Five Cost-Cutting Health Care Trends to Watch


Posted by Joel Wittman

With health care reform requiring close scrutiny of financial performance, hospital and health systems are closely examining ways to reduce spending.  Following is one person’s thoughts about how fiscal responsibility can be achieved:

1. Mergers and Consolidations

Mergers and acquisitions in the health care sector are at an all-time high in terms of dollar value.  Hospitals and physicians are no doubt integrating and other providers are combining and coordinating care delivery models in response to the current and expected changes resulting from health care reform.  There are experiments in reimbursement and payment methodologies that should lead to fiscal sanity but can also lead to a concentration among providers.  Some believe that this will lead to less expensive care while others argue that it will lead to monopoly and its attendant effects on the health care financial landscape.  What do you think?

2. Reduced Readmissions

Tied to reimbursements, readmission rates are the target of hospitals to reduce the number of patients for the same condition.  Previous studies have found that a number of things can help reduce readmissions, such as home health use after hospitalization, patient engagement and education, use of nurses for patient follow-up, and remote health monitoring.  Hospitals should be focused on reducing readmissions and unnecessary admissions for conditions that probably would not have led to an admission if the person had gotten proper primary care.  Will accountable care organizations help in this regard?

3. Comparative Effectiveness Research

As leading institutions continue to look at evidence-based medicine and patient outcomes, new research is being developed about what is most effective.  A most hopeful trend is occurring in health systems where they are really looking in detail at examining what doctors actually do and what the results are in terms of outcomes and then feeding it back into the system.  Look into Geisinger and Kaiser Permanente as leaders in this practice.  but, will this be widely accepted by physicians as their medical decisions and care are more frequently scrutinized?

4. Care Coordination

With initiatives already in motion for accountable care organizations and patient-centered medical homes, more attention will focus on outcomes from care coordination and managing the entire care spectrum of the patient.  There is a trend to reimbursing health care providers based on outcomes instead of paying for more care.  Will the government (read Medicare and Medicaid) focus on this paradigm of paying providers or will extraordinary pressure be exerted by various advocacy organizations to maintain fee for service reimbursement?

5. Collaborative Communication

With increasing requirements for compliance, hospitals and providers will need to collaborate in their communication efforts.  New ways to work together will evolve resulting in more lines of communication.  Hopefully, the expansion of health information technology will lead to virtual connections between providers.  But at what cost and in what time frame?

And so it goes.  Payors are aligning with providers either through acquisitions or other creative forms of working together.  With increased emphasis on outcomes-based medicine, companies that provide care coordination oversight and patient care management will assume more importance in the health care cycle.  Was Humana prescient in its acquisition of SeniorBridge Family of Companies with the strategy of positioning them to favorably respond to the changing health care environment?  Will others follow?  Stay tuned.

Joel Wittman is an Adjunct Associate Professor at the Wagner School of Public service of New York University.  He is the proprietor of both Health Care Mergers and Acquisitions and The Wittman Group, two organizations that provide management advisory services to companies in the post-acute health care industry. He can be reached at joel.wittman@verizon.net.


SOTU: What Obama Didn’t Say


Posted By Errol Pierre

President Obama filled up close to 90 minutes of TV airtime giving his 3rd State of the Union Address last week. With 6,953 words (about 12 pages) to choose from political pundits filled the airwaves all across the country with animated reactions commenting on everything from the details of his plans to his tone, his demeanor, and overall performance. But all too often we forget that with great orators, it is more important to focus on the words that were not said than the ones that were….

Here are the facts:

– “Health” was used only 7 times during his speech (roughly 0.001% which takes up less than 1 line on a page).

– His comments regarding Healthcare made up only 332 words. That represented 4.7% of his speech (about a page and half). A little better but still severely lacking in substance.

How can that be?

– Health expenditures in this country represent more than 16% of our GDP while the average percentage among high income nations is roughly 10%.

– 13.1 million Americans lack a job but more than 50 million Americans in this country lack health insurance. Doesn’t healthcare deserve more attention?

– Since inauguration, he has spent 60% of his time in office getting what he called his #1 domestic policy agenda, healthcare reform, passed through Congress. If you recall, he entered office on January 20, 2010 and healthcare reform was passed on March 23, 2011. So 15 out of his now 25 months were dedicated to the pursuit of universal healthcare.

– Lastly, most of the popular provisions of the law have already been instituted. Millions of young adults in their twenties have been able to get insurance through their parents. And even more promising, no child under 18 can be denied coverage for pre-existing conditions.

So why were there so few words on healthcare? Discussing income inequality yet avoiding healthcare is not having an honest discussion about the problem. America spends more money on healthcare than any country on the planet. What is not widely known are the percentages spent by the government versus the private sector and how that impacts the American pocketbook. This country is actually on par with other high income nations spending 7.4% of their GDP on government health expenditures like Medicare, Medicaid, and Veteran healthcare. For a comparison, countries like France (8.7%) and Germany (8.1%) are at higher levels with government run universal healthcare. However, when it comes to expenditures from the private sector, America spends an additional 8.5% of its GDP representing almost half (52.2%) of total health costs for the entire country. That is 4 times higher than most like nations. In fact those private sector figures put us in 50th place between Rwanda (49th) and Gambia (51st) according to the World Health Organization.

WHY IT MATTERS

Most Americans get health insurance through their employer leaving American businesses on the hook for large portions of the country’s private health expenditures. It’s been the catalyst for corporations moving jobs overseas. It’s why the United States Postal Service is teetering on the edge of insolvency. It’s why America bailed out General Motors and restructured their Union contracts to be the #1 car company in the world again.

Most Americans work for businesses with 200 or more employees. According to the Kaiser Family Foundation, 99% of the time these businesses are offering health insurance to those employees. The foundation goes on to highlight that the cost of these employer health plans have gone up by 113% over the past 10 years with employers paying close to 73% of those costs on behalf of their employee population. As a result they have shielded much of the exorbitant healthcare increases from their employees. This has had grave repercussions to the average American salary. You cannot talk about income inequality and ignore non-salaried benefits like health insurance. These increases have poked huge holes in the bucket of funds that corporations use to payout employee compensation. You also cannot blame health insurance companies for these increases either. Their profit margins barely surpass 4% compared to pharmaceutical companies that enjoy 15% margins. The blame really goes to the actual cost of providing healthcare.

The U.S Social Security Administration has tracked the national average wages in this country since 1951. In 2001 it was $32,921. In 2010 it is $41,673. So despite the increases in health insurance costs, wages have still gone up 27% in the past 10 years. American employees however have seen 131% growth in the amount of money they must contribute to their health plan. It has gone from $1,787 in 2001 to $4,129 in 2010. So Americans have literally went from paying 5% of their salary on health insurance to 10% in 10 years not even accounting for the increase in co-payments, deductibles, and out of pocket costs.

If you truly want to tackle income inequality, look no further than tackling the increases in healthcare spending. Healthcare reform did not go far enough on this issue. It increased access via health exchanges, protected more patients via insurance regulations like profit ceilings and mandated benefits. But it did nothing to tackle costs. Even worse, our healthcare system will continue to shield costs from the consumer by giving subsidies to lower income Americans so that insurance can be more affordable. But these subsidies are paid for by taxes and fees levied on health insurance companies ($60 billion), on Americans with rich “Cadillac” type health plans ($32 billion), on pharmaceutical companies ($27 billion), and on high income earners use of hospitals ($210 billion). The only problem with these types of revenue streams are the laws of economics. Since individual Americans and large businesses will be required by law to purchase insurance by 2014, they as consumers will be more inelastic than their suppliers. In the end most of these taxes and fees will be passed on to the most vulnerable consumers further eating away at their hard earned income.

President Obama concluded his healthcare remarks conceding that he was “willing to look at other ideas to bring down costs, including one that Republicans suggested last year — medical malpractice reform to rein in frivolous lawsuits.” The only problem is here is the sad reality. According to the Kaiser Family Foundation only 11,000 malpractice claims were paid in 2009 amounting to $3.6 billion. That sounds like a big number but it is only 0.2% of total U.S. health costs. So the only question left is how much medical malpractice reform could help to actually close the income inequality gap. Well, the average malpractice suit is only $11.99 per capita, putting $12 bucks back in everyone’s pocket. I guess the good news is this kind of policy change would help fight the common cold giving every American the extra disposable income to buy a bottle of Robitussin from CVS.

Errol Pierre works at a large insurance company focused on business development, sales, and strategy for employee benefits. He is currently pursuing a degree in Health Policy and Management with a specializing in health finance. He can be reached at errol.pierre@nyu.edu

 


Working for the Federal Government


Posted by Debbie Koh

Welcome to 2012! Moving forward, I will alternate my posts between more career development-focused entries and more general musings on the public service field (similar to last month’s “The Business of Non-Profits”).So, let’s get started.

A Non-Official Guide to Possibly Working for the Federal Government

I’ve talked to enough people curious about how to crack into this area, so here’s my quick and dirty primer for Wagner students looking to work for the federal government. My disclaimer: I am not an expert. This is based on my personal views and experience at the US Agency for International Development (USAID) and only the tip of a very large iceberg. While at Wagner I did attend an excellent overview by someone who is an expert: Paul Binkley, Director of Career Development Services at the Trachtenberg School of Public Policy at George Washington University. His presentation, “U.S. Federal GovernmentCareer Opportunities,”is still available via Career Services.

1. Identify your agency: for many people with a desire to work in international health and/or development, USAID is the logical first step. But other “domestic” agencies, like the Centers for Disease Control and the U.S. Department of Health and Human Services, also do internationally focused work.(HHS recently developed its own Global Health Strategy). Or, consider smaller agencies like the Millennium Challenge Corporation.

Lesson learned: government agencies are huge and may do work in your area of interest, despite first impressions. Start with the big names, but don’t overlook less obvious opportunities.

2. Do you really want to work for the government: getting a job working directly for the government (known in DC parlance as a “direct hire” position) is harder than it sounds.There is a whole science and strategy to applying to usajobs.gov or avuecentral.com that I won’t even attempt to broach. The best-case scenario is to identify some sort of fellowship or program that will narrow down the application pool of thousands; eligibility is typically based on current enrollment in a graduate program. Below are a few starting points:

  1. Presidential Management Fellows (PMF): though still highly competitive, PMF is a two-year fellowship that allows for appointment into a government position upon completion. I came across PMFs at USAID who completed their two years there and others who began working there after completing their fellowships at other agencies. Check in with Career Services for instructions on the application process, as schools are only allowed to nominate a certain number of applicants. You may only apply during your final academic year.
  2. Student Temporary Employment Program and Student Career Experience Program (STEP/SCEP): I knew a USAID summer intern who returned to her masters program in the fall, returned to USAID as a SCEP intern and then converted to a position at the Agency. I know the least about these programs because I wasn’t eligible, but USAID details its own STEP/SCEP opportunities.
  3. Other fellowships/internships: this is where you have license to use creative Internet searches and your networks. For example, the USAID Indonesia Mission is recruiting interns in Health, Education, Democratic Governance, and Economic Growth (application deadline February 2012) but the announcement didn’t make the main website. A good start for those thinking about international health is the Global Health Fellows Program. Eligibility requirements may vary.

Lesson learned: current Wagner students should take advantage of their status and look for opportunities now. Don’t wait until after graduation!

3. So you don’t really want to work for the government: recent grads haven’t missed the boat. A better strategy may be to identify some of the many organizations and companies (“contractors”) that won government contracts and are looking to hire. I won’t mention any specific contractors but to start, here’s a list of 2011’s Top 100 Contractorsvia Washington Technology and one of many international development coalitions. Again, start big but try to identify smaller companies where competition may be less fierce. Many people jump between contract and direct hire work; it’s all about getting your foot in the door at first.

A not-so-recent grad with at least a couple years of experience, including work in developing countries, and a willingness to be based overseas may also consider a direct hire option at USAID called the Development Leadership Initiative (DLI). This initiative is meant to double USAID’s Foreign Service workforce. I saw new batches of DLIs coming in fast and furious, but the program is scheduled to end this year.

Lesson learned: decide whether one’s best option is to work direct hire or contract and proceed from there.

My advice is to pursue several strategies at once. I failed at one of PMF’s many elimination rounds and received rejections or no responses from multiple internships. When I landed an internship and got to Washington D.C., I attended workshops and presentations, volunteered at conferences and talked to as many people as I could about how they got where they were. Eventually, I transitioned into a contract position. It just took some perseverance.

Debbie graduated from Wagner in 2010 with her MPA in Health Policy and Management, International Health. She returned to her native California in 2011 and currently works for Venture Strategies Innovations. Follow her on Twitter at @thedebkoh or connect via LinkedIn. All views expressed are her own.


Building an Exchange Strategy Part I – Changing Your Vantage Point


Posted By Errol Pierre

Health benefit exchanges are set to be fully operational by 2014. As part of the Patient Protection and Affordable Care Act (PPACA), these exchanges seek to be a marketplace for consumers to purchase affordable coverage. Subsidies to reduce both the cost of insurance and the out of pocket expenses from copayments and deductibles will be available to eligible consumers as well. Estimates suggest close to 30 million Americans will find coverage through this avenue lowering the uninsured rate to 3%.

These exchanges will revolutionize the way health insurance companies operate. Most Americans receive insurance through their employer. As such, insurance companies have built their world around marketing to them rather than directly to individual consumers. Over the years, insurance company processes, products, and strategies have all conformed to employer choice and preferences. Even the way customer service is organized and how information is shared caters to an employer-centric business model.  However, by 2014 health insurance companies will need to operate differently to capitalize on the million of new health consumers entering the market.

Consumers purchase products much differently than employers. Consumer motivation is largely based on personal preferences and emotions while companies make rational decisions based on economic value.  So business to consumer (B2C) marketing has been much more demanding and onerous than business to business (B2B) marketing. Health insurance companies as a result have gotten away with minimal efforts in advertising using business publications and newspaper ads that reach CEOs, CFOs, benefit consultants, and decision makers. Marketing campaigns targeting decisions makers has been an easier road to handle than attempting to market the average consumer.  In fact most of the insurance policies sold in the United States are through brokers or independent agents hired by a business that receives compensation from the company whose product gets sold. Consequently, the construct of this industry has kept marketing innovation and ingenuity at bay. For years the basic message segmentation for B2B advertisements has been limited to industry and firm size.

Not all insurance companies suffer from this lack of consumer centric segmentation however. The car insurance industry is a perfect example of what the health insurance industry will aspire to be by 2014. Geckos and cave men, made up stores with humorous sales representatives, over the top actors representing natural disasters and unfortunate accidents, and catchy jingles all represent the car insurance industry’s push for market share catering to consumer preferences. Geico, Progressive, Allstate, and State Farm have all used innovative TV, internet, and other media ads recently to differentiate themselves. One main reason is because car insurance is largely purchased at the consumer level. As such, the industry caters solely to the wants, needs, and desires of the personal shopper. They have developed enhanced customer service levels, easy to use online tools, and a wide array of products and services all with a focus on consumer appeal. The consumer is essentially the center of the strategy. After all, it is the consumer who has the power to terminate the policy at any time; not the consumer’s employer.

Health insurance companies have a tough road ahead if they wish to compete at the same level. Moving from an employer-centric model to a consumer-centric model is more than just a mission and a vision. It really is a shift in corporate culture. It starts from the top down as much as it does from the bottom up. The CEO must believe in the change as well as the customer service representative answering the phone. There must be a commitment to innovation, ease of use, positive public perception, and consumer preference. The products offered must allow for customization and flexibility. The policies for grievances, appeals, and complaints must be customer friendly and aimed at pleasing the client. Such attributes have unfortunately been foreign to the health insurance industry and they have less than 2 years to quickly figure it all out.

Errol Pierre works at a large insurance company focused on business development, sales, and strategy for employee benefits. He is currently pursuing a degree in Health Policy and Management with a specializing in health finance. He can be reached at errol.pierre@nyu.edu


Sticky Notes & Pairs: Dial Up Staff Collaboration and Improved Solutions in your Performance Improvement Work!


Posted by Paloma Medina

Situation: You have an organizational issue that would benefit from the use a team approach. Perhaps you need to update a work flow or improve organizational performance on a specific measure. However, during staff meetings you find that engagement is low, brainstorming lacks innovation, specific people dominate the meeting, and/or inter-departmental tensions impede collaboration.

Solution: Change your meeting structure! The following “Meeting Recipe” will dial up staff energy and lead to better performance improvement solutions!

What you’ll need:

Meeting time of 1 – 2 hours (epending on the depth of the problem or area you’re focusing on)

20 or more sticky notes and one pen per attendee

Dry erase board or flip charts

A volunteer to act as a high-energy facilitator & time keeper

Instructions:

  1. Assign attendees into random or strategic pairs
    Have them sit together in their pairs
    I highly recommend being strategic — think about how pairs might increase collaboration among departments or individuals. You could pair up nurses with providers, administrators with front-line workers, etc.
  2. Pass out sticky notes and pens to each attendee
  3. State the challenge and the goal. Be clear and concise
    For example, “We want to increase provider productivity by 20% in three months” or “We want to improve our patient check-in process to decrease patient and staff stress”
  4. Give individuals 5 minutes to brainstorm on their own ideas for how this could be done
    Rules:
    1. One idea per sticky note
    2. Each attendee must write down  4 – 10 ideas (yes – this is doable!)
    3. At least one idea must be crazy, really fun, or pie-in-the-sky big (I often award candy to craziest ideas — this greatly energizes and revs up divergent thinking)
  5. Have individuals now share ideas in their pairs
    Give them 2-3 minutes per person to share their ideas, call “time” when it’s time to switch and have the other person share
  6. Have pairs generate ideas
    Give them 10 minutes to come up with 10 more ideas with their partners. Ideas can be  completely new or building on each others. Again, one idea per sticky, at least 2 new crazy ideas.
  7. Call everyone back together and round-robin to report back ideas
    Rules:
    1. Have pairs come up and post their sticky notes as they explain their idea onto the dry erase board or flip charts
    2. Hold off on judgement – responses to ideas can only be praise or clarification questions
    3. Limit reporting to 60 seconds per idea – make it a fun but strict cut-off to assure pairs report concisely and energy stays high in the room
    4. If an idea was already presented, just have pairs say “ditto on ___ idea” rather than repeat it
    5. Spread out the area where you’re posting the stickies, the more spread out, the better
    6. Anyone at any point can “build” on an idea that is being presented and write down a new sticky note for it
  8. Everyone vote for their 5 favorite ideas
    Have everyone walk up at once and move around to review the ideas, then “vote” by marking the chosen sticky notes with a star. Give this just 5 minutes for this to assure people move fast and energy doesn’t drop – you’re almost there!
  9. Now re-vote to narrow it down
    Take down all but the top 10  voted-on ideas. Have everyone vote again but this time everyone gets one vote – this will lead you to your top 2-3 ideas to test out.
  10. Decide on next steps
    As a group decide what are the next steps to test out the chosen ideas, include time frames. Have pairs volunteer to take on the tasks. Pairs can them meet outside the meeting to plan how they’ll carry out their tasks. Have everyone report back in a meeting within a week.

After the meeting: Have someone transcribe all the ideas and note which were the highest rated. Refer back to these when you’re ready to try out a new test.

Real-life example:

A New York community health center faced this exact challenge — front-line staff were tasked with improving their productivity numbers but felt frustrated by leadership’s lack of support for their ideas. Months of meetings went by with little improvement in the situation and their numbers remained low.  The front-line workers requested to have a potluck lunch meeting with leadership to re-energize the group and used this “recipe”. They paired up management team members with frontline staff members to break down hierarchy walls. After the meeting both leadership and front line workers reported loving the voting structure and noted the high energy among everyone- a significant change from prior meetings! They now plan on using “pairs” for all of their performance improvement work.

Paloma Medina is an MPA HPAM 2012 candidate with a specialization in organizational coaching and development. Her background is in homeless health care, community development and design. In her spare time Paloma can be found tailoring her clothing, re-organizing her craft supplies or coming up with new toppings for hot dogs.


Let’s Meet to Meet


Posted by Jacob Victory

The routine is the same every morning. I enter my office. I walk in, put my large coffee, banana and yogurt (creamy, please) on my desk, hike off my hiking boots (I walk to work) and look for that button under my desk that officially starts the day: the “on” button on the computer. I guzzle a few sips of the piping hot coffee as I wait for the computer to boot up. Once the computer’s ready (it’s temperamental), I search not for new emails, not for documents, but I search for my schedule as I know they’ll be something (or, a lot of things these days) on my calendar that makes me wince. There is always one (or three) meetings staring back at me that garners the “I-don’t-want-to-meet-just-to-meet-anymore” sentiment.

In a time of doing more with less, with job cuts eating into staff productivity, with the excessive amount of presentations executives must present to other executives, most meetings don’t make sense anymore. I’ve reported to “Ms. Healthcare” for awhile now. She is brilliant, fun and very driven. Yet, she is obsessed with meetings—so much so that she proposes pre-meeting meetings to meet about what to meet about. She also requests that I prepare documents for these pre-meetings and send them to her 24 hours prior our meeting. Here’s how one typical meeting rolls:

First 10 meetings: I wait outside her door for her to wrap up her last meeting.

First “official” 5 minutes of the meeting: “What are we meeting about again?” she asks with her arms folded.

Next 10 minutes: I’m trying to walk her through the rationale of why I was asked to prepare a document for this meeting and guide her on what was in the document. It is clear she has not read it.

Next 20 minutes: We spend only 5 minutes talking about the relevant items and the next 15 trying to undo everything we discussed in the last 30.

Last 15 minutes: We discuss alternatives to what we think trying to do, only to nix all of the options in every second that follows.

Last 30 seconds: “I’m late for my next meeting,” I’m told, as I collect my pad and walk out of there with a bewildered look that leaves me confused on my next steps.

Amusingly, I’ve noticed that my meetings are scheduled only on Mondays and Fridays, which leaves me anxious on Sundays and exclaiming TGIF! on most Friday afternoons.  I will bet you cash-money that if you ask a fellow executive, you’ll get a similar response on what a typical meeting feels like. You may ask, “Why don’t you just refocus your boss and do a better job managing up?” Well, our response will be that the executives are not listening to their staff and are so immersed in meetings that they don’t realize this pattern of unproductive busy-ness that most take so much pride in.

Here’s how I’ve learned to focus the meetings that I lead:

  1. Send out the documents prior to the meeting and require people to read them before the meeting.
  2. Do not bring copies of the documents to the meetings. For the non-readers, they will quickly learn that you mean business!
  3. Send an agenda prior to the meeting. Keep it less than 4 bullets.
  4. With the agenda, send out the question you need to answer with the meeting members before the meeting ends. This will focus the meeting.
  5. Respect people’s time—you get extra brownie points for ending the meeting earlier than planned.
  6. Thank people for their work and make sure there are next steps, with accountable folks and deadlines.
  7. Set up the next meeting immediately, following the timelines given at the meeting.
  8. Presto. Here’s another cash-money bet: You’ll end the meeting in less than 40 minutes.

Now, I’m not espousing that we don’t connect with our fellow workers, and that we don’t mingle, schmooz and banter around. But we’re all busy and we’re all drowning in governmental regulations, expenditure reduction initiatives, staff shortages and changing policies due to the new health reform projects. To keep the ship afloat, let’s meet more efficiently!

Here’s another quick solution to reduce meeting time and keep things focused: conference calls. There is no better way to get a one hour meeting condensed into a 10 minute discussion that is pointed, productive and empowering. Chat away!

Jacob Victory, an NYU-Wagner alum, is the Vice President of Performance Management Projects at the Visiting Nurse Service of New York. Jacob spends his days getting excited about initiatives that aim to reform and restructure health care.  He’s held strategic planning, clinical operations and performance improvement roles at academic medical centers, in home health care and at medical schools. Jacob also exercises the right side of his brain. Besides drawing flow charts and crunching numbers all day, he makes a mean pot of stew and does abstract paintings, often interpreting faces he finds intriguing.


Strategies for the Health Care Reform Era


Posted by Joel Wittman

The Patient Protection and Accountable Care Act (PPACA) has unleashed a flurry of activity by health care providers and executives in response to some of its provisions.  While the PPACA primarily addresses the issue of access to health care services by patients, it also touches on the areas of cost-cutting, reimbursement and improvement in quality of care.  This article will refer to some strategies for hospitals to consider in adapting to the changing health care climate. Future articles  will indicate five cost-cutting health care trends to watch and will provide a list of recommendations for savings  developed by health care executives that were submitted to the now-failed “Super-Duper Congressional Deficit Reduction Committee”.

Hospitals and health systems are developing and implementing strategies to adapt to the dynamic health care environment.  The American Hospital Association Committee on Performance Improvement recently issued a report on priority strategies for hospitals and health systems of the future, which included responses from health care executives, which should be undertaken in the coming decade.  The top four are:

  1. Aligning hospitals, physicians, and other providers across the care continuum:    Described as a shifting paradigm from “competition to interdependency”, according to the report, aligning providers across the care continuum is essential to true partnerships and care coordination.  This can include shared savings incentives and sharing of data.  Wenatchee (Wash.) Valley Medical Center held meetings with all providers and acted on their suggestions.
  2. Utilizing evidence-based practices to improve quality and patient safety: Quality is directly tied to reimbursement, especially as hospitals with high readmission rates will be penalized starting in 2013.  Hospitals need to improve outcomes and should employ multi-disciplinary teams to review cases that failed with the goal of modifying processes accordingly.  Flowers Hospital in Alabama was able to achieve a more than 99% compliance rate with CMS core measures, tied to its financial reimbursements.
  3. Improving efficiency through productivity and financial management: Hospital executives are looking for ways to cut redundant efforts and standardize processed to cut costs and improve patient care.  North Mississippi Medical Center sought to improve patient satisfaction in the ED around wait times by implementing bedside triage, allowing for X-ray viewing abilities in each patient room, and installing a computerized tracking system to increase patient flow
  4. Developing integrated information systems: While health IT is critical to connecting providers with information in real time, in addition to owning the technology, hospitals and health systems must perform sophisticated data mining and analysis for continuous improvement in patient care and for the organization.  Piedmont Clinic in Atlanta, using several sources of electronic data, created a single data warehouse with information on patient satisfaction, core measures, physician quality reporting, population health statistics, and billing.  In addition, Piedmont provided daily updates about the critical data.

Change is inevitable and will occur.  What will vary is each organization’s journey to develop responses to these changes.

In next month’s column, I will suggest five cost-cutting health care trends to watch and, perhaps, what cost-cutting measures health care leaders suggested to the now-defunct Congressional Deficit Reduction Committee.

Joel Wittman is an Adjunct Associate Professor at the Wagner School of Public service of New York University.  He is the proprietor of both Health Care Mergers and Acquisitions and The Wittman Group, two organizations that provide management advisory services to companies in the post-acute health care industry. He can be reached at joel.wittman@verizon.net.