Nebraska Medical Center is integrating its care sites into a single clinical enterprise. It's a massive, but necessary, undertaking that requires new roles and a culture change.
Clinical integration is an ongoing trend among healthcare provider organizations. But what does it really entail, and what are the difficulties? Omaha-based Nebraska Medical Center is in the process of integrating its hospitals and other care sites into one clinical enterprise with the goals of increasing efficiency and creating a better, more consistent patient experience. It's a major organizational transformation for the 621-bed institution.
"We recognize that to be successful going forward, we have to become one clinically integrated organization and break down the silos. That is very important," says William Dinsmoor, who until recently was CFO and is now CEO of the clinical enterprise for Nebraska Medical Center. Brad Britigan, MD, serves as president of the clinical enterprise under the new structure. The new leadership structure, announced in January, is meant to reflect the new organization's needs.
The organization will also likely change its name in conjunction with the new enterprise management strategy, but a final decision on branding has not been made yet.
Reducing Waste
Within the new framework, clinicians throughout the system will be able to access all patient records, which Dinsmoor says will "significantly reduce waste and improve the patient experience."
He expects to see a 15% to 20% reduction in waste over the next few years as billing and collections processes become more streamlined, fewer redundant resources are utilized, and system-wide communications are improved.
"For example, right now, there are lots of redundancies with our billing department, and the patient could get five bills. Beginning on July 1 and moving forward, our patients will see one bill. We will have one phone call to make to collect." A lean process will create a better patient experience, Dinsmoor says. "Having the IT connection between locations to be able to pass patient data will help provide a consistent experience throughout the organization. Standardizing the experience reduces variations in care and will also reduce cost…. We are creating a seamless environment and reducing all that waste and inefficiency."
Reallocating Resources
More efficient workflows and revenue cycle practices will also allow Nebraska Medical Center to shift employee roles toward a greater emphasis on creating value for patients—something Dinsmoor says will be a key to success for the organization in "the new world of healthcare."
"We expect to take FTEs and reallocate those resources and think about how we can reinvent ourselves for the future," he says. "Think about the value we would add for the patient if we went to their home and looked in their medicine cabinet to see what medications they should be taking and tried to reconcile those drugs at home. Even though we might not get paid per se, that would bring value into the system, which is what we need to be able to do."
Improving Population Health Capabilities
As the organization moves to one IT system, Nebraska Medical Center will be able to gather a larger data set to use in its population health management efforts, Dinsmoor says.
"We will be able to collect a lot of public health data. We will be able to leverage the data as we collect it and be proactive. I think that is the exciting part of having big data and looking for opportunities to improve the health status of our community in a real sense."
Although figuring out how to manage the health of populations is new territory for most provider organizations, it is necessary as the industry moves away from traditional fee-for-service payment models towards ones that reward value, Dinsmoor adds.
"I think we have to, and society is expecting us to. Will it be easy? No, but looking at the environment of health reform, I think it has to happen…. We do complex interventions, and we do that very well … but if we could intervene earlier, we could save millions and millions of dollars."
Nebraska Medical Center's population health efforts include launching a recent program with another local provider organization to increase its experience and knowledge in this area.
"We've created a care alliance with another health system in Omaha combining our two employee bases and managing them," Dinsmoor says. "We are piloting with about 17,000 to 18,000 lives. We are learning a lot and seeing where the different opportunities are. We are trying to learn about managing populations. We are doing it with our employees first … because we are already at financial risk with this population anyway."
The Difficulty of Changing Organizational Culture
Dinsmoor expects to have difficulty in breaking down institutional silos and moving toward population health.
"The hardest thing is figuring out how to change the culture," he says. "How do we create a truly team-based environment to manage populations? … It's going to happen, but it isn't going to happen overnight."
With healthcare delivery becoming increasingly focused on outpatient care, Dinsmoor says it is also a challenge for clinicians to adjust their thinking about what is optimal for the patient.
"How do you change the mindset that maybe the best thing for the patient is not to come to the institution? It's a financial challenge in the end, but it's really also about organizational culture," he says.
Preparing for New Trends
Although it may be difficult to adjust the culture to keep pace as the industry evolves, Dinsmoor says providers always have to be looking ahead to what the next trend will be so they can respond effectively.
"As I see it, for example, the next generation of patients is not going to want to come and wait in a waiting room. They want instant gratification. They want to do things electronically. They are going to ask, 'Do I really need to come in?' Providing that care is going to require much different technology and infrastructure than what we are used to," he says.
Having an enterprise-wide clinical strategy will make it easier for Nebraska Medical Center to analyze these important next steps in determining how best to deliver care, Dinsmoor adds.
"We are building the electronic infrastructure to be able to do more with predictive modeling to see where the real value propositions are," he says. "A lot of research is being done into how we should deliver care and what makes the most sense for the future."