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EXCHANGE

HCE

Real Issues : Real Solutions

SEP/OCT 2015

Ameritas Keeps Pace with Constantly Changing Marketplace

HEALTHCARE EXECUTIVE EXCHANGE MAGAZINE | www.healthcareix.com


Real Issues : Real Solutions

CONTENTS

06 Ameritas

Karen M. Gustin, LLIF, Senior Vice President of Group Distribution

HCE EXCHANGE


IN-FOCUS STORIES 06 Ameritas 10 Phoenix Children’s Hospital 14 Physicians Care Surgical Hospital 18 Rice Memorial Hospital 22 UW Medicine 26 College Medical Center 29 Comanche County Memorial Hospital 32 Global Partnership for TeleHealth 35 Heritage Provider Network 38 Gramercy Surgery Center 40 Martin Luther King Jr. Community Hospital 42 Richmond University Medical Center 44 DeKalb Medical

SEP/OCT

2015


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AMERITAS

Ameritas Keeps Pace with Constantly Changing Marketplace Hospitals and physicians aren’t the only ones that have spent the past few years adjusting to the Affordable Care Act. Payers have also had to change up their systems and business models to accommodate new rules and a new generation of consumers. Ameritas, which is headquartered in Lincoln, Neb., has adjusted to the reform marketplace rather smoothly, Karen Gustin, LLIF, senior vice president of group distribution, said.

Real Issues : Real Solutions


MAINTAINING FLEXIBLE INTERNAL SYSTEMS Ameritas offers standalone vision plans and has

integrated healthcare liability risk specialists insurance programs for hospitals/healthcare entities, physicians, and ancillary healthcare providers

been offering standalone dental plans since the late 1950s. Its plans are marketed directly to indi-

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viduals or to companies as part of their employee benefits packages. “Our systems are specific to dental, which has allowed us to be flexible and accommodate the needs of the market,” Gustin said. “We have high accuracy for our customers based on our experience and understanding of risk.” The company also has a strong grasp of exchanges. “You have to be great at file-eligibility transfers and risk management with exchanges,” she said. “It’s not enough to sell something on a platform. dental case to one with a large number of people

FOCUSING ON CUSTOMER SATISFACTION

across a wide geographical area.”

Gustin credits much of the company’s success in

You have to shift the risk profile of the typical

Ameritas has transitioned well throughout any

the market to its customer service. She said in the

changes that have come up in the past 30 years and

dental market, many people only stay with a com-

has been able to save other insurance companies

pany for about two to three years.

that didn’t fare as well. “Most carriers have to worry about system, plan design, customers, and the market when changes come about,” Gustin said. “We just have to worry about market.” Since the 2008 recession, Ameritas has seen

“Ameritas has 92 percent or more persistency,” she said. “We get our customers in a state of wellness, and they stay with us.” Customer service remains key to Ameritas’ strategy, and recruiting people with the right dedication and focus is a challenge. Gustin said the

a change in how people use their plans. With a

company holds high standards for each employee,

decline in employment, people have been visiting

and employees are measured based on consistent

the dentist less often for major services. They also

metrics every year.

receive fewer major procedures and opt for more basics that usually pay at 80 percent. In fact, consumers have just recently begun to come back to dental plans in order to use more of their benefits for major procedures, Gustin said.

“We have built our culture over time,” she said. “We need to find people who want to be a part of that culture.” Culture quickly translates to customers, Gustin added.

HCE EXCHANGE MAGAZINE

7


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Adapting to multiple generations of customers is another challenge Gustin said the company is facing, especially since Baby Boomers and Millennials view their insurance needs and the value of insurance differently. Gustin said Millennials may be more likely to avoid purchasing dental insurance until they plan on receiving services. They also seem more likely to look at the price tag above other considerations. In this new marketplace, Ameritas is figuring out how to reach the new generation of consumers and the best avenues for marketing. Gustin’s team is asking such questions as, Who should Ameritas’

The company also makes strong efforts at employee engagement. Pay scales and incentive programs are based on metrics that support the customeroriented culture. Its selectiveness and high standards have served Ameritas well. The company has won the Purdue Award of Excellence for Service, a worldwide recognition program for contact centers, for eight years in a row.

DEALING WITH TECHNOLOGICAL AND GENERATIONAL CHALLENGES Keeping up with the latest technology and the latest threats to that technology and doing it in a costeffective manner is, of course, a challenge for any business. Gustin said Ameritas is staying on top of these changes through constant attention to the latest in software tools.

plans be marketed to? Should it be the broker, a human-resources representative, or the consumer directly? Gustin said marketing needs to be much more multifaceted. With younger generations, they are more likely to respond to text messages over emails. Brokers and employers need printed materials or other avenues of marketing. With Baby Boomers, the challenge is to keep them with their dental plans after they retire. Ameritas is examining multipronged approaches for marketing across generations and across decision-makers, from individuals to employers. In addition, it has to keep the contracts and plans appealing to these different generations. “If you’re not growing, you won’t be around long,” Gustin said. “Ameritas will keep growing. We always have.” BY PATRICIA CHANEY

HCE EXCHANGE MAGAZINE

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PHOENIX CHILDREN’S HOSPITAL

PCCN Forms Largest Pediatric Clinically Integrated Network in Arizona Shared savings. Population management. Risk. Physician leadership. These are the commonly heard buzzwords in the healthcare industry today, and more and more hospitals and healthcare systems are trying to implement the concepts behind these terms within their care-delivery models.

Bob Meyer, President and Chief Executive Officer

Increasingly, hospitals and providers of adult medicine have looked to clinically integrated networks as a strategy for achieving success in these areas. For example, Phoenix Children’s Hospital in Arizona has invested nearly two years in developing a pediatric-only network, and so far, it has been a great success.

Real Issues : Real Solutions


02 | PHOENIX CHILDREN’S HOSPITAL

BRINGING THE NETWORK TOGETHER As of 2015, the Phoenix Children’s Care Network (PCCN) includes more than 800 physicians across Maricopa County, but it started with the hospital and a small group of leaders who had big ideas. Bob Meyer, president and chief executive officer of Phoenix Children’s Hospital, said the idea for PCCN began with the need to integrate primarycare pediatricians into the hospital’s network in a manner that would provide high-quality clinical outcomes and would be financially beneficial to all parties. It also needed to have a strong contracting ability, since Arizona healthcare is primarily managed care. The hospital employs nearly 80 percent of the pediatric specialists in the state, but it made a stra-

CREATING THE GOVERNANCE MODEL In addition to the quality focus, the operational and governance structure were important to growth.

tegic decision against employing general pediatri-

Ultimately, the hospital is the sole corporate

cians or primary-care physicians in order to focus

member of PCCN. However, physicians make up

on partnerships and not competition with private-

the majority of the board of directors. By having

practice physicians.

a self-governance model, the physicians were

Nevertheless, while the hospital and specialists

not asked to put up any capital, which had been a

were brought on board first, it did take some time to

sticking point in the past. Nor were they asked for

convince the private-practice physicians to join in.

exclusivity, as is demanded in Medicare’s account-

“Historically, there has been distrust between private-practice physicians and the hospital, as well

able-care organizations. “We listened to the physicians in building this

as between primary-care and specialist physicians,”

network,” Meyer said. “We wanted participation

Meyer said. “We have had to engage all parties and

to be their choice, which is why we didn’t

build a level of trust before moving forward.”

demand exclusivity.”

Meyer found that with the hospitalist movement, tal to check on their patients. However, they still

LOOKING AHEAD TO LEVERAGE THE NETWORK

wanted to follow the care of their patients. The first

Now that the network has grown and shown suc-

part of opening a dialogue was to talk about col-

cess, payers are excited about working with PCCN.

laboration, listening to their concerns and develop-

The network has two shared-savings contracts with

ing quality measures.

two of the larger Medicaid contracts in the state. It

many pediatricians stopped coming to the hospi-

“With our first core group of about 60 primarycare pediatricians, we developed internal metrics and quality goals,” Meyer said. “Then those physicians were out recruiting on behalf of the network.”

is also working with commercial payers to establish partnerships. The network has also partnered with Arizona Care Network (ACN), an adult-focused clinically

HCE EXCHANGE MAGAZINE

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training, and the remaining are looking for jobs in the area. Meyer sought to leverage the network to help place those graduates without the hospital having to be-

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“Our main competitor was hiring many of these graduates, and we needed to see how our existing practices could grow and accommodate these new physicians instead,” Meyer said. The initial conversations were not quite what Meyer was looking for. “The first time we talked about the need to employ these residents, it was a pretty negative discussion,” he said. “However, we were eventually able to open it up into a dialogue. We now seek to find employment opportunities with our exist-

integrated organization led by physicians and

ing partners for the 10 or so graduates we want to

owned by Dignity Health and Tenet/Abrazo,

keep. This will be a positive for our network in the

to have an adult-care partner to broaden the con-

long run.”

tracting network. With all of this integration, there is more data

PCCN plans to keep building on its success in contracting and quality, pushing out the initiative to

flowing in, allowing physicians a more complete

other cities in the state. It is currently the largest

picture of what’s happening with each child. The

pediatric-dedicated clinically integrated organiza-

hospital and PCCN have worked to integrate the

tion in the state and one of few available in the

electronic medical records across all practices in

United States.

the network to make this data merge more easily. The group is also looking at other ways to

BY PATRICIA CHANEY

improve care for the area’s children, as well as provide opportunities for physicians. Phoenix Children’s Hospital has about 40 residents that graduate every year. About half go into subspecialty

HCE EXCHANGE MAGAZINE

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PHYSICIANS CARE SURGICAL HOSPITAL

Physicians Care Embraces the Future of Healthcare When we last spoke with Chris Doyle, MBA, chief executive officer of Physicians Care Surgical Hospital in Royersford, Penn., the Rothman Institute had just opened its newest medical building.

Chris Doyle, MBA, Chief Executive Officer

As the largest owner of Physicians Care, the Rothman Institute has coordinated with the original surgeon owners who created the hospital with the goal of achieving the highest quality of patient care. Over the last two years, Doyle told us, the facility has taken off very quickly. Physicians Care Surgical Hospital serves as the west corridor for the Rothman Institute, and because the facility has been so busy, Rothman began shifting several surgeons to the hospital. This shift assisted Physicians Care in building up its case volume. The relationship with the Rothman Institute also enabled Physicians Care to network with a pool of highly qualified candidates. Doyle said the hospital was able to engage with Thomas Jefferson University’s resident and fellowship training program as well, and it has become one of the centers the university uses for training.

Real Issues : Real Solutions


03 | PHYSICIANS CARE SURGICAL HOSPITAL

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INCREASING ORTHOPEDIC SERVICES Thanks to its affiliation with the Rothman Institute, Physicians Care Surgical Hospital has been able to increase its orthopedic case volume by roughly 50 percent. These services deliver about 75 percent of the hospital’s revenue. “In prior years we were largely outpatient with some other specialties, which we continue to provide as part of our complement of services, but the orthopedics has increased our inpatient capacity somewhere in the order of 35 percent over prior years,” Doyle said. “For us, this is significant because we are a small-capacity hospital.” Physicians Care is now building up other services around its orthopedics line. This build-up has enabled the hospital to fortify the preadmission testing process.

HCE EXCHANGE MAGAZINE

15


“It gives us a focus and it helps the nurses perfect

for our patients. The patients have actually com-

their craft,” Doyle said. “So they’re able to provide

mented on that in their patient surveys.”

care that they can focus in one area and become well-educated in that area.” Employee engagement is currently at 87 percent, which is well above the national average for

The hospital has successfully tested for Meaningful Use Stage 1 and is looking to test for Stage 2 once CMS authorizes it.

considering it was at 50 percent when he was first

LEADING BY EMBRACING CHANGE

hired.

The best way for healthcare leaders to succeed

their peer group, and a remarkable improvement

ESTABLISHING VALUABLE PARTNERSHIPS

right now, Doyle said, is by embracing the change within healthcare. “Whoever embraces this change will probably be seen as the best provider in health-

Physicians Care has been serving as a hospital

care. My team members need to know that if we’re

pilot site for software company Amkai SIS. Amkai

embracing change, then I trust that that change is

has traditionally serviced a surgery-center model,

good for them and the organization and

but it is looking to transition into hospital systems.

their patients.”

The pilot program has required Physicians Care

However, it’s not enough, he added, to embrace

to develop an inpatient module and begin meeting

change. You also have to be transparent and clear

Meaningful Use standards.

about that change, especially if you’re a smaller

“We love Meaningful Use,” Doyle said. “Some

organization. One thing his hospital does is share

people have fought it. We have found that we have

information with the staff, even if it’s not finalized,

been able to master it. The features that are en-

so they can receive feedback.

couraged with Meaningful Use, such as the barcode

Doyle said he has learned a great deal from

scanners, we actually were not early adopters. We

working closely with physicians who are genuinely

have since begun using them, and they are won-

interested in leadership. He and his team have

derful. We love them, and our nurses love them

begun shadowing surgeons in the OR and at the

for the safety they deliver. We also have software

bedside to learn more about how leadership can

programs which we have set up that are ancillary to

support the physicians and how physicians can be

our main EHR, which provides a consistency of care

active members within the leadership.

Real Issues : Real Solutions


When surgeons and physicians join committees and

care organization as its Tier 1 provider.

governing boards, they can contribute to initiatives

“To us we do not see a reason to fight where the

in valuable ways, such as targeting the cost of ma-

future of healthcare will be.”

terials and supplies within the surgical community.

INSPIRING PEOPLE WITH THEIR OWN SUCCESS

The hospital’s leadership is also considering the addition of an ambulatory center and exploring ways to continue embracing the latest technologies. Doyle referenced the hospital’s use of Force Thera-

It’s important to remind physicians, nurses, and the

peutics last year, which enables them to discharge

rest of your professional staff of the integral role

patients after training them to use an iPad or tablet

they play in providing care, Doyle said. “People are

to communicate with their surgeon and interact

most inspired by their own success. It provides a

with their physical therapist.

certain energy when we can identify the individual and team successes.” Looking for ways to acknowledge staff members for real things they’re accomplishing will give them the strength to do more. In fact, he credits a culture of encouragement with helping them to achieve his

“We see ourselves as a younger, slimmer, quicker organization,” Doyle said. “We are quicker to embrace the initiatives that larger facilities might have a bigger challenge with.” BY PETE FERNBAUGH

proudest moment as a leader: Being ranked No. 3 in the nation for HCAHPS scores. “The way we position our hospital is that we are obviously, according to our data, a much higher-quality facility than our peers throughout the country. And we do that because we are able to specialize in areas where others have not taken the initiative.” As Physicians Care Surgical Hospital looks ahead, he and his leadership team plan to engage a larger health system within the next year. Physicians Care would like to partner with that health-

HCE EXCHANGE MAGAZINE

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RICE MEMORIAL HOSPITAL

Rice Memorial’s OB Stronger Thanks to TeamSTEPPS™ Over the years, HCE has interviewed many executives, the majority of whom has found leadership and institutional success once they began adhering to a core principle: communication.

Kenneth Flowe, MD, Chief Medical Officer

Communication is the key to a successful hospital. As obvious as this principle may seem, however, it’s possible for a hospital or healthcare organization to have good communication, but not consistent communication. Consistency in how medical professionals communicated with each other was the primary challenge Kenneth Flowe, MD, was facing when he accepted the chief medical officer position at Rice Memorial Hospital in Willmar, Minn.

Real Issues : Real Solutions


04 | RICE MEMORIAL HOSPITAL

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BECOMING A PHYSICIAN LEADER Prior to accepting the CMO position at Rice, Dr. Flowe had worked for 20 years as an emergency physician and had spent approximately a decade as a medical-staff leader. Early on in his career, he had resisted leadership positions, until he realized how important the decisions of the medical executive team were. He was eventually elected a medical staff leader, and his eyes were gradually opened to the breadth of opportunity he had. “The ability to care for one patient at a time is easy for a doctor, but the ability to care for a whole group of patients or even a county or a population is medical administration,” Dr. Flowe said. “So I found that I really enjoyed that opportunity, but I didn’t have the tool set.” He began attending business school in order to acquire that tool set. Proving himself adept at

HCE EXCHANGE MAGAZINE

19


administration, Dr. Flowe was appointed CMO of the hospital in North Carolina where he had been working, but he did not abandon practicing medicine entirely. “I feel a physician leader or administrator loses a lot of credibility as soon as he hangs up his white coat, so to speak,” Dr. Flowe said. “I can have a conversation with the other administrators and be able to explain the reality of taking care of patients instead of just what I’ve heard. Sharing patients with others on the medical staff gives me a credibility with physicians that I would never otherwise have. It’s win-win.”

IMPLEMENTING THE TEAMSTEPPS™ APPROACH

ily physicians who do OB; we’ve trained all of the obstetricians; we’ve trained all of the nurses on the units; and this has had some very good effects.”

identified Rice’s OB department as exemplifying

CULTIVATING A DEPARTMENT OF CONSISTENT COMMUNICATION

both the strengths and weaknesses of the hospital.

First, Dr. Flowe made an effort to understand the

Three years ago, Dr. Flowe accepted the CMO position at Rice Memorial Hospital. He immediately

Dr. Flowe said he was impressed with the de-

inner workings of the OB department. He realized

partment’s innovative spirit, especially with regards

that the OB care team was already using evidence-

to safety. The weakness was in the consistency of

based strategies, and the framework was

their intradepartmental communication.

already in place and the environment was right for

While in North Carolina, Dr. Flowe had worked as a Master Trainer with Team Strategies and

Team STEPPS™. He then pitched strategies for implementing the

Tools to Enhance Performance and Patient Safety

program to the OB leadership, including both physi-

(TeamSTEPPS™) from the Department of Defense

cians and nurses. The response was positive, and

and the Agency for Healthcare Research & Quality

he received conceptual buy-in.

(AHRQ). TeamSTEPPS™ is an evidence-based set

He followed this up by enlisting two nurse lead-

of tools that fosters consistent communication and

ers to collaborate with him on the program. These

enhanced respect among care-team members.

nurse leaders, Lori Thorson and Amanda Vander-

Rice Memorial had experimented with the pro-

Hagen, had been involved in the OB Safety Team for

gram before, but its initial experience was

a long time, and Dr. Flowe said they were wonderful

not great, Dr. Flowe said. The hospital knew

evangelists who prevented TeamSTEPPS™ from

of the program’s potential, but it was unsure about

becoming “just another program of the year,” as

committing to the implementation of the

many technique rollouts are considered.

program’s techniques. “I was able to help encourage them to put the energy into it,” he said. “We’ve trained all the fam-

This team of three turned the OB team’s conceptual buy-in of TeamSTEPPS™ into actionable buy-in. Together, they were able to determine how

Real Issues : Real Solutions


long they were going to spend on each aspect of

“Even people who initially didn’t want to do the

the implementation strategy, including the didactic

simulations were able to say it was a valuable

elements and simulation activities.

opportunity, and they were able to do things they

“The three of us were able to go to several

didn’t expect to learn,” Dr. Flowe said. “There’s

department meetings and also several nursing

always skepticism towards any change, especially

meetings and playact a lot of the techniques,” he

for professionals who pride themselves on doing a

said. “There was plenty of fun and joviality, but we

good, safe job. And in the OB case, they were doing

were always teaching the point. We were able

a great job already, but they still had the innovative

to keep people’s interest. And the two nurses

mindset to try something a little bit different, and it

were exceptional.”

has had pretty significant results.”

EXPANDING TEAMSTEPPS™ TO THE ENTIRE HOSPITAL

BY PETE FERNBAUGH

The most important decision he made with TeamSTEPPS™, Dr. Flowe said, was implementing it within the right department. “If we had wanted to start something like this in surgery, for example, it would not have gone as well because parts of the critical team weren’t ready,” he said. “Surgery is very safe, and staff and physicians have implemented some of the TeamSTEPPS™ techniques even, but they didn’t have the same innovative mindset that they did in OB. And a mindset of innovation is really key for having something like this work.“ With 800 deliveries annually, the OB was busy enough to demonstrate the success or failure of the program, and thanks to the popularity of the simulations with the entire OB team, TeamSTEPPS™ has been an overwhelming success within the OB. Evidence for this was found on the before-andafter survey results using the AHRQ’s Hospital Survey on Patient Safety. The already-good scores showed universal intradepartmental improvement. Thanks to that success, beginning this fall, TeamSTEPPS™ has begun expanding to other departments.

HCE EXCHANGE MAGAZINE

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UW MEDICINE

Performance Improvement Teams Unite UW Medicine as a System Comprised of Harborview Medical Center, the University of Washington Medical Center, Northwest Hospital and Medical Center, Valley Medical Center, UW Neighborhood Clinics, UW Physicians, UW School of Medicine, and Airlift Northwest, UW Medicine has a broad footprint within the Evergreen State. Johnese Spisso, RN, MPA, Chief Health System Officer

As the largest provider of charity care in the state, UW Medicine served 60,000 inpatient admissions and more than 2 million outpatient visits in 2014. Johnese Spisso, RN, MPA, chief health system officer for UW Medicine, brings more than three decades of award-winning experience to her role. For the past 20 years, she has worked in several different capacities at UW Medicine. Seven years ago, however, she was asked to develop the brand-new position of chief health system officer. At that time, the organization had decided to break down the silos among its various entities, she said, and unite as a full-fledged healthcare system. Paramount to their success was the implementation of performance-improvement initiatives across the entire UW system.

Real Issues : Real Solutions


05 | UW MEDICINE

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DEVELOPING PERFORMANCEIMPROVEMENT TEAMS Three years prior to the creation of Spisso’s role, UW had begun developing performance-improvement teams that were stationed within each member organization. As the chief health system officer role has evolved, Spisso has been able to improve the communication among these teams. Various methodologies have been tested at each member entity, and the performance-improvement teams consist of experts in such methods as Lean and 5S. Meeting as a committee, each team is responsible for overseeing performance improvement (PI) and care transformation at their member organization, exploring ways in which costs can be reduced and the Triple Aim can be met. The teams focus on three areas in particular: transformation of care,

HCE EXCHANGE MAGAZINE

23


supply-chain management, and revenue-cycle

By actively collaborating with social workers, medi-

management.

cal students, financial counselors, and employee

“It’s really been a program that starts at the

volunteers, UW Medicine’s community-outreach

ground up,” she said. “We have physicians and staff

initiative resulted in approximately $10 million in

at every level of the organization engaged in it, and

improved revenue and an 11 percent reduction in

we try to provide an efficient administrative struc-

self-pay patients (from 14 percent to 3 percent).

ture so those great ideas and opportunities can be

Within the emergency department, physicians

resourced. And once we establish a best practice,

led an initiative to reduce sepsis rates, saving UW

we can quickly roll it out to all of our sites.”

$3 million. Another $3 million was saved through

“The structure has been key,” she added. “At

a series of pharmacy initiatives, and standardizing

each site, we have one PI director and that indi-

spinal-implant procedures yielded an additional $5

vidual works with all of the physicians and staff at

million in savings.

that institution to make sure all of the projects are being implemented.” Each team leader collaborates with a central-

Furthermore, UW Medicine collaborated with community leaders on developing energy-efficiency opportunities that would reduce utility usage, which

ized committee of experts who understand Lean,

totaled over $1 million at Harborview Medical Cen-

5s, and other system-improvement methods.

ter alone.

In 2014, UW successfully completed a PI plan with over 100 initiatives that ended up saving the system $100 million.

DISCOVERING THE IMPORTANCE OF PI TEAMS

The key to these initiatives, Spisso said, was the team mentality behind the implementation. “It is important, though, to have that entity ownership at each site when they establish the PI plan that we approve in the budget process,” she said. “That leadership team is held accountable for deliv-

Washington is one of the states that has opted to

ering on that $25 million book of business. Working

move forward with both Medicaid expansion and

together as a system, we really have the benefit of

the establishment of a health information exchange

getting initiatives done much faster. Once we see it

(HIE). As a system, UW wants to support this effort

done at one site and we know it has value, we can

by attracting new patients to sign up for healthcare.

quickly roll it out to all four. So it allows each entity

Real Issues : Real Solutions


to be working on different things that we can then

“We’re a health system that provides everything

share as best practices.”

from prevention through primary, secondary,

The biggest challenge before UW Medicine,

tertiary, and quaternary care,” she said. “Because

Spisso said, is providing physicians with accurate

of the services we provide, we have very high-cost

and reliable data and producing dashboards that

patients. We have to make sure that the services

define PI opportunities while using comparative

we’re providing are also leading to better outcomes

benchmarks with other healthcare entities.

for patients so that they will over time be reducing

“Once we found that we could actually highlight the opportunity for people, the physicians and staff were really excellent in coming up with things

their utilization of services.” BY PETE FERNBAUGH

that they could do differently and also talking with other organizations about best practices on what they were doing different to get to that cost level,” Spisso said. This included areas such as radiology that could yield a better return on investment.

KEEPING MORE DOLLARS AT THE BEDSIDE As UW Medicine has grown, Spisso said the organization has become more skilled at consolidating various infrastructure services in cost-effective ways that “keep more dollars at the bedside.” “Because of that motto, we have tremendous buy-in from physicians and staff,” she said. “They really feel like they’re leading that piece, since they should know the most about the care that’s needed and they have the ability to really identify things at the patient-contact level that could lead to reductions of waste and improvements in care and satisfaction.” In the future, UW Medicine hopes to reduce variations in practices as evidence-based standardization and choosing wisely concepts are introduced. As the UW team continues to deploy information technology, they’re constantly dealing with the question of how to use multimillion-dollar IT investments in a way that transforms care delivery.

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COLLEGE MEDICAL CENTER CMC is Meeting the Behavioral Health Needs of LA County

Joe Avelino, RN, BSN, MHSA, CPHQ, Chief Executive Officer

In 2013, College Medical Center (CMC) acquired the assets that had been Pacific Hospital of Long Beach, Calif. Pacific Hospital had served the workers-comp and spinal-surgery needs of the Long Beach patient population for more than half a century. CMC transitioned the organization to a true community hospital and established a unique partnership with Molina Healthcare to manage the acute-care side of the center.

Real Issues : Real Solutions


06 | COLLEGE MEDICAL CENTER

OPENING A NEW HOSPITAL Joe Avelino, RN, BSN, MHSA, CPHQ, was hired as the hospital’s chief executive officer in August 2013, just as the organization was preparing to unveil its new hospital building on Oct. 9. His first few months were hectic, as numerous deadlines had to be met in order to secure the proper licensing for operation. CMC’s psychiatrist call panel was officially established on Oct. 18. On Oct. 29, CMC was issued its own CMS Certification Number (CCN) for Medicare funding. The state-required LPS designation came

m e • • • • • •

MEDICAL ELECTRONICS

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on Nov. 19, enabling the organization’s psychiatric emergency team (PET) to travel to other ERs, nursing homes, clinics, and hospitals to conduct psychiatric evaluation assessments. In opening the new hospital, behavioral-health services became a centerpiece of CMC’s service line. The hospital began promoting its first Patient Access or intake 800 number on Dec. 2, equipping it

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customerservice@medicalelectron.com

to receive behavioral-health referrals from other ERs. CMC also began managing the local transportation services for ambulance and for non-emergent house and access services. Avelino said having times and with efficiency in patients being admitted

PARTNERING WITH MOLINA HEALTHCARE

to CMC.

College Medical Center’s ER is also busy. With only

the services in-house has helped with turnaround

Two years later, the behavioral-health service line has proven itself to be a necessary and successful component of CMC’s footprint within

seven beds, the hospital still manages an average of 1200 to 1300 visits each month. Per a management-service agreement, Molina

a highly competitive marketplace. In fact, the

Healthcare oversees the hospital’s acute-care

organization is planning to add another 64 beds for

services. Avelino said having two employers in

behavioral health on top of its current 73 beds for a

one building was challenging at first, but he and

total of 137 behavioral-health beds.

Molina’s chief administrative officer work together

However, not having enough behavioral-health

to communicate the operational challenges in the

beds is an ongoing struggle, Avelino said.

emergency department and to identify patients with

“The demand is phenomenal with regards to behav-

multiple diagnoses who are in need of acute-care

ioral health.”

and/or behavioral-health services.

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“We have a daily huddle to discuss operational issues and challenges within the acute-care services and the behavioral-health services,” he said. “We negotiate, and we work it out. We had some growing pains when we started out, like anything else, but we’ve really established a nice collaborative partnership.”

CULTIVATING A CULTURE OF CAMARADERIE Avelino first networked with CMC while he was serving as chief executive officer at Los Angeles Metropolitan Medical Center. After two years as CEO, Avelino’s enthusiasm for CMC is effusive. “I tell people I’m going to retire here,” he said. “We have a great culture.” In addition to providing high-quality care, the leadership goes out of its way to foster a spirit of community and camaraderie among its employees and medical staff. Its community outreach efforts are also laudable. For example, CMC has partnered with Jackie Robinson Academy, a local school that is located across the street from the hospital, to provide gift baskets for needy families. Turning it into a friendly competition, CMC had 13 of its departments each design a gift basket that was then donated to the school. “We do a lot of those things,” Avelino said. “There’s an old adage, ‘To whom much is given much is expected,’ so I’m really fortunate we are an organization that is able to give back to our community. It’s very exciting.”

Even though on paper, CMC’s service area is limited to Los Angeles County, Avelino said the hospital has received behavioral-health patients from Riverside, Orange County, and even the San Francisco-Reno area, which is a good seven to eight hours away. “College Medical Center has created a workplace environment where employees are trusted and valued, where communication is constant and clear, and morale is high,” Avelino said. “That is a tall order in an industry that is rapidly changing and under intense financial pressure. If you have a culture where employees are happy, it’s a domino effect on your patient care. If you have that kind of work environment, they can’t help but treat their patients in a positive, caring manner.”

With the new facility an overwhelming success, Avelino and his leadership team continue to strug-

BY PETE FERNBAUGH

gle to maintain pace with CMC’s rapidly expanding behavioral-health patient volume.

Real Issues : Real Solutions


07 | COMANCHE COUNTY MEMORIAL HOSPITAL

COMANCHE COUNTY MEMORIAL HOSPITAL

CCMH Turns IT Department into a Hybrid Shop On April 1, 2014, Comanche County Memorial Hospital (CCMH) in Lawton, Okla., took a bold step with its department of information technology.

James Wellman, Chief Information Officer and Senior Director of IT

Once a fully outsourced shop primarily devoted to McKesson, the largest hospital west of Oklahoma City brought its outsourced personnel entirely in-house and implemented a remotesupport model, mixed and matched from a few different vendors. As James Wellman, chief information officer and senior director of IT, said, this move created a tremendous amount of savings for the hospital, increased customer satisfaction, and streamlined the department’s workflow.

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29


contract was already under review. What he didn’t Anthelio Healthcare Solutions’ Physician Documentation Solution impacts patient care and safety while helping to improve

know was that CCMH was interested in offering him the opportunity to be the organization’s first CIO.

a hospital’s bottom line

RESTRUCTURING THE IT DEPARTMENT Anthelio supported Comanche County Memorial Hospital with streamlining and enhancing their documentation templates, resulting in a 137% increase in physician usage in just 120 days!

Wellman’s first project as CIO was to determine the positions he could fill for the hospital and the degree to which he could expand the IT program. He then began to build his department, hiring various network people who were already at the hospital as McKesson employees. He was also able to hire

To learn more contact us at 214-257-7000 or info@antheliohealth.com

some former Haliburton employees after the company’s international IT group relocated to Houston, as well as some personnel from nearby Fort Sill.

www.antheliohealth.com

When the dust settled, Wellman was able to bring all infrastructure and informatics in-house. For cost reasons, specialty applications that required 24/7/365 monitoring were still outsourced, including the help desk, which was contracted to Anthelio Services. As the department was brought further inhouse, Wellman noticed that a long-standing silo

DIVERSIFYING ITS IT INFRASTRUCTURE

was beginning to crumble. “When I first came in here, there was very much

For 15 years, CCMH had a productive relationship

an ‘us and them’ mentality between the hospital

with McKesson, fully outsourcing even its local IT

and the IT department, even though the bulk of

staff to McKesson Support.

people in this IT department had been hospital

However, in recent years, CCMH began diversi-

employees years prior and they just transitioned

fying its IT infrastructure and lessening its devotion

over when the hospital contracted with McKesson,”

to one particular company’s products. For example,

he said. “We saw that aspect change a little bit. The

the hospital had switched from the Horizon EMR

IT staff has become more involved in a lot of the

platform in 2013 to the Paragon platform and also

hospital projects and programs that are going on.” When they were McKesson employees, the

contracted with eClinicalWorks. Because of these changes, CCMH’s leadership

IT staff didn’t receive much recognition for their

decided that its top IT person should be a hospital

contributions to CCMH. For three months in a row

employee, not an outsourced corporate representa-

after the restructuring, however, members of the IT

tive. In other words, the leadership wanted a fresh

staff were recognized for outstanding commitment

perspective from someone who wasn’t locked in

to the hospital. Under Anthelio, the help desk also improved its

with a product, Wellman said. Wellman had been a McKesson employee since

first-call rating, which had been very low. Wellman

he arrived at the organization in December 2010,

set a goal of achieving 50 percent calls closed on

but he knew upon being hired that the McKesson

the first call. Within 120 days, the goal had been

Real Issues : Real Solutions


“I wanted to be able to put a team into place that I could go in and transition to a new technology and still not upset the dynamic locally,” he said. “If we went completely cloud-based tomorrow, the team would stay intact.” Instead of thinking short-term, you have to think long-term, Wellman said. What will your department look like three or four or five years down the road? Having an environment of constant, unexpected change as opposed to an environment primed for evolution doesn’t help anyone, including the hospital. “I think that sends the wrong message to your administration and to your organization and definitely to your team because it puts them not at ease to come out and do their best work. I think they’re more worried about surviving sometimes, surpassed with 58 percent of first calls

and we want our team to feel comfortable to make

being closed.

a mistake and know that there’s not the sword of

MAINTAINING A LOCAL IT PRESENCE

Damocles hanging over their heads each day,” he said. “At the end of the day, a good, solid dependable

Wellman said a restructuring of this magnitude

IT staff in your facility is a key component to

demands a clear vision, and his vision was focused

your success.”

on being local. “I had a goal in mind,” he said. “You see a lot of

BY PETE FERNBAUGH

hybridization because a lot of people are going to the cloud, and you’ll read some articles that will tell you that this is the death of the local IT shop. From my perspective, it’s not. You still have to have a local presence. “Regardless of virtualization, desktop support will still be there. Their roles and skill sets will evolve, but at the end of the day, there’s a physical device somewhere that’s in the patient’s room or on the physician’s desk or med cart and we’re taking care of those components.” A local staff can also speak for the hospital, he added. That staff has the hospital’s mission in mind and in heart. And when a cloud system is implemented, they’re able to handle it because the department has been preparing for it over the course of many years.

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GLOBAL PARTNERSHIP FOR TELEHEALTH

Global Partnership Believes Telehealth is the Future of Healthcare The Georgia Partnership for TeleHealth began a decade ago with the mission of bringing healthcare to rural sections of its state. A little over two years ago, its reach began to expand beyond the United States and into such countries as Guatemala, Honduras, Zambia, and Nicaragua.

Paula Guy, Chief Executive Officer

Paula Guy, chief executive officer, said it was only logical to change the partnership’s name to the Global Partnership for TeleHealth in light of its international growth. Georgia is leading the United States in telehealth, Guy said, and the Global Partnership is one of the many reasons for this, with 800 in-points and 250 participating physicians. She said the partnership covers the whole continuum of care, from home-health monitoring to primary care.

DOUBLING ITS ENCOUNTERS ANNUALLY IAccording to Guy, the partnership has nearly doubled every year in the number of telehealth encounters that are being done. Last year, over 200,000 encounters were completed. In 2013, it was 136,000 encounters. “And we’re expecting that to double this year,” she said. Even though the public as a whole still sees telehealth as a novelty, Guy said the proof is overwhelming that it works, and now, all of the insurers in Georgia are paying for it. Managed-care organizations also assist with funding. Governors from such states as Florida and Alabama have solicited the partnership’s services. All told, the Global Partnership for TeleHealth is currently in eight countries and 16 states.

Real Issues : Real Solutions


08 | GLOBAL PARTNERSHIP FOR TELEHEALTH

PARTNERING WITH A VARIETY OF ORGANIZATIONS The Global Partnership for TeleHealth will partner with virtually any entity that is interested in bringing telemedicine to its service base, including schools, jails, hospitals, clinics, physician offices, nursing homes, urgent-care centers, and stroke centers. “It’s a variety,” Guy said. “Just about any kind of facility that provides healthcare are partners of ours. And what we do is basically we provide the tools that enable our partners to do telemedicine successfully.” Originally, the partnership was grant-funded, but once the grants ran out, Guy said the organization started charging monthly fees to belong to the network. Physicians also pay a fee to be on the network. But the benefits are sterling, she said, and feature a dedicated HIPAA-compliant network, strong IT support, and an advanced scheduling system. Beyond patient consultations, the network is also used for continuing education, grand rounds, and many other healthcare-related activities. “The ones who get the technology embrace it,” she said. “We still have a lot of work to do in educating physicians on what telemedicine is and what it can do to enhance their practices. It is almost

Bluetooth technology; and performing ultrasounds

every day that I speak to a physician, and they don’t

with USB technology.

have a clue as to what telemedicine really is and

“With telemedicine, they can be seen, evalu-

that telemedicine can really be equal or superior to

ated, and diagnosed,” Guy said. “I could tell you

what they can see in their office.

story after story.”

“But once they see it and can use it on their smartphone or iPad, they’re amazed.”

CHANGING MINDS AND ENRICHING LIVES

One anecdote involved a child who was perceived as difficult by his teachers. Because of this, his education was handled one-on-one with a ParaPro. Thanks to telemedicine, the child was correctly diagnosed with autism by a physician at Children’s

Guy is quick to emphasize that what the partnership

Healthcare of Atlanta and was placed on the cor-

does not do is phone triage, but the “real deal.”

rect medication. He is now excelling in school as

Physicians can use the telemedicine technology to see their patients for a multitude of problems,

part of the gifted program. “Telemedicine was a life-changing experience

including conducting ear, eye, nose, and throat ex-

for the kid, for the school, the teachers, and for that

aminations; listening to heart and lung sounds with

mom,” Guy said.

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EXPANDING INTO ISOLATED, IMPOVERISHED AREAS A few years ago, Guy was preparing to go on a mission trip to an orphanage in Guatemala with her friend, Dr. Donald Hines, from LSU. On a whim, she took the telemedicine equipment with her, not knowing if it would work. When she arrived at the orphanage, she was surprised to find that she could connect with some doctors at LSU. The LSU doctors diagnosed a young lady at the orphanage with a bad murmur and instructed her to have emergency surgery.

one particular company, the partnership is able to experiment with various technologies, because it knows that telemedicine is more about the future than the latest upgrade. “Telemedicine is changing lives,” Guy said. “It is not about the technology, and it’s not even going to be called telemedicine in the next five years. It’s just going to be the way we access our care, and either you get on the train now or you’re going to be left behind.” BY PETE FERNBAUGH

Word quickly spread and soon the partnership was asked to go down to Honduras and bring the technology to several clinics that were in the middle of nowhere. Miraculously, Guy said, the clinics still had Internet and a cell tower. The partnership has since worked with a veterinarian group from South Dakota who went to Kazakhstan to handle some issues among the livestock. The International Health Alliance also funded telemedicine endeavors in Africa and specifically Zambia. Thanks to the partnership, the Northside Hospital out of Atlanta is connected with a hospital in Macedonia on a daily basis to provide neonatal intensive-care services. The Macedonia hospital has since seen a dramatic decrease in ER visits and readmissions. Currently, the partnership is working with the Ministries of Health in eight other countries, including China.

GETTING THE ATTENTION OF THE U.S. GOVERNMENT Telemedicine is opening up gateways of diplomacy around the world, but so far, Guy said, the U.S. government doesn’t seem to grasp the technology’s full diplomatic potential. She has presented the partnership’s work before the Office of Planning and Budget and before the FDC, and while they were interested, Guy said she “would love to have a better opportunity to share what we’re doing.” Guy said the partnership prides itself on being equipment agnostic. Instead of being owned by

Real Issues : Real Solutions


09 | HERITAGE PROVIDER NETWORK

HERITAGE PROVIDER NETWORK

HPN Leads the Nation in Healthcare Innovation and Progress In 1979, Richard Merkin, MD, founded the organization that would eventually become Heritage Provider Network. In its earliest days, HPN lacked the financial and human capital to provide traditional solutions to troubled hospitals and health systems. According to Dr. Merkin, this forced HPN to think differently and to approach problems using nontraditional strategies.

Dr. Richard Merkin, Founder and Chief Executive Officer

In other words, with over three decades of healthcare experience, Dr. Merkin never does anything the same way twice. He’s always looking for methods and processes that will yield better outcomes from one day to the next.

PIONEERING THE INTEGRATED DELIVERY NETWORK

many efforts are currently focused on establishing models from within the healthcare industry, HPN is

Headquartered in Marina del Rey, Calif., HPN

seeking solutions from outside the industry.

reaches more than 700,000 Californians. That fact

NETWORKING WITH OTHER INDUSTRIES

alone qualifies it as one of the country’s largest independent practice associations (IPAs). Accounting for its New York branch, which serves more than 70,000 patients, and its Arizona group, which handles Maricopa County’s Medicare Advantage population, the reach of HPN’s integrated delivery network is impactful. All told, 62 group-model clinics and 15 urgent-care centers and IPA structures have been formed across these three states under HPN’s influence. Long before healthcare reform was implemented, HPN was perfecting an integrated delivery network that was focused on lower costs, higher quality, physician and patient education, and preventive healthcare. Likewise, HPN also anticipated the industry’s current passion for predictive modeling, and while

At first, HPN experimented with predictive modeling in-house, but eventually, the organization hit a wall. Fresh eyes were needed, Dr. Merkin said. These challenges demanded experts who would look at healthcare as a data problem, not as a health or healthcare problem. To find such innovative experts, Dr. Merkin created, developed, and sponsored the two-year, $3-million Heritage Health Prize. “The health plans felt they already had experts and teams that did this,” Dr. Merkin said. “And it became apparent very quickly that the people that were entering these events were doing it five or six times more accurately than the best of the health plans.”

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35


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In 2012, HPN sent out a global call to innovators

And that, he added, was the primary advantage

across all industries, asking them to develop an

of the Heritage Health Prize. Now, when a problem

algorithm capable of predicting the number of

arises, he can turn to an online global

days a patient would spend in the hospital over a

community that consists of hundreds of the most

given year.

effective analysts.

“The theory is,” Dr. Merkin said, “if hospitaliza-

The winning algorithm itself has garnered a

tions can be predicted, then preventive measures

great deal of interest from the healthcare industry

can be taken and unnecessary hospitalizations can

at large, Dr. Merkin said. “We have had interest

be avoided,” possibly to the tune of $40 billion.

from large medical systems and large hospital

HPN received 39,000 entries from 41 different

systems, both for-profit and not-for-profit, that

countries. One of the entrants, for example, was a

have licensed our technology. This has been pro-

group of astrophysicists whose day jobs involved

fessionally satisfying to us, because we are able to

top-secret work for the federal government.

help change healthcare, not just for ourselves but

Even though the contest has ended, Dr. Merkin

for the whole country, by having very large systems

said HPN is still in touch with these astrophysicists

begin to use our algorithms and our intellectual

as they rethink their algorithm and continue to

property to better provide healthcare to their pa-

develop it into something worthwhile to the health-

tients and their members.”

care industry.

Real Issues : Real Solutions


“HEALTHCARE IS ATTRACTING PEOPLE FROM DIFFERENT INDUSTRIES, AND PEOPLE ARE FINDING IT INTELLECTUALLY CHALLENGING.”

is rapidly leading to partnerships with other health systems. The network’s continued breakthroughs and innovation is largely the result of the culture Dr. Merkin has nurtured. “We’re very careful about acquiring talent,” he said. “We believe in diversity and getting great talent. Talent then attracts talent.”

EMBRACING CHANGE WITH AN OPEN MIND Dr. Merkin advises healthcare leaders against dismissing seemingly off-the-wall ideas. “Frequently a breakthrough idea today was a crazy idea yesterday,” he said. He also urges them to embrace change in an

ANTICIPATING THE FUTURE OF HEALTHCARE

ambitious way. Instead of shooting to be a little bit better than what they are now, shoot to be 10 times better, he said. Yes, you may fail, but the chances

In 1979, HPN invented the concept of hospitalists.

are you’ve stretched yourself to such a degree that

The network introduced interdisciplinary teams,

your organization is now three times better than

now known as collaborative medicine, in 1982.

when you began. This establishes a solid, progres-

This anticipation of the future continues to guide HPN’s myriad endeavors and its persistence in forming alliances with the foremost institutions in the country. For example, Dr. Merkin established The Rich-

sive foundation upon which you can then build. “Healthcare is attracting people from different industries, and people are finding it intellectually challenging,” Dr. Merkin said. “I believe there’ll be a

ard Merkin Foundation for Stem Cell Research at

convergence of technology. I think the world will be

the Broad Institute at Harvard and MIT. At UCLA,

different. I think the science will be different. I think

he established The Richard Merkin Foundation for

the payers may be different. And with the conver-

Neural Regeneration, and at the Johns Hopkins

gence of technology, I think this will improve the

Brain Sciences Institute, he implemented The

quality of healthcare not only for the United States,

Richard Merkin Initiative. Nearly a decade ago, he

but for the world.”

endowed the Richard Merkin Distinguished Fellowship in Emergency and Tropical Medicine in the

BY PETE FERNBAUGH

Division of Internal Medicine at the Keck School. On June 30, HPN backed a new professorship at USC for regenerative medicine. The success of the Heritage Health Prize led HPN to co-sponsor a breast-cancer prize with the National Institute of Health and an open-architectural health prize with UCLA. HPN recently formed a partnership with Trinity Health System to transform its 83 hospitals from volume-based to value-based. Its work with Trinity

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GRAMERCY SURGERY CENTER Gramercy Strives to be a Cost-Effective Alternative within Healthcare Gramercy Surgery Center, a freestanding, Article 28 facility, was founded in 2006 by Katy R. Chiang, chief executive officer and president. It is operated and managed by Jeffrey Flynn, chief operating officer and administrator, who joined the center when it was established. Located in New York City, Gramercy is one of Manhattan’s leading multispecialty centers. Jeffrey Flynn, Chief Operating Officer and Administrator

Flynn said the organization’s development strategy over the last nine years has been rooted in his team’s cognizance of future trends. “Gramercy’s success has been our ability to kind of look at what’s coming down the pike and being ahead of the curve because we’re always evolving.” Gramercy was originally an out-of-network center from 2006 to 2009, but after the 2008 economic crash, some of the services it offered, such as podiatry, were no longer in demand. “We looked for other things,” Flynn said. “We expanded to other specialties. The one good thing in ambulatory care is that everything always changes.” Flynn said the team had to step back and reevaluate which services were needed, which weren’t, and which services needed to be added to their offerings.

FOSTERING A SENSE OF TEAMWORK

limited resources. In 2006, a vascular surgeon told Gramercy that he could only perform 5 percent of

Another secret to Gramercy’s success is its team

what he needed to do at their center. As of 2013, a

mentality, Flynn said. “One of our tenets is we want

vascular surgeon can now do 75 percent of his work

people to thrive and take ownership of their jobs.”

at the center.

Everyone owns Gramercy, he added, because

Over the years, Gramercy has expanded to 14

everybody on the team brings something different

specialties and is able to conclusively demonstrate

and unique to the table.

that its costs are lower than a hospital’s costs in

Having a unified team is especially important

terms of basic complications, infection rate, return-

when it comes to listening, Flynn said. You can’t be

to-surgery rate, and hospitalization rate. It was the

divided on the inside and listening to what’s going

first surgery center to do lap-band in New York,

on in the healthcare world outside, which trends

charging patients three times less than what the

are picking up steam, and what the needs of com-

procedure would cost in a hospital.

munities are. You have to be able to listen to doc-

“I challenge any outpatient surgery department

tors in order to know where they’re coming from

at a hospital to meet my numbers,” Flynn said. “And

and what challenges they’re facing.

through collaboration with local New York payers,

BRINGING 14 SPECIALTIES TO THE COMMUNITY When Gramercy began as an out-of-network center, it had only four specialties and severely

the insurance companies are willing to pay us more because we have proven we can do it for cheaper and at a higher quality.” Flynn said infection control at Gramercy is tighter and more easily controlled than in a hospital

Real Issues : Real Solutions


10 | GRAMERCY SURGERY CENTER

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setting, where a variety of contaminants can enter a surgical suite. He goes to great lengths to ensure his staff is thoroughly trained in all areas. For example, he requires his nurses and technicians to be ACLStrained, since there aren’t 50 extra nurses in a

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surgery center. He even runs drills with expired

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dantrolene, so they understand how difficult it is to

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“I can control who touches what in my center,” Flynn said. “I can show that I’ve gone after certain

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procedures that have notoriously high infection rates and show that those rates won’t happen in my center.”

SUPPORTING HOSPITALS AND OTHER CLINICS Gramercy is not an adversary to hospitals, Flynn said. Rather, it is an alternative and an assist to hospitals. Nevertheless, hospitals are resistant to the idea of ambulatory care, and Medicare is proposing cuts that will handicap single-specialty centers. With 14 specialties, Gramercy is well-equipped to convince hospitals of its worth to them while weathering the many storms of modern healthcare. Flynn said there’s good camaraderie among all of the surgery centers in New York and with certain hospitals as well. If Gramercy doesn’t have something, then it can send a patient to the center that does. This frees the organization to focus on doing the programs that are right for it. “Again, it comes down to looking at costs and looking at where you can share,” Flynn said. “The original centers in New York, we all talk to each other. Because at the end of the day if I need to borrow something or if they need to borrow something, I want to know that they’re down the road and ready to do it. The same with the hospitals.” If clinics get involved in subterfuge, where they’re stealing patients and doctors from other centers, then they won’t last long. “We’re all facing a crisis in New York, not so much if you’re multispecialty, but I know the endoscopy centers have been hit, given the Joan Rivers situation,” he said. “And I have to tell you the one thing is: If you’re not following the rules, that’s just shame on you.”

This is something that the national companies who are coming into New York have yet to grasp, he said. They don’t understand the sharing culture among the centers or how to handle contracts with insurers or even how to deal with the department of health. “Within the healthcare industry in general, we are really the alternative to the future that’s going to be helpful to hospitals,” Flynn said. “We should see ourselves as allies to hospitals. It’s time to really educate and collaborate with the insurance companies. At the end of the day, there is still going to be a certain aspect that’s going to be outside the hospital system. I really think you can survive and thrive outside the hospital system, but you don’t have to be an enemy of the hospital systems. You can work with them.” BY PETE FERNBAUGH

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MARTIN LUTHER KING JR. COMMUNITY HOSPITAL

MLKCH Opens with a Fresh Culture and a Fresh Start In 2007, the historic King Drew Medical Center in Los Angeles, Calif., closed, after years of persistent and unresolvable quality and patient safety problems. King Drew had originally been founded by the county of Los Angeles following the Watts Riots as a public hospital.

Elaine Batchlor, MD, MPH, Chief Executive Officer

It served a low-income, medically underserved community of 1.3 million people. When it closed, the need for a new hospital to replace it was immediately apparent to county and state leaders. Los Angeles County and the University of California entered into an agreement to support the development of a new private hospital on campus. As part of that agreement, they then jointly selected a governing board for the hospital. Elaine Batchlor, MD, MPH, chief executive officer, was selected for the governing board in August 2010 and eventually appointed CEO. On May 14, 2015, Martin Luther King Jr. Community Hospital officially opened. Dr. Batchlor described this hospital as being different from King Drew. “It’s now a private, not-for-profit, safety-net hospital,” she said. On May 14, 2015, Martin Luther King Jr. Community Hospital finally opened.

STARTING FROM SCRATCH

“We built this organization as a start-up,” she said.

Dr. Batchlor said starting a hospital from scratch is

“That means that we started with things like buying

exciting. It may also be one of the ultimate career

insurance establishing our nonprofit status, hiring

challenges. MLKCH’s board made a point of laying

core staff, and bringing in people with expertise in

the foundation for the organization before they even

different areas to help create the infrastructure. I

had a building.

was employee number one. We now have a staff of

“I recognized the risks involved, but the people who came together to start the hospital had a vision

over 680 people.”

it to be,” she said. “That vision was exciting and

OPENING IN A CHALLENGING MARKETPLACE

meaningful. We felt that we were coming together

Early on in the process, the governance board

to do something important for a community that

conducted a community-needs assessment to

really needed it.”

inform planning. One key finding was a shortage of

of what they felt it could be and what they wanted

It also fit Dr. Batchlor’s background as a safetynet provider.

700 primary-care physicians and 1,000 specialists within the community.

“Taking on this project was a continuation of the

“It’s a market that is challenging from a busi-

population-health and safety-net focus in my career

ness perspective because it is a low-income com-

and part of my identity as a physician.”

munity with Medicaid as the dominant payer, and

When Dr. Batchlor says they started from

unfortunately, despite the expansion of insurance

scratch, she means it. She and her team had noth-

under the Affordable Care Act, there continue to

ing when they began.

be residents who are uninsured and aren’t eligible

Real Issues : Real Solutions


11 | MARTIN LUTHER KING JR.   COMMUNITY HOSPITAL for public programs because of their immigration status,” Dr. Batchlor said. The community-needs assessment also revealed that the population was younger than other parts of L.A., and the women in the community were having a high volume of babies. The board placed top priority on expanding the hospital’s OB program to both meet the needs of families and to maintain high-quality OB services. A fundraising foundation was established and its first project was to raise money to expand the OB program before the hospital opened. The drive was successful and $8 million was brought in, basically doubling the number of deliveries MLKCH could do. Dr. Batchlor points out that they did this even though more deliveries doesn’t necessarily result in a better bottom line. From the beginning, the board was determined to preface every organizational decision with the question, “What is best for the community and for our patients?” she said. In opening this hospital, Dr. Batchlor also said she was reminded of how essential good project management is. “I’m not sure that’s something a doctor would ordinarily know, but you really need to have good project management and good contingency planning. You have to be flexible and creative at solving problems.” Furthermore, she learned to hold out for the best hires, to have the confidence to take risks, and

“We are leading development of an integrated, coordinated system of care that starts before people need us, with prevention and wellness, and includes all aspects of care that people need in the arc of their health life,” she said. Martin Luther King Jr. Community Hospital was designed as an all-digital hospital. When it opened, there were no paper records. The electronic health records platform was already in place, as was its telemedicine program, a patient interactive system in each room, and a patient and physician portal for the EHR. “We’re designing innovative approaches into our hospital,” Dr. Batchlor said. “We’ve identified best practices and evidence-based protocols that are integrated into our EHR so the physicians who prac-

to make bold, daring calls.

tice here have an easy path to doing the right thing.

ESTABLISHING A FRESH CULTURE

that is appropriate for the moment that we’re in

“We had the advantage of starting from the beginning and being able to establish the culture that we wanted for the hospital,” Dr. Batchlor said. “We

“We have the opportunity to create a hospital right now. In creating a new organization, we’re building for healthcare’s present and its future.” BY PETE FERNBAUGH

were thoughtful about what that culture should be, and we designed our policies and infrastructure to support that culture. More importantly, we hired staff who were in alignment with that culture.” Employee candidates are evaluated not only for their technical qualifications, but also for their fit and alignment with the organization’s mission. The hospital already has prevention and wellness programs in place, and care coordination tops the list as they work with outpatient providers to strengthen the outpatient network of care.

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RICHMOND UNIVERSITY MEDICAL CENTER

RUMC Transforms Patient Experience through Community Commitment After a series of losses, Richmond University Medical Center in Staten Island, N.Y., has made great strides in turning around its finances, patientsatisfaction scores, and community involvement. Many organizations discover that, along with improvements in efficiency, efforts to boost patient satisfaction and community outreach also improve finances.

Daniel Messina, PhD, FACHE, LNHA, President & Chief Executive Officer

Daniel Messina, PhD, FACHE, LNHA, has been president and chief executive officer of the medical center for nearly two years. When he came on board in early 2014, the organization was budgeting for a loss. With focused leadership and employee engagement, Dr. Messina began to implement cost-management initiatives and promote efforts to maximize supply chain in order to reduce the deficit. These changes led to seven-figure improvements. RUMC also began leveraging technology to improve workflow and has received $1.5 million in Meaningful Use incentives so far.

REDESIGNING THE STRATEGIC PLAN By engaging the board and the leadership, Dr. Messina developed a new strategic plan for RUMC and began expanding its outreach to the community. “We needed to refresh our priorities, our true performance indicators, and better understand the competitive landscape,” he said. “I listened to the workforce, the medical staff, our patients, and our community to learn more about the frontline challenges and opportunities.” Through listening and learning, Dr. Messina, his leadership team, and the board have changed the direction of the medical center and have begun numerous initiatives for aligning the hospital with current developments within the healthcare industry. The 470-bed facility has been providing medical services to Staten Island residents for 100 years. RUMC renewed its focus on population health through a number of initiatives.

Real Issues : Real Solutions


12 | RICHMOND UNIVERSITY MEDICAL CENTER

The organization has begun discussions with several schools to offer wellness programs and is working with Babies “R” Us to offer a mother/child health education program. In collaboration with the North and South YMCA, RUMC also offers diabetes education classes.

TAKING ADVANTAGE OF FEDERAL INITIATIVES Richmond University Medical Center has embarked on new approaches to care that are inspired by healthcare reform. First, RUMC developed an ac-

MONARCH MEDICAL 101 Ellis Street Staten Island, NY 10307 www.MonarchMedical.com

countable care organization under the Medicare Shared Savings Program. The ACO brought together primary-care physicians on Staten Island and within the hospital. “The ACO has been a terrific opportunity for us to enter into the risk-based contracting world, which will help us compete in a new environment,” Dr. Messina said. RUMC also participated in the Centers for Medicare and Medicaid (CMS) Delivery System Reform Incentive Payments (DSRIP) program. The program offers incentives to hospitals that implement specific programs that improve efficiency, quality, population health, and access to care for patients with Medicaid. New York is a unique and exciting place to be part of this program because of the state’s support. New York has been working to transform the healthcare system and has put up state funds in addition to federal Medicaid funds to support DSRIP programs. Dr. Messina said the program has encouraged RUMC to collaborate with the community on wellness, chronic-disease management, post-acute care, and substance abuse. RUMC partnered with its neighboring hospital on Staten Island to improve the health and clinical performance of residents over the course of five years. Dr. Messina said Staten Island has a popula-

“Medicaid recipients comprise a significant part of care for both hospitals,” Dr. Messina said. “This project creates an environment where community collaboration is the foundation and expectation of delivery of care.”

ENHANCING CLINICAL SERVICES AND PATIENT SATISFACTION In addition to gains in community collaboration and financial success, RUMC is looking at ways to continue improving the patient experience. The hospital recently began planning an expansion of the emergency department and a new observation program within the ED. RUMC added a robotics program and bolstered the cardiology services with the addition of angioplasty. RUMC is also expanding ambulatory care centers within the community. The RUMC Ambulatory Care Center received Level 3 designation as a Patient Centered Medical Home Program. “In an age of population health, we need partnerships to move forward,” Dr. Messina said. “RUMC continues to create efficient, high-performance, yet fiscally accountable care.” BY PATRICIA CHANEY

tion of about 500,000 people, with about 130,000 Medicaid recipients.

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DEKALB MEDICAL

DeKalb Medical Earns Baby Friendly Designation In January 2015, DeKalb Medical became the first hospital in Georgia to achieve a Baby Friendly designation and in doing so, earned a 5-STAR Hospital Recognition from the Georgia Department of Public Health.

John A. Shelton Jr., FACHE, President and Chief Executive Officer

According to John A. Shelton Jr., FACHE, president and chief executive officer of DeKalb Medical, which is located in Decatur, Ga., in order to achieve Baby Friendly, you must first accomplish 10 steps, each of which is worth two stars. Because it’s a two-year process, an organization has to be seriously committed to the goal, he added. “From an organization perspective, it’s something that you have to really be focused on and prioritize everything you want to do to achieve it within that timeframe. It’s very, very difficult. That’s our staff that’s working with our obstetricians and just going down the list of everything you have to accomplish to achieve the designation.”

EMPHASIZING BONDING AND BREASTFEEDING

A hospital must also redesign its patient rooms for the purpose of rooming in. Rooming in is where

Generally speaking, a hospital must rethink its en-

babies and mothers are kept in the same room,

tire approach to caring for mothers and their babies

so they’re together 24 hours a day after the child

if it’s going to earn the Baby Friendly designation.

is born.

Shelton said that Baby Friendly is centered on two ideas: mother-baby bonding and breastfeeding. A hospital must first formulate a written breastfeeding policy that is clearly communicated with the

Finally, a hospital has to establish a breastfeeding support group to connect and counsel mothers upon discharge from the hospital. “We had started ‘rooming in’ before we began

staff. It then has to train all of its staff on the skills

this initiative,” Shelton said. “Outside of that we

needed to implement that policy.

had not formally done the other nine steps that it

Pregnant females must be informed and

takes. It’s just quite a commitment to be able to do

educated about the benefits and management of

that and to do it effectively. Once they understood

breastfeeding. This education involves teaching

the true benefits it provides for the mother and the

them about maintaining lactation and ensuring that

baby, the staff readily accepted it.”

they’re only giving the baby breast milk. In fact, the

Furthermore, since the program encourages

GIVING INDIVIDUALIZED ATTENTION TO EACH MOTHER AND BABY

breastfeeding on demand, artificial nipples or paci-

Because DeKalb has the unique distinction of be-

fiers are not handed out.

ing the first hospital to achieve a Baby Friendly

goal is to avoid giving infants any food or drink apart from breast milk while they’re at DeKalb.

Real Issues : Real Solutions


13 | DEKALB MEDICAL

program in Georgia, the door to many productive partnerships has been opened, Shelton said. Almost immediately after receiving the Baby Friendly designation, an extremely busy OB/GYN group and a competing hospital both made the decision to relocate their practices to DeKalb. “So obviously, that practice saw the great benefit and the commitment that we had made institutionally to our OB/GYN service line,” Shelton said. “And we’re right now getting interest from other groups as well.” Another discovery produced by the program was how many women within the community were

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actually looking for alternative ways for childbirth as opposed to the traditional ways. “We have achieved 95 percent of our moms who want to exclusively breastfeed and are able to do so, which is an extremely high percentage,” Shelton said. To meet this demand, DeKalb has hired lactation specialists who educate mothers on various breastfeeding techniques. They work around the

said, and they need to know about the hospital’s commitment to it. For those organizations who are interested in establishing their own Baby Friendly initiatives, he advises caution in developing it and communication in attaining buy-in from the staff. “Before agreeing to move in that direction, I

clock with the mothers, Shelton said, and consider

would clearly understand the commitments that

education to be a major component of the program.

are going to be required and understand that

“Attention is also more specialized and individualized to each mother,” he added.

UNDERSTANDING THE COMMITMENT NEEDED FOR THE PROGRAM

there’s got to be a strong collaboration between the physicians, the staff, and the administration. You cannot accomplish this with only one of those parties pushing it.” BY PETE FERNBAUGH

Shelton takes little credit for the success of the Baby Friendly program, instead redirecting praise to his OB/GYN team. “It was really the product of some of our OB/ GYNs seeing great benefit in this,” he said. “The staff understood it and stressed that they really wanted to give it a go.” The administrative staff also had to be onboard, he added, since some products are no longer free to the hospital under the program, such as formulary. DeKalb’s goals for the Baby Friendly program going forward are focused on marketing. The community needs to know about this program, Shelton

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SEP/OCT

2015

HCE Exchange Magazine EDITORIAL Editor: In-Focus Pete Fernbaugh Contributing Writers Teresa Pecoraro Jacqueline Rupp David Winterstein Meghan White Patricia Chaney Kathy Knaub-Hardy Editorial Associates Levent Nebi Deepa Bhatia Lori Ryan Anami Mittal ART DEPARTMENT Art Director Kiki Ikura Associate Art Director Devdutt PRODUCTION DEPARTMENT Production Director Russell Ford Production Associate Ivan Bogdanovich SALES DEPARTMENT Sales Associates Rahul Bhende

HCE EXCHANGE

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