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

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


How Healthcare Can Benefit from Good Design

Posted by Paloma Medina

Good design can create the foundation for health professionals to be on the same page.

In my previous post, I delved into the use of infographics and data visualizations in healthcare, with an emphasis on the patient as the audience. In this segment, we’ll explore how design can help get health professionals on the same page and on the road to productive collaboration.

Good design captures their attention: The first step in having health teams that hold common goals and strategy is to first get everyone on the same page about facts. Information dissemination for front-line workers and providers is a difficult task however because they are largely a mobile work force whose main roles keep them away from personal computer stations. More so than other professions, they are less likely to have the time to read through informational emails and text memos. Enter good design: A well-designed poster in the elevator, for example, trumps an email in two ways:

1. It brings the message to the place where they staff have time to absorb it

2. It captures staff’s attention and holds on to it just long enough to deliver the message

Smart design can thus engage the mind even when the message would otherwise be  less-than-exciting.

Good design rallies and inspires: Well-designed infographics, posters, etc. stimulate more than just one part of our brain. Within seconds, a great design can make us smile, enrage us, make us feel sadness and empathy, or just fill us with wonder and inspiration. By evoking emotions in us, the right visual language has the ability to motivate us towards action — action that could be anything from re-thinking our work flows to something as simple as reading an entire poster about medication side affects. This type of motivation and emotional engagement is what we need to get staff talking and caring about key health care issues.  Once staff are emotionally engaged, the hard work of creating shared visions, goals and game plans is, well, a little less hard.

Examples of good design with health professionals in mind:

The Unknown Killer
Another in a series from GE’s Healthymagination, this time in partnership with the creative agency JESS3.  A poster of this kind is a perfect platform from which to build buy-in around a performance improvement initiative. The design is instantly engaging — it’s use of color is lively and the design is clean. The effect is a poster that makes hospital-acquired infections (HAIs) interesting to read about – quite an accomplishment indeed! An improvement to this poster might be to have icons or imagery that highlight the comparison between HAI deaths and breast and prostate cancer deaths – a powerful fact that could use an equally powerful graphic besides a bar graph.

Fosamax: Just the Facts

An excellent example of how a poster can pack a wallop of information without overwhelming the senses – this “Just the Facts” poster is aimed at updating providers on new information on a medication (in this case, it was for a medication that was in pre-recall stages).

Why this poster works:

- The color palette is calming and simple: Blues and beiges are the only colors used — shading and text size are instead used to bring key items forward and move secondary information to the back

- Icons are used to build empathy: The usual text heavy, small-font list of side-effects in medication ads and pamphlets dehumanizes the effect that these symptoms have on patients’ lives. Providers are more likely to consider the implications of side effects on their individual patients when imagery is used. A great example of the power of images is the simple but emotive “Stomach pain” icon.

What’s Happening on a Night Shift?

Arm nurses and health professionals with information, follow it up with empowering quality improvement infrastructure, and you have a recipe for targeted performance improvement. This night shift infographic uses three-dimensional illustration to “walk” the viewer through the dangers on the night shift.  There are some flaws in the poster design — some numbers are confusing as to what they relate to and the flow chart could be much clearer. That said, this is still a great example of how we can turn data into a story by contextualizing the information into a place or scenario. This results in increased engagement, information comprehension and retention for the viewer.

Relating back to our work: What information-rich message do we have that needs to be conveyed to providers? Would investing in a few poster prototypes result in something that busy staff members would be more likely to feel engaged with? As a side benefit, could a well-designed poster add color and contribute to a better aesthetic in staff areas, rather than the posting of drab memos?

We do not need to hire a designer or firm to create great materials — we can move away from text-only communication to a design approach by simply learning from this field (or collaborating with it) and incorporating the successful elements of good design into in-house created pamphlets, posters, and web pages.

Next Up: In my next post, I’ll share some example of health infographics and data visualizations that target health policy makers and analysts as the key audience.

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.

Who I Am and What I Hope to Achieve

Posted by Jacob Victory

While inaugural game-day outings, presidential swear-ins, or grand openings of the local laundromat tend to have a lot of noise, glamour and “a 15 percent discount on your first five pounds of laundry,” my premier blog post comes with a large dose of humility, a little about who I am and what I hope to achieve with this blog.

 About Me: As a kid, I was the one who batted a home-run but couldn’t catch the ball (the mitt was too tight remains my excuse). As an artist, I paint my portraits to zoom-in on what I think is going on behind the mask of someone’s face. As a person, I believe in merit and in understanding that the ego doesn’t matter. As a professional, I seek to make an impact in serving those who are vulnerable—in other words, those who are rich, poor or like spicy foods, anyone who needs health care, healthy or otherwise, is always in a vulnerable spot. Why am I sharing my thoughts? Well, I want to give you my angle and I remember what is was like to be a student or what it was like early in my career and I’d like to share my thoughts because I’ve learned a thing or two from my experiences that others could benefit from. I also want to open up a discussion so we all can learn more, too.

My Blogging Roadmap: My blog will primarily focus on two areas. First, I write as an NYU-Wagner alum whose goal is to encourage current students and fellow alums to focus on what is relevant, what I consider smart things to do and not do, and how to work with others to chip away at making an impact. I’d like to address the need for mentorship, for reflection, and for relationship building. Also, I think students and alums always need strategies for job hunting or an understanding of how to network and find who may seem to be an elusive mentor.

Second, as a quiet observer of, but an active participant in, the theatrics of health care delivery, outcomes and, these days, reform, I wish to offer the practical viewpoint of what matters, what gets in the way, and what, in my self-exalted viewpoint, we should focus on. I’ll zero in on the need to maintain the viewpoint that “patient care is the only reason we are here” and what is needed to support this view; the need for collaboration between clinicians and “those business folks;” how performance improvement and succession planning must be priorities; as well as what I think the federal, state and local levels need to tackle in order to help health care organizations, clinicians, and administrators make this health care reform work..

Perhaps most importantly, I’m looking for a dialogue with you. If I can stretch your thinking (or make you chuckle), I’ll consider this blog successful. I’m flattered to write and excited to share.

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.