2012 HealthLeaders Twenty
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Mapping a Course for Each Oncology Patient
Sharon Gentry, RN,MSN, AOCN, CBCN
Facing breast cancer is a frightening thing. The chemo. The radiation. The surgery. The survival odds. The lonely hospital rooms and the herds of specialists. The unending appointments and the cost of treatment. And the daunting task of somehow getting through it all with dignity.
Enter Sharon Gentry, RN, MSN, AOCN, CBCN, a breast nurse navigator at Derrick L. Davis Forsyth Regional Cancer Center in Winston-Salem, N.C.
"One of the philosophies of navigation is you walk in the shoes of that patient," says Gentry. "It's someone to take that patient's hand when they're told that they have a cancer diagnosis, and you make sure that they have a safe journey throughout the treatment continuum."
Today, the Academy of Oncology Nurse Navigators has more than 1,700 members and hosted its third annual conference in September. But when Gentry became one of North Carolina's first nurse navigators 12 years ago, there was no blueprint, no road map for her new role. So Gentry created one.
"If that patient identifies a barrier to care or a not-pleasant experience, as navigators we need to hear that," Gentry says. "I've been very fortunate to work in a system that listens to the feedback of the patient."
For example, she discovered that women in Winston-Salem were resistant to having mammograms done at the hospital, so they have kept open the mammography center a mile down the street and Gentry meets with patients at both facilities.
But navigation goes beyond simply guiding patients through treatment. As a navigator, Gentry also understands that there's more to a patient than simply her disease.
"You start looking at all the socioeconomic factors around her as well as educating her on the specific type of disease that she has and what to expect next in the journey," Gentry says.
—Alexandra Wilson Pecci
Winning a Grudge Match With Hepatitis C
Douglas Dieterich, MD
An accidental needlestick back in 1977 would shape his life as a patient and a physician. When Douglas Dieterich, MD, now a professor of medicine at Mount Sinai Medical Center in New York City, contracted a then-fatal disease as a resident, he had been planning to specialize in ophthalmology. Instead, he switched to gastroenterology, explaining, "Even though I could have gone into something much more lucrative, this became a grudge match in trying to go into the field to do battle with this thing."
Dieterich has spent most of his time in research on clinical trials of drugs aimed at hepatitis C, which has led to better treatments—all have some level of personal customization. Dieterich himself was treated twice with drug regimens for the disease, which he says cured him the second time.
New drugs are in the pipeline, and are desperately needed, he says, adding that up to 50,000 people per year will likely die in the United States from hepatitis C by 2020 "if we don't intervene." At this point, even though cures are possible and new and better drugs are still being developed, the likely deaths will occur largely because half of those with the disease don't even know they have it.
"It's a really good time to have this, but lots of people don't know they have it," he quips.
Ask Dieterich how it feels to have made such a difference in healthcare and he avoids the question, instead drawing on his own personal experience with the cure.
"It feels fantastic to be back to normal," he says. "Ask any of my patients who have been cured and they'll tell you."
Survival and the Need for Continuous Change
Bruce Bodaken, the long-time chair, CEO, and president of Blue Shield of California in San Francisco will retire at the end of 2012.
He acknowledges that he is walking away from his healthcare career just as a lot of exciting things are happening in the industry but Bodaken thinks 12 years is long enough for one CEO to lead a company. "When I took over I told the board that in my vision, for organizations to evolve and make sure they are at their very best requires continuous change," he says.
Bodaken's tenure included his early support for universal coverage, as well as Blue Shield's 2011 announcement that it would voluntarily limit its income to 2% of revenue and redistribute anything over that amount to its members, providers, and the Blue Shield Foundation.
The Blue Shield that Bodaken is leaving is quite different from the struggling insurer he took over in 2000. That company had around 1 million members and made its payroll by pulling money out of its limited surplus funds. "It simply wasn't going to survive," he explains.
Today the insurer is a dominant player in the California market. Membership has tripled, its surplus has grown to billions of dollars, and the company is on solid financial ground.
When asked to name his biggest accomplishments Bodaken points to the company's journey toward helping to make sure everyone has access to affordable healthcare, including prevention and wellness services. "All of us have a responsibility to be a part of the system and we need to make a way for those who can't afford to get care," he states.
He is proud of the work Blue Shield has done to expand accountable care organizations across the state. It now has eight ACOs throughout California.
—Margaret Dick Tocknell
Engaging Staff, Analyzing Data, Reducing Costs
Aurelia Boyer, RN, MBA
The demands keep coming: Decrease length of stay. Reduce admissions. Produce good quality measures for all to see, even as the industry struggles to agree upon which quality measures are most important.
But given a visionary CIO with a passion for data accuracy, accompanied by some physician champions, progress is possible. At New York-Presbyterian Hospital, astute use of data aggregation cut the number of deep-vein thrombosis cases resulting from venous thromboembolisms by nearly 50% in a 12-month period.
"It's not as simple as you think it's going to be when you start," says senior vice president and CIO Aurelia Boyer, RN, MBA. "How are we going to decide who's at risk for DVTs? With a great advocate in a particular physician, we started looking at those things using Amalga," which supports patient-centric analytics, a unified view of data across disparate systems, and perspectives both from the individual patient and across a population of patients.
Among the surprises: more upper-extremity DVTs than expected. Another analysis with a different group of physicians dealing with congestive heart failure patients resulted in a savings of $1.5 million, Boyer says.
Boyer represents the kind of CIO who moves more into traditional CMIO roles than usual. "I may be more clinically focused," says Boyer. "I really interact with my IT team about patient care all the time. I'm doing some great desktop work with the guys, asking, 'Do you really understand how the clinicians use this desktop?' Then I try to find the right doctor or nurse or administrator—to partner with them—to make those kinds of things really happen, and I think it energizes the IT staff , because they're pushed closer to the actual hospital business than they would be otherwise."
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- 76% of Physicians Don't Like CMS Quality Reporting Programs