The new campaign will address a range of issues, including rural healthcare, challenges in post-acute care, and the state of mental health services in New Hampshire.
The healthcare system is notoriously complicated, and The Thread is designed to educate patients, policy makers, and members of the general public about key healthcare issues.
"One of our greatest motivators for launching The Thread is that historically a lot of our campaigns have been driven by informing communities about the services we offer, and we wanted to go beyond that approach," says Maria Padin, MD, CMO of the Dartmouth Health Southern Region/Community Group Practices. "We are the only academic medical center in New Hampshire dedicated to education—not only the education of our future clinicians, but also the education of the public."
In this edition of HL Shorts, Padin discusses Dartmouth Health's goals for The Thread. Click on the video below.
Essential value-based care competencies include robust data analytics, a compliance approach to coding, and an understanding of what makes an ACO successful at the clinic and individual provider level, says this CMO.
Medical groups and health systems have been implementing value-based care models such as accountable care organizations (ACOs) for more than a decade. But the fee-for-service model has remained stubbornly in place for many healthcare providers.
Wilmington Health has partnered with the AMGA to establish the AMGA Value Care Network, a strategic initiative designed to help medical groups and health systems succeed in value-based care.
In 2013, Wilmington Health launched one of the first ACOs in North Carolina, adopting the Medicare Shared Savings Program ACO model. Currently, Wilmington Health is operating an ACO REACH accountable care organization—a Medicare ACO model that involves full risk.
"The AMGA Value Care Network gives us an opportunity to help other medical groups," says David Schultz, MD, CMO of Wilmington Health. "We have developed competencies with our accountable care organizations, and we think we can share these competencies with other medical groups."
Wilmington Health expects to benefit from participating in the AMGA Value Care Network.
"For Wilmington Health, the AMGA has a large network of high-performing healthcare providers, and I expect that we are going to learn just as much from the partnership as our partners are going to learn from us," Schultz says.
David Schultz, MD, is CMO of Wilmington Health. Photo courtesy of Wilmington Health.
Keys to ACO success
To be successful in an ACO, a medical group must have several competencies, according to Schultz.
"These include data analytics, a compliance approach to coding, and understanding what makes an ACO successful down to the level of the clinic and individual provider," Schultz says. "We have this knowledge and can share it with others through the AMGA."
Data analytics are essential, Schultz explains. One big factor that contributes to the success of an ACO is trying to figure out who are the high-risk patients and who has rising risk.
"You can use data analytics to find out which patients are likely to have trouble and need more touches," Schultz says. "You can use data analytics to find out which patients need care designed around them such as chronic disease management."
Transparency is also crucial, according to Schultz.
"We have openly shared data on quality metrics among our providers," Schultz says. "We learned that we could quickly improve the quality of care just by being highly transparent."
Transparency also boosts the performance of clinicians. Schultz explains that when there is data transparency, there is rapid learning within an organization, and clinicians improve their performance.
"They ask questions such as why a colleague's screening rates are much better than theirs," Schultz says. "Those providers end up sharing information about what works. This is how transparency is helpful at the clinic level."
Access to care and data sharing have also contributed to Wilmington Health's success in value-based care, according to Schultz.
"You need good access to care for patients, which keeps your patients out of high-cost settings such as emergency rooms," Schultz says. "You need to give individual providers actionable information—providers need to step back from just seeing the patient in front of them and seeing their whole population of patients, with awareness of patients who should be in front of them."
Establishing a system of care around patients has also contributed to value-based care success at Wilmington Health, Schultz explains.
"When patients need complicated care or expensive care, you need to have your own specialists and lower-cost imaging centers that can drive down costs and improve quality as well," Schultz says.
By following best practices for value-based care, Wilmington Health has been a top performer in ACO REACH.
"Our savings in 2023 were $23 million," Schultz says. "We have other medical groups who are partners in our ACO, and they have also done well. Overall, our ACO REACH is among the best in the country—we have ranked in the Top 10 in percentage of savings. We also have been a high performer in quality metrics."
The National Labor Relations Board has rejected the health system's bargaining unit objection.
The National Labor Relations Board (NLRB) has ruled in favor of Mass General Brigham (MGB) primary care physicians who are seeking to unionize.
Primary care physicians at MGB began organizing efforts for a union last year with the Doctors Council, the country's oldest and largest union of attending physicians. MGB filed with the NLRB seeking to block the unionization effort by arguing that many of the 400 doctors trying to unionize did not belong in the same bargaining unit.
The April 18 NLRB ruling rejected MGB's claim, clearing the way for the primary care physicians to hold a union election in May.
MGB declined a HealthLeaders' request for an interview about the NLRB ruling, but the health system provided a prepared statement.
"Primary care physicians are critical to the health of our patients and community," the prepared statement says. "We know that PCPs across the Commonwealth are facing unprecedented volume and stress as a result of a confluence of factors that are not unique to our organization. We share the common goal of offering world-class, comprehensive care for our patients and believe we can achieve this best by working together in direct partnership, rather than through representatives in a process that can lead to conflict and potentially risk the continuity of patient care."
The prepared statement says MGB is reviewing the NLRB ruling.
Zoe Tseng, MD, a primary care physician at Brigham and Women's Primary Care Associates of Longwood and a union organizer, told HealthLeaders that her colleagues were confident the NLRB would rule in their favor.
"We expected this outcome," Tseng said. "We were confident that the bargaining unit that we had established was the proper one—it included all primary care physicians."
Tseng called MGB's bargaining unit objection a delay tactic.
Doctors' motivations for forming a union
MGB's primary care physicians are seeking to unionize for several reasons, including the lack of a voice in decision making and onerous working conditions, according to Tseng.
"We have had a very limited voice in the decisions over the years, and it has gotten worse," Tseng said. "We want to be able to represent the patients and the clinical staff that we work with. We want to advocate for resources and the services we need to do adequate primary care for our patients."
"We have understaffing—there are not enough staff to help us with administrative tasks, whether that be paperwork, getting patients the prescriptions they need authorized, or answering phone calls," Tseng said. "That burden is falling on primary care physicians as we try to see patients."
MGB has not invested in primary care, instead concentrating on more lucrative specialty care, according to Tseng.
"They have had the opportunity to lead in investing in primary care as a world-class institution, but they have chosen not to," Tseng said. "Instead, they have built up their specialty care."
Primary care is an essential service for a high-functioning health system, Tseng explained.
"You get into a crisis when you do not build a foundation for primary care," Tseng said.
Forming a union will give the primary care physicians more sway at MGB, according to Tseng.
"The reason for the union is so we can hold them accountable for all of the things that we need and they have promised," Tseng said. "As we have seen over the years, promises have often been empty."
Photo: Primary care physicians affiliated with Mass General Hospital and Brigham and Women's Hospital (BWH) hold an informational picket line outside BWH in December.
The new campaign will address a range of issues, including rural healthcare, challenges in post-acute care, and the state of mental health services in New Hampshire.
The healthcare system is notoriously complicated, and The Thread is designed to educate patients, policy makers, and members of the general public about key healthcare issues.
"One of our greatest motivators for launching The Thread is that historically a lot of our campaigns have been driven by informing communities about the services we offer, and we wanted to go beyond that approach," says Maria Padin, MD, CMO of the Dartmouth Health Southern Region/Community Group Practices. "We are the only academic medical center in New Hampshire dedicated to education—not only the education of our future clinicians, but also the education of the public."
One of the goals of The Thread is to explore issues and opportunities related to rural healthcare, according to Padin.
"That is important for our government officials, who are often making decisions that we want to be fact-informed around the needs of communities," Padin says. "We want to focus on solutions and partnerships."
Padin says rural healthcare issues that will be addressed by The Thread include access to clinical services in rural areas, recruitment of clinicians in rural communities, challenges in maternity services in New Hampshire because several hospitals have discontinued those services, and transportation options for patients in rural communities.
The Thread will address a range of other issues.
"The other areas we will tackle include transgender care in the state and within Dartmouth Health, challenges in post-acute care such as access to long-term care facilities, and exploring models of care for our aging population to remain at home," Padin says. "We also want to address the state of mental healthcare in New Hampshire."
Maria Padin, MD, is CMO of the the Dartmouth Health Southern Region/Community Group Practices. Photo courtesy of Dartmouth Health.
For patients, The Thread is an opportunity to have concise information from a reliable source.
"The Thread will guide patients to where services can be obtained," Padin says, "but, more importantly, the value of The Thread for patients is to inform them and educate them around the issues that face healthcare in their communities."
The Thread will also help patients navigate the complexities of healthcare, Padin explains.
"Our hope is to at least provide a basic foundation of understanding in a simple format of facts," Padin says. "We want to help patients during a time when reliability is not always present in what we read."
Dartmouth Health has a responsibility to offer the kind of information that will be provided through The Thread, according to Padin.
"As an organization that serves communities across the state, it is a responsible shift for us to be engaged during a time when there is polarization and risk for our communities," Padin says. "For us as a leader in the state's healthcare, we want to take the lead in education of our communities as it relates to issues that are relevant to health and wellness."
UnityPoint Health CMO Gregory Johnson was involved in a successful crisis management effort last year after Hurricane Helene inflicted severe damage on a medical-grade fluid manufacturing plant in North Carolina, which led to a nationwide shortage of IV and sterile fluids.
When the health system was notified that there would be a 60% reduction in the supply of IV and sterile fluids across the country, executives activated incident command protocols within 24 hours. They assessed their supply of IV and sterile fluids and convened an ad-hoc committee of 60 physicians, advanced practitioners, nurses, and other clinical team members led by Johnson and the chief nursing officer.
View a video of Johnson describing UnityPoint's response to the IV and sterile fluid shortage below.
Health systems can be early adopters, fast followers, or incremental movers, according to this ProMedica executive.
As health system leaders think about adopting AI tools for clinical care, they need to think strategically, according to Brian Miller, MD, the top AI officer at ProMedica.
Miller is CMIO and vice president of telehealth at the Toledo, Ohio-based health system. He is one of nearly a dozen executives who are participating in HealthLeaders' AI in Clinical Care Mastermind program.
Miller says health systems can take one of three strategic approaches to AI tool adoption: early adopter, fast follower, or incremental mover.
The early adopter approach involves high benefits and high risk.
"You are going to see positive clinical impacts earlier than others," Miller says. "You are also going to incur the highest risk because the early tools tend to be the most expensive up front, and in an industry with tight margins you need to think about risk."
One of the risks of being an early adopter is riding the wave of explosive growth in clinical AI, according to Miller, who adds explosive growth comes with winners and losers.
"When the first personal computers came out, there were dozens of manufacturers and a whole lot of claims, and now there are just a couple of manufacturers," Miller says. "When the robotic surgery craze started, there were seven or eight manufacturers; now, there are just one or two manufacturers in that space."
Miller says one area of explosive growth in clinical AI that is destined for consolidation is AI scribes, which record the encounter between a clinician and a patient then produce a clinical note for the electronic health record.
"There are about 70 companies in the past 30 months that have launched an AI scribe tool," Miller says. "In a couple of years, there will not be 70 companies—there will be five at best."
The primary challenge of being a fast follower in AI tool adoption is being fast enough, Miller explains.
"Waiting to see how AI shakes out, waiting to see which tools land, waiting to see where the ROI might be, and waiting to see where the standard of care lands is going to put you behind the curve," Miller says. "Because the pace of change is so quick, when you finally make a decision, implementation and adoption is going to be a steep curve."
The incremental mover strategy is probably best suited for AI tool adoption, according to Miller. The goal with this approach is to create knowledgeable users in your organization.
"You are going to need to get IT people educated," Miller says. "You need to get people ready in your IT departments, your security departments, your clinical departments, your legal departments, and your compliance departments."
Incremental movers are agile, Miller explains.
"You need to be reviewing and adapting your governance structures," Miller says. "You need to be prepared. You need to grow your knowledge base."
Incremental movers advance continually and thoughtfully in the AI space, Miller explains.
"The industry will not stop moving forward—there is no going back," Miller says. "You need to keep up thoughtfully and incrementally."
Brian Miller, MD, is CMIO and vice president of telehealth at ProMedica. Photo courtesy of ProMedica.
AI's impact on physicians at ProMedica
The physician experience with AI tools at ProMedica is best described as a bell curve. According to Miller, there were a small number of clinicians who had personal experience with AI tools where there was a miss that they didn't actually miss.
"For example, radiologists have looked at a CT scan and said they would not have seen an abnormality unless the AI tool was steering them to it," Miller says. "It could have been found later and impacted the outcome of the case."
For the bulk of the physicians in the middle of the bell curve, AI is just another tool that they have adopted and expect to be present, according to Miller.
"They don't think about the impact on their lives that much," Miller says. "AI is just something that they have come to expect from the tools we give them to help them do the job that we ask them to do."
There is a small percentage of physicians who are disgruntled over AI tools, who experience AI as a continuation of digital intrusion, Miller explains.
"It's like the experience with the electronic health record, where there are too many alerts and too many digital interactions," Miller says. "For them, it feels like a barrier to care."
Miller and his colleagues are taking the disgruntled physicians seriously by listening to them and hearing their feedback.
"In some ways, they are not wrong," Miller says. "In general, the switch to the electronic health record as well as the digitalization of our documentation tools and our encounters with patients have been an additional burden for our clinicians."
Healthcare leaders need to focus on making digitization better, according to Miller.
"There is an incarnation in the next phase of AI that is going to make the clinician experience better," Miller says. "The more we can just let clinicians focus on patients and have more components where the computer is for all intents and purposes listening to clinicians, we will be able to tee up interventions more cleanly and more simply."
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This Mastermind series features ideas, solutions, and insights on excelling in your AI programs.
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Focusing on too many quality measures is counterproductive, this CMO says.
Simplifying the metrics is the key to success in UnityPoint Health's quality program, according to the health system's CMO.
Gregory Johnson, MD, became UnityPoint’s CMO in July 2024. Prior to joining UnityPoint, he held several clinical leadership positions, including CEO of hospital medicine and chief health equity and diversity officer at Sound Physicians, a physician-founded multispecialty group based in Tacoma, Washington.
To promote high quality care, Johnson says, UnityPoint has gone from focusing on more than 140 quality measures to concentrating on 26 metrics.
"One of the things that we recognized for our overall quality program is getting away from a focus on many metrics because so many people were getting thrown various metrics at various times," he says. "By keeping it simple, reporting it consistently, and having structures such as market performance reviews and service line clinical reviews, in each of those cases everybody is focused on the same items so that we can row in the same direction."
Johnson says the two dozen quality measures that UnityPoint is focusing on are similar to the top quality metrics at other health systems. These include length of stay, mortality, hospital-acquired infections, and hospital-acquired conditions.
Readmissions are also a crucial quality measure, he says.
"One of the biggest areas that we recognized to function as an integrated health system was to take a step back and look at readmissions," he says. "A lot of people roll their eyes at readmissions and say it is a financial metric. For us, we spend a lot of time focusing on readmissions for our acute care space, but we also look at UnityPoint at Home for preventable hospitalizations as well as our UnityPoint Clinic in terms of looking at transitional care management visits."
Johnson says readmissions have a significant impact on patient experience.
"To create an exceptional experience for our patients, we do not want them coming back to us unnecessarily," he says. "We have reconfigured ourselves to intentionally focus on the steps we have to take to deliver an exceptional experience. We want to help our patients avoid unnecessary hospitalization."
UnityPoint has seen a 9.6% absolute reduction in its observed-to-expected ratio of readmissions within the first few months of rolling out readmission initiatives.
Gregory Johnson, MD, is CMO of UnityPoint Health. Photo courtesy of UnityPoint Health.
Promoting patient safety
Structural elements are essential to boosting patient safety, according to Johnson.
"Recently, we have focused on making sure that when we discuss a culture of patient safety, that it pervades every level of the organization," he says. "We have highlighted and simplified what we had in terms of reporting for patient safety concerns. We recognize that when we support just culture, it avoids blame and focuses on the best outcomes. We want people to increase their reporting."
Structural elements include what is happening at the bedside and at the health system and local board level, Johnson says.
"We want about 20% of what our boards are discussing to be around patient safety and how they can engage in terms of being notified of serious safety events as well as getting these events resolved," he says.
Another structural element is the use of "respect huddles," according to Johnson.
"These huddles occur at every level of the organization on a daily basis," he says. "Last year, about 17,000 respect huddles occurred across the health system. Ultimately, these huddles highlight areas of safety, whether there are concerns or great catches that we identify."
Johnson says UnityPoint is also fostering a culture of patient safety.
"It can't be a sign that we put up," he says. "It must pervade everything that we do."
"Ultimately, we want zero harm to come to our patients, and it takes a level of rigor in terms of daily interactions with the staff to achieve the zero-harm goal," he says.
Crisis management
Johnson was involved in a successful crisis management effort last year after Hurricane Helene inflicted severe damage on a medical-grade fluid manufacturing plant in North Carolina, which led to a nationwide shortage of IV and sterile fluids.
When the health system was notified that there would be a 60% reduction in the supply of IV and sterile fluids across the country, executives activated incident command protocols within 24 hours. They assessed their supply of IV and sterile fluids and convened an ad-hoc committee of 60 physicians, advanced practitioners, nurses, and other clinical team members led by Johnson and the chief nursing officer.
"Once we were able to articulate the concerns that we had about conserving fluid, then each group went back and did their homework," Johnson says. "They identified where we could conserve fluids and the process for notifying bedside team members of what was going on. Ultimately, that led to more than 140 clinical interventions that were applied."
With UnityPoint now in the recovery phase, Johnson says the health system rose to the challenge and made permanent changes to how it uses IV and sterile fluids.
"Almost 70% of the clinical interventions we developed have been accepted as the new standard at UnityPoint," he says. "Most importantly, we never turned a single patient away in terms of procedures, including surgeries that needed to be performed during the peak of the national emergency."
The shortage has had a lasting impact on operational considerations at UnityPoint, according to Johnson.
"We are setting a new bar for what our approach is not only in terms of understanding what a clinically integrated supply chain looks like, but also how we involve our clinicians in terms of operational decision making," he says.
"There is a metric that we call time outside of scheduled hours, which is simply how much time physicians are spending in the EHR outside of the patient schedule. Our physicians are scheduled to see patients from 8 a.m. to 4:30 p.m.," Weiner says. "The other euphemism for this is 'pajama time,' which is the time physicians spend at night finishing up documentation, answering patient inquiries, and refilling medications."
Physicians working in the EHR during their time off, particularly pajama time, is also a concern at Ardent Health, according to the Nashville, Tennessee-based health system's CMIO, Bradley Hoyt, MD.
"It happens all the time," Hoyt says. "It's just the way things are. I did it for years."
There is a primary consequence of physicians working in the EHR during their time off, Hoyt explains.
Recent research found that a significant percentage of primary care physicians work in the electronic health record during vacations.
In this episode of HL Shorts, we hear from Sam Weiner, CMO at Virtua Medical Group, about ways to reduce the amount of time that physicians spend working in the electronic health record. To view the episode, click on the video below.
David Schultz, MD, is CMO of Wilmington Health. Photo courtesy of Wilmington Health.
Maria Padin, MD, is CMO of the the Dartmouth Health Southern Region/Community Group Practices. Photo courtesy of Dartmouth Health.
Gregory Johnson, MD, is CMO of UnityPoint Health. Photo courtesy of UnityPoint Health.
