we’re having a

are lacking,” he said. “We want to be that smaller

much more open, collaborative dialogue with doc-

outpatient-minded institution, but when patients

standpoint, whether it’s clinical technology or data

tors and payers about how to do things together

show up at our door for an emergency or inpatient

technology, is just critical,” Breslin said.

that will make the community healthier,” he said.

services, they’re getting high-quality efficient care

“Certainly alignment is important. I think doctors

that patients are pleased with and that pleases pay-

are starting to see how challenged the environ-

ers to have us in their networks.”

“Staying ahead of the curve from a technology

A RENEWED FOCUS WITH GREATER COMMUNICATION

ment is. They are starting to ask the question of

If healthcare reform has done anything, Breslin

where they fit in to the new world order, if you will.

said, it’s prompted his medical team to be more

I think the more progressive-thinking ones are

BY PETE FERNBAUGH

realizing that collaborating and partnering with the hospitals to provide the best care, the needed care in the needed areas for the community, is the best strategy.” He added, “We just want to reverse engineer. If we’re not at an expected level of outcome, why and what is it going to take to get us there?”

FUTURE IN WHICH ALIGNMENT IS KING In the coming years, Breslin and Richmond are looking to align with a premier academic center or health system. It is Richmond’s belief that stand-

BRESLIN AND RICHMOND ARE LOOKING TO ALIGN WITH A PREMIER ACADEMIC CENTER OR HEALTH SYSTEM.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

49


SEP/OCT

2013

Real Issues : Real Solutions

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