A KPMG survey shows that 47% of healthcare payers and providers experienced security-related violations or cyber-attacks that compromised data in 2017, yet 87% rated their readiness to defend at four or better on a five-point scale.
There are two types of payers and providers: Those who have been the victim of a cyberattack and those who will be. At least that’s a reasonable conclusion based on responses from senior leaders in the healthcare provider and payer sectors to the comprehensive 2017 KPMG Cyber Healthcare & Life Sciences Survey.
What gives?
Payers and providers must be in denial. That’s the only explanation for a group of more than 100 respondents from healthcare organizations of more than $500 million in annual revenue, 87 of whom said their organizations rated at least a four out of five in a gauge of organizational readiness to defend against a concerted cyber-attack. 35% rated their organizations as “completely ready” to defend against such attacks.
How can one rate his or her organization’s readiness so highly when 47% of those same respondents experienced security-related HIPAA violations or cyber-attacks that resulted in data loss or system compromise in the past 24 months?
It doesn’t make much sense.
“Healthcare payers and providers are on treacherous ground here and some organizations are underestimating cyber-security risks,” KPMG Healthcare Advisory Leader Dion Sheidy said in a press release announcing the survey findings. “There needs to be a higher degree of vigilance among boards and executive suites as attacks become much more sophisticated, especially as doctors need to share information to improve quality and as connected medical devices and wearables proliferate. The WannaCry ransomware hack in May was a warning shot against our collective ability to protect patient safety and privacy.”
Despite rising threats, KPMG’s survey found that cyber security as a board agenda item has declined over the past two years (79% versus 87% in 2015). In addition, KPMG found a disconnect regarding cyber investment in this volatile environment. A smaller majority of healthcare companies made investments in information protection in the prior twelve months (66% versus 88% in the 2015 survey).
When asked to identify specific attack vectors that led to data loss or cyber-attack, external hacking of a vulnerability led the pack at 69%, while malware introduced to the system through human error followed closely behind at 60%. Other vectors included phishing emails (39%), a third-party device product or service (37%) and internal bad actors (19%).
Some 32% of attacks from those vectors resulted in ransomware being introduced into the organization’s environment, while 66% said they were able to catch the attack before that occurred.
Perhaps most chilling: Of the organizations that were infected with ransomware, 41% paid the ransom to regain their data.
With Congressional delays in Medicaid disproportionate share funding cuts set to expire Sept. 30, CMS issues a proposed rule that details billions in reductions that will begin in 2018.
As the Senate tries repeatedly to repeal the Affordable Care Act, so far without success, CMS is moving ahead with detailing how cuts in disproportionate share funding will be administered under a political deal the hospital lobby agreed to in exchange for getting more people covered by health insurance under the ACA.
The first step of the DSH cuts, which were supposed to have been implemented in stair-step fashion beginning in 2014 and running through 2020, had been delayed by Congress until 2018 after hospitals successfully argued that uncompensated care costs weren’t declining as much as expected under the ACA.
The cuts will now begin in 2018 with $2 billion, with $1 billion in cuts added each year until 2024, when DSH payments will be cut by $8 billion. Another $8 billion in cuts is scheduled for 2025.
Cuts will total $43 billion over the eight years.
The proposed rule lays out the DSH Health Reform Methodology (DHRM) that will be used to implement DSH funding reductions by state, in an attempt to target more heavily hospitals that experience the least financial impact from uncompensated care.
The DHRM will incorporate several sources of data to determine the amount by which each state’s DSH funding will be reduced for each year, in an attempt to account for a variety of factors that influence the financial impact of uncompensated care burdens in each state.
The methodology must, according to CMS “impose a smaller percentage reduction on low-DSH states.”
The largest reductions will be imposed on states with the lowest percentage of uninsured during the most recent year data is available, to states that do not target their DSH payments to hospitals with high volumes of Medicaid inpatients and to states that do not target DSH payments to hospitals with high levels of uncompensated care.
Data that will influence the DHRM will include United States Census Bureau Data and Medicaid DSH audit and reporting data submitted by the states.
The proposed rule is open for public comment until August 28.
Hospitals and health systems have a major chance to grow and diversify with site-based clinics, but a host of for-profit competitors are competing with them on this fast-growing opportunity.
It's no secret that healthcare is being "disintermediated." But that word has become something of a cliché in a world in which Amazon serves as the disintermediator-in-chief.
Think of disintermediation as death by a thousand cuts—for-profit companies setting up businesses based on pieces of what the hospital or health system used to exclusively control in a given market.
This has been going on for years in imaging, outpatient surgery, and even primary care. But it's also evident in other areas that hospitals may count on to diversify their revenue streams, such as direct-to-employer contracting.
One area of direct-to-employer contracting that many hospitals and health systems have sought to exploit is so-called site-based clinics.
Many employers know they can realize potential cost savings by getting employees to access regular healthcare services as a way to prevent more expensive interventions down the road.
But site-based clinics can also be a gateway to population health. On-site clinics can be used to change behaviors, leading to greater adherence for employees who suffer from chronic conditions such as obesity or diabetes.
If hospitals can't use onsite clinics to provide more than illness and injury treatment, they'll face strong competition that may be able to outmaneuver them.
The 'Irony' of Population Health
"If you can manage patients more proactively, you can manage them more effectively," says Debra Geihsler, principal with Activate Healthcare, an Indianapolis-based for-profit provider of site-based clinics and wellness services for employers.
One of the ironies of population health is that to cut the cost of providing health care to a group of people, there's no substitute for managing health at the individual level.
Clinicians who staff the onsite clinics, including doctors and nurses, understand that their overarching priority is to help coach the patient toward better overall health—not to triage sick patients, although they do that too.
Geihsler knows wellness is often where hospital and health system-based clinics are deficient.
Before starting Activate with former Steak & Shake CEO Peter Dunn in 2009, she served as president and CEO of Harvard Vanguard Medical Group and Atrius Health System in Boston. Before that, she was CEO of Advocate Medical Group in Chicago.
Geihsler says many organizations don't understand that the patient is the ultimate arbiter of improved outcomes. Managing them on an individual basis is often the missing link.
"The patient is the only one in the room who can improve outcomes, so we strive to get 85% of employed members to utilize the clinic," she says.
"We try to engage the employed members to be leader of the communication process and we provide critical wellness counsel."
Beer, Wine, and Health
Monarch Beverage, a 750-employee, family-owned beer and wine distributor in Indiana, uses Activate for its on-site clinics and health management services.
Before engaging Activate, it partnered with a local health system to manage its on-site medical clinics, used primarily for physical therapy and primary care.
The idea was to minimize workers' comp expenses, but over time, the company recognized the need to manage workers' unhealthy behaviors and lifestyle choices.
"If people are unhealthy, it will play itself out on the medical front," says Natalie Roberts, a senior vice president who once managed human resources for the company.
"When we went to expand the concept years ago, we were able to partner with a big hospital."
The hospital was the partner for the onsite clinic for five to six years, but couldn't really get past managing the low-hanging fruit of providing low-cost office visits and convenient follow-up care.
It wasn't equipped or interested in population health, including health coaching, better weight management, reducing smoking rates and reducing cholesterol levels.
"The providers didn't really get it," Roberts says.
Activate, which employs the clinic's physicians and other clinicians, also provides health coaching and offers virtually unlimited (and typically free) access to primary care physicians.
Most appointments are seen on a same-day basis. Employees see wellness services as an added benefit, typically, which makes it easier for Activate to get to its stated goal of having 85% of employees using the on-site clinic for their care.
"Over time, costs go down because patients are managed more effectively," says Geihsler.
Many of Activate's clients are county or city health plans or manufacturers, and they pay Activate a per-member, per-month fee, guaranteed at a negotiated level for three years, to engage consumers on their care, with the ultimate goal of reducing high-cost interventions among the population by in part, tying changes in lifestyle to changes in patients' health.
Changing the Message
Along with the change in partners, Monarch started to change its messaging to employees. It had eliminated premium increases for employees for five years, but that became untenable as the "low-hanging fruit" was harvested, says Roberts.
"We started to change our message," she says. We told employees "if we see a decrease, you'll also see one, but if we see an increase, it will go up for you as well. You have to help us with this problem."
That gets employees to sign up for health evaluations and use the resources the on-site clinics offer.
"If you choose not to take advantage of these programs, you'll pay disproportionally to your co-workers," she says.
In addition to the onsite clinics, Monarch boasts a yoga gym, a cardio gym, and other incentives to manage health better.
"If your risk factors aren't improving, you have to pay more," she says. "What has happened is our culture has really shifted—whether you're a driver or material handler or executive, you have to get with the program."
The CEO of Atlantic Health System shares tips for delivering high-value performance.
Atlantic Health System CEO Brian Gragnolati began working out the metrics responsible for demonstrating value he was in charge of Johns Hopkins Medicine's Integrated Delivery and Financing System. Two years ago, he was appointed to lead the $2.6 billion (revenue) Morristown, NJ-based health system, and has implemented a measurement regime he believes will improve value.
Morristown, NJ-based AHS, with 1,000 employed physicians, rehab, home care, hospice and one of the largest ACOs in the nation (390,000 attributed lives) is ideally structured for value-based care, but that doesn't mean value will just happen. Gragnolati revealed six tips to delivering value in a recent conversation.
1. Avoid patient harm.
AHS seeks to measure patient harm at an elemental level.
"Our payment structures are set up to hit certain quality measures like readmissions, mortality and HAIs (healthcare associated infections)," says Gragnolati. The health system measures activity levels by area, looking at quality metrics, focusing on preventable harm, and the need, where appropriate, for pre-emptive intervention, such as precautions against falls, pressure ulcers, and line management.
"We discuss [on a daily basis] any patient who has a line or catheter, and make a deliberate effort to know when it's coming out," he says. "We also celebrate the days and months and in some cases, a year-plus that we haven't had a line infection."
2. Measure what affects your ability to get paid.
Value-based care and risk-based contracts represent a small percentage of total revenue for AHS, but it's growing and will continue to do so. Gragnolati says the health system's ACO work provides a great learning experience. Yet there are still frustrating issues with value creation, including the inability to view a patient's healthcare experience from outside the health system.
"I'm looking forward to a day when everyone is connected on either our EHR or one that interfaces with us so we don't have to guess what's happened to the patient before they hit our door," he says. "That inherently will create more safe and effective care."
Top administrators also get reports on more traditional measures, such as volumes and readmissions, and the health system uses a capacity planner to predict future staffing levels. The health system's physician enterprise also is able in real time to view at not only total patient activity, but also how many of those patients are staying in the system for care. Post-acute care report cards are also a critical part of the evaluation of value creation.
3. Consider patient experience.
"We measure door-to-physician time, and door time to disposition," says Gragnolati. "In real time, we look at patients being held in the ED and focus on what we need to do to get them elsewhere."
This leads to better integration with the rest of the healthcare enterprise, so, as Gragnolati puts it, "no longer do EDs feel like they're living in isolation." Also, he says with affordability a top concern to consumers, value has to be a part of the equation from their point of view.
"The reasons are apparent," he says. "They're experiencing more out-of-pocket costs, and healthcare takes a higher percentage of their income."
4. Measure employee engagement.
Gragnolati says about 15% of the system's total measurement effort goes toward evaluating performance and engagement of its employees. For the past eight years, AHS has been among the top 100 places to work according to Fortune magazine. Gragnolati says his philosophy is always to make sure the leadership is caring for the caregiver.
"If you do those things well, your organization is ultimately successful," he says. "That sounds naïve, but quite frankly, we leaders overcomplicate things a lot."
He adds that the entire health system's employees are measured the same way and with one report card the one the entire staff sees. Also, everyone is able to view the CEO's objectives for the year. Gragnolati says that level of transparency helps people connect to their piece of the puzzle.
"As we continue to become more integrated, we're measuring the degree to which direct care providers feel engaged," he says.
Getting employees, especially care team members, to understand the importance of the role of each individual on the team is also an area of focus. Which leads to:
5. Conduct patient care huddles.
At each hospital, whole-house huddles take place at 11 a.m. for 15-minutes. They're populated by the clinical staff and the leadership team, focusing on what's happened to patients in that facility over the past 24 hours.
"I go out to clinical sites a lot and I time my visits so I can go to patient care huddles," he says. "I encourage corporate folks to get into the huddle. I showed up at one a few weeks ago and my CFO was there."
6. Build credit strength.
The revenue base is shifting for AHS. Some 54% of it is now ambulatory. Two years ago it was less than 50%.
"We're pushing more care to the outpatient side so we stay attendant to operating revenue, which implies market share growth," he says. "As inpatient become less relevant, you have to grow aggregate operating revenue, which comes from your patient touches."
Part of that effort means making sure the health system's balance sheet is completely connected to its profit and loss statement. With earnings before interest, depreciation and amortization (EBIDA), Gragnolatis gets a better view of where the organization is generating cash flow. In uncertain times, it's important to stay focused on building credit strength.
"It's a complicated dance with analysts, but [to fund investments] we need sufficient reserves and a balance between debt and profitability."
EHR/EMR conversions and upgrades can significantly affect hospital operations and credit quality, but for most organizations, the negative impact is limited to a one-year decline in cash flow and liquidity.
Don’t believe the hype about electronic health record system installations making a positive impact on your hospital or health system’s finances, at least not right away. In fact, while there may be good reasons to undertake such a massive disruption, conversions and upgrades can result in prolonged margin contraction as well as negatively affect credit quality, according to a new report from Moody’s Investors Service.
The analysis by Moody’s shows that most hospitals that have recently executed EMR and revenue cycle installations navigated the disruptions successfully, but at the cost of reduced revenue and increased expenses outside the cost of the new IT itself.
If well managed, the analysis found, the disruption could be limited to a single year.
The subjects of the analysis were Moody’s rated organizations that ranged in annual revenues from $170 million to $3.8 billion, suggesting that size did not play an outsized role in whether the transitions were managed well. Most institutions studied completed the installations all at once, often referred to as a “big bang” approach, rather than staged over a number of months or years.
The hospitals that underwent such a conversion experienced a median drop in absolute operating cash flow of 10.1% during the installation year. Unsurprisingly, the period immediately preceding and following the go-live installation phase brings the most margin compression.
Generally, if recovery is not seen within a year, the health system risks being viewed differently by bond rating agencies.
Moody’s references the rating downgrades experienced by Wake Forest Baptist in 2013 and 2014 as a direct result of that health system’s high level of business interruption during the installation and go-live phase, which resulted in weakened financial performance and narrowed debt service coverage. The health system has since recovered.
Many hospitals and health systems’ management teams are evolving in their views of EMR and other IT investments. Where they were once seen as one-time capital expenses, they are now being viewed as a utility, or cost of doing business.
That means they will continue to invest in such capabilities despite the disruptions they bring about because they are viewed as needed to boost patient safety, clinical quality and provide decision support to clinicians.
Such investments become even more essential as hospitals seek to prevent cyberattacks, enter into risk-bearing contracts with payers, or establish their own risk-bearing insurance products. IT is also seen as a selling point in physician recruitment and retention, as well as a way to meet new data reporting requirements for Medicare.
The deal represents another step on the road to recovery for the debt-riddled for-profit health system.
Embattled for-profit hospital operator Community Health Systems got a much-needed infusion of cash with its $425 million sale of Rockwood Health System to seven-hospital MultiCare Health System, based in Tacoma, Washington. The sale of Rockwood, which includes Deaconess Hospital, Valley Hospital and Rockwood Clinic, announced in November 2016, closed this earlier this month.
MultiCare adds 3,200 employees and three healthcare facilities in the acquisition, which will convert Rockwood, based in Spokane, to MultiCare’s nonprofit status.
“This is an important step for MultiCare,” said Bill Robertson, MultiCare’s president and CEO, in a press release. “This acquisition will help the organization advance toward our vision of becoming the Pacific Northwest’s highest value system of health.”
Brentwood, Tennessee-based Community Health Systems has been shedding assets since 2015 amid declining profitability and concerns about its heavy debt load. The company’s high point surrounded its multi-billion-dollar acquisition of Health Management Associates in 2014.
The Fortune 500 company’s stock price has recovered somewhat since the acquisition was announced, but it is still far below its historical average. In the wake of its decision to sell assets in the face of a heavy debt load and intermittent operating losses that became apparent in 2015, the company’s stock has dropped from more than $52 a share in early 2015 to less than $5 a share in late 2016. CHS has struggled in part from the healthcare industry’s general move away from expensive hospital-based services, but more specifically because it was heavily exposed to rural markets, especially in states that did not expand Medicaid under the Affordable Care Act.
Among other deals meant to help the company recover, Community Health spun off 38 hospitals to form Quorum Health Corporation in April 2016, a deal that provoked accusations of fraud and an internal investigation of the behavior of the former parent company by Quorum’s board of directors, which, according to the board, did not produce conclusive evidence of intentional fraud or misconduct by CHS officials. CHS’s debt load is just less than $15 billion.
Lately, CHS stock has recovered to just less than $10 a share as its turnaround plan has started to show positive results.
Using minimal training and a four-part strategy, a hired gun helped an academic health center save $54 million in hard cash over a three-year period.
By the time Alicia Schulhof came on the scene, Indiana University Health had already tried some performance improvement projects aimed at improving its cost competitiveness.
The problem: IU Health is an academic health center with more than 2,500 beds. Its projects, though effective, were scattershot and not deployed system-wide, limiting their effectiveness.
The board and CEO recognized that the process needed to be more unified, and it needed to move faster. To improve the speed of the transformation, then-IU Health CEO Dean Evans brought in Schulhof, a former HCA chief operating officer, to direct an effort to reduce the cost of care at IU Health.
She was put in charge of convening a study group to find a system-wide value-improvement tool that could enlist all employees.
Schulhof ultimately chose Lean because of its ability to engage large swaths of employees by transforming culture. Named to lead performance improvement at IU Health's Office of Transformation, she was ready to roll.
She credits four critical strategic steps that ultimately helped the health system save $54 million in actual costs, and overall, more than $130 million "if you add in efficiency," she says.
1.Convince your work force that transformation is not a euphemism for layoffs.
The Office of Transformation was created concurrently, but unrelated to, a reduction in force. Schulhof had to convince the first of 12 local offices of transformation she would open during 2013 of the fact that Lean was not brought in to cut jobs. Indeed, she says, it was intended instead to remove redundancies in processes and reduce expenses to avoid the need to cut jobs.
2.Base your transformation on a 'unified philosophy.'
When Schulhof was evaluating performance improvement methods, she was agnostic. But what appealed in Lean was the fact that it allowed anyone in the organization not only to participate but lead projects to improve their work efficiency with minimal training, unlike methods such as Six Sigma, which requires a skill set many team members don't have, she says.
Employee surveys show that their perception of engagement with IU Health is higher if they have been involved in the Lean program, which now reaches all 15 hospitals and has been introduced through 1,150 "events" and 345 "projects" to 9,411 employees.
"Physicians are the best example of this," says Schulhof. "Their time is precious. They'll always say they can't commit two-to-three days for an event. I would always ask if they could just come in for first hour or two hours. Time after time they would come in and never leave."
3.Let employees lead it.
"[Lean] allows every one of our 35,000 team members to be a problem solver,"says Schulhof.
That may be a slight exaggeration. Slightly fewer than 10,000 employees have participated in a distinct performance project so far, but the transformation effort has reached wide. It's been installed at all 12 regions and 15 hospitals.
And it goes and deep, as Lean performance improvement projects can be extremely specialized. Schulhof does not prescribe efficiency projects. Her office and the consulting company IU Health hired to help with the process rollout train local offices in the statewide health system to find promising projects.
While many companies use industrial engineers as project managers, at IU Health, those engineers are ordered not to solve problems themselves. Instead they are instructed to act as coaches.
4.Use a dashboard to track progress.
Each IU Health region tracks its Lean projects using about 15 metrics that are the same across the system, and are based on quality, people (employees), service (patients), finance and growth. On Schulhof's dashboard and those of people who are managing the projects locally, those metrics for each project appear either red or green based on progress against goals.
"That's how we can save $54 million," says Schulhof. "If you add in efficiency, we're over $130 million now."
Convincing clinicians that getting to zero infections is possible, says one CQO. It requires a culture change, adherence to evidence-based practice, and leadership.
Danielle Scheurer, MD, believes that the plague of hospital-acquired infections and other patient harm is within clinicians' power to cure. Infections, no matter how small the ratio to the number of surgical interventions, are not simply part and parcel of surgery, she contends.
If that belief does not permeate among clinicians involved in surgery, it's tough to make headway on the national scourge of avoidable patient harm—a reality made frighteningly mainstream with the publication of the report, To Err Is Human, by the Institute of Medicine, way back in 1999.
Convincing is Half the Battle
Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina, where she is also an associate professor of medicine.
She says big progress can be made in infection control, especially where surgery is concerned, from convincing clinicians that getting to zero infections is possible.
"I'm not sure a lot of people even believed that was true as short as 10 years ago," she says.
But now, there is at least proof of concept that if evidence-based practices are applied consistently, it is possible to achieve zero harm—or come extraordinarily close.
Among others, both Memorial Hermann and Cincinnati Children's hospitals have both proven that near-zero harm is possible, but to achieve those results, the board and clinicians had to believe it was possible.
"Before you do anything else, make sure your care team members believe that's true," says Scheurer. "You can't get rigorous practice without variability until everyone believes."
On its face, that's a strange concept—the idea that belief is a critical component of something being possible. But belief presages action, and action is certainly critical to limiting harm, from infection to surgical site errors—to near zero levels.
Dashboards, Champions
There are many ways to convince clinicians to believe in zero harm, says Scheurer.
At MUSC, they started by studying other healthcare organizations—such as Memorial Hermann or Cincinnati Children's—where buy-in went well beyond bedside care and the OR—to frontline workers, the administration, and even board members.
Scheurer started by identifying high performing teams within her organization. At MUSC, one such team is in the pediatric cardiac ICU, which cares for some of the sickest, most vulnerable patients.
Patients go there there for complex cardiac surgeries, and they're already in a weakened state when they arrive. Prior to surgery, they're often in the ICU, and they often have, as Scheurer says, "a half-dozen portals of entry into their bodies—pacing wires, catheters, and central lines."
"That team sort of just accepted as their mental model that 'we're here to save the baby's life, there will be some infections, but that's just the risky business we're in,'" Scheurer says.
"I'm not sure anyone on that team believed zero harm was possible."
But working diligently on compliance with a dashboard of known infection-reduction techniques, including building a culture of safety and reducing the time, even to the hour, that infection pathways are in the patient's body, yielded payoffs that drastically changed that attitude.
"Some of our ICUs have gone up to two years [without an infection] as risk factors have been reduced," Scheurer says. "Those are the best evangelists for other teams."
She says that a single champion who can vouch for a proof of concept in a complex area makes culture change easier.
Her husband is a cardiac pediatric intensivist who once argued with Scheurer that eliminating infections in such settings was not possible. Thanks in part to the results in the pediatric cardiac ICU, "he has totally come around," she says.
Chipping Away at Barriers
With infections, there's often no way to prove when or where the inoculation occurred, which is one reason adherence to a bundle of evidence-based procedures is so important.
The St. Louis-based health system has a deal with the Sisters of St. Agnes to take over its Wisconsin-based hospitals.
SSM Health, the St. Louis-based Catholic health system that owns 20 hospitals in four states, including Dean Clinic and its health plan, Dean Health Plan, in Wisconsin, has signed a letter of intent with the Congregation of Sisters of St. Agnes to acquire Fond du Lac, Wisconsin-based Agnesian HealthCare and Monroe, Wisconsin-based Monroe Clinic. Both parties will conduct due diligence on the proposed acquisition over the next several months. Terms were not disclosed.
Sister Jean Steffes, general superior of the order, told the Wisconsin State Journal the deal should be completed in January.
Agnesian’s flagship hospital, St. Agnes Hospital, has 175 beds, and the parent organization also owns two 25-bed critical access hospitals: Ripon Medical Center and Waupun Memorial Hospital, in addition to the 58-bed Monroe Clinic.
The deal continues the rapid consolidation trend in acute healthcare, as market and regulatory factors change the delivery of healthcare services. The acquisition would give SSM a foothold in the eastern part of Wisconsin to add to its 2013 acquisition of Dean and its properties, which extend across 18 counties in the south central part of the state, including its capital, Madison.
In a press release, Steffes said that changes in the Wisconsin payer and provider markets, combined with the changing demographics of the congregation, led the sisters to making the decision to ally with SSM Health.
“The time is right for us to focus on the long-term sustainability of Agnesian HealthCare and Monroe Clinic,” she said in the release. “With their reputation for mission-driven, high-quality and compassionate care, we believe SSM Health is a strong strategic partner to both preserve and advance the organizations.”
Laura Kaiser, president and CEO of SSM Health, said the facilities her organization will acquire “have a bright and vibrant future.”
Steve Little, Agnesian’s CEO, told the Journal that the facilities would likely be renamed under the SSM Health brand.
The emergence and growing affordability of genetic testing along with patient demand means healthcare organizations need a strategy for their role in precision medicine.
Precision medicine is, ironically, an imprecise term.
As it is often used today, the phrase suggests that precision is novel to the practice of medicine, and to many, it means incorporating sophisticated genetic testing into its practice.
The term can even suggest that there are now possibilities of miracle cures that were never possible before.
Sometimes healthcare organizations encourage that attitude through their marketing and advertising, but to a degree, that kind of thinking more represents hype than substance.
And while genetic testing and the information it can provide can help better tailor treatment options for individual patients, especially in cancer care, experts say healthcare executives and clinicians must be careful not to encourage false hope among vulnerable patients and their families.
Yet in a time of rapid evolution of more precise and tailored treatment options, executives and clinicians are charged with divining the difficult calculus between the possible and the practical in their precision medicine organizational structure and service offerings.
In reality, precision has always been the goal of physicians as medicine has evolved over the past couple of hundred years, says Robert Mennel, MD, director of the Baylor Precision Medicine Institute in Dallas.
"In some areas we're there. We have well-accepted tests for certain diseases that, if you're not using them, I would consider to be malpractice in many situations," he says.
However, even top-level academic medicine is still quite far away from being able to look at an individual's whole genome and predict a therapy for every disease.
"But the promise of precision medicine is there, and medicine 10 years from now is going to be quite different than it is now," he says.
One area where genetic testing is ready for prime time is in noninvasive prenatal testing, says Scott A. Beck, administrator of the Center for Individualized Medicine at the Mayo Clinic in Rochester, Minn.
"Uptake has been phenomenally fast with one of the first widespread applications of whole-genome technology: noninvasive prenatal testing," he says. "Many women can now avoid amniocentesis. That's a step forward for patients. It's much less invasive and much less risky. We'll see more of those over time."
Another area where genomics is finding its way into therapy is cancer care, says Eddy Yang, MD, deputy director of the Hugh Kaul Precision Medicine Institute at the UAB School of Medicine in Birmingham, Alabama.
"There are targeted therapies available based on genomic findings, and we do find patients that have excellent outcomes with them," he says. "At present, it is a small percentage of the cancer population that benefits."
Precision medicine is developing fast, and opportunities are vast for organizations to incorporate it into their service lines.
However, because the demand for genetic and molecular testing currently outpaces reimbursement mechanisms, executives must consider how these diagnostic services will impact their cost and revenue structure—and their competitiveness—under various models.
It's not an easy task.
"We work with 1,700 health systems with sophisticated lab operations, and our research suggests that anywhere from 30% to 40% of the tests may be the wrong test, over-ordered, or the right test that doesn't get used in the right way downstream," says Matthew Hawkins, president at Sunquest Information Systems in Tucson, AZ.
"So we're big believers in the concept of diagnostic medical teams, especially in an anatomic pathology setting."
Indeed, teamwork among clinicians is critical as precision medicine evolves. It must become cross-disciplinary and cross-functional in the form of the clinician partnering with the informatics experts, the information technology experts with the infrastructure team, and the oncologists partnering with the genetic counselor— thus breaking down traditional silos.