Cambridge (MA) Health Alliance has announced that it will reduce its workforce by more than 300 employees, end inpatient services at Somerville Hospital, and shut down its pediatric and addiction units. The three-hospital system has been struggling with its finances for at least a year, but state budget cuts last fall and the recession made the situation more dire, executives said.
Several key public health programs face sharp cuts under the Massachusetts budget proposed by Governor Deval Patrick for the next fiscal year. The $28 billion spending plan also freezes Medicaid reimbursement rates for doctors and hospitals who care for poor patients, after steep cuts made in October. The state's closely observed health insurance initiative, emerged largely, but not entirely, untouched in the budget blueprint. A program that provided $3.5 million to help the uninsured enroll for health coverage was eliminated.
Google, which last year launched a personal online repository called Google Health, is refuting a charge by a different consumer group of "a rumored [Google] lobbying effort aimed at allowing the sale of electronic medical records." The group further claimed that Google is "reportedly" pushing for items in the economic stimulus bill that would allow the company to "sell patient medical information" to advertisers. Google posted an item in its public policy blog calling the claims "100% false and unfounded."
WellPoint Inc. reported a 61% drop in fourth-quarter profit and held off on a detailed prognosis for 2009 as rising unemployment continues to reduce the ranks of people enrolled in its health plans. The country's largest health insurer in terms of members also reported enrollment declines, compared with the third quarter, in nearly every segment of health plans that it sells. Much of the decline isn't because employers are dropping health plans, Chief Executive Angela Braly said, but because thousands of jobs are being shed from work forces.
The Certification Commission for Health Information Technology has become the de facto stamp of approval for EHRs. Now, CCHIT is expanding its scope of certification, and not everyone is happy about it. +
Jerry Miller, MD, president of Holston Medical Group in East Tennessee, talks about strategizing on investments needed to make in strategic initiatives to diversify revenue streams. +
HealthGrades this week released its annual study of hospitals it says are in the top 5% in the nation as measured by mortality and complication rates. According to HealthGrades, Medicare patients at these 270 hospitals—out of more than 5,000 hospitals nationally—are on average 27% less likely to die and 8% less likely to suffer a major complication.
Robinson Memorial Hospital in Ravenna, OH, 35 miles southeast of Cleveland, has made HealthGrades list of Distinguished Hospitals for Clinical Excellence. Robinson, a community hospital with 150 staffed beds, serves the 12,100 residents of Ravenna and the 142,585 or so souls living in Portage County.
Robinson's rise to the top was no accident, but the result of a conscious decision nearly a decade ago to be among the best. Deborah Small, vice president of patient care services and CNO at Robinson, says the competitive environment for hospitals in northeast Ohio, which she calls a "hospital Mecca," forces them to perform well. "If we don't, our clients can seek hospital care elsewhere," she says.
To determine the top hospitals, HealthGrades analyzed nearly 41 million patient records from CMS for fiscal years 2005, 2006, and 2007 for 26 medical procedures and diagnoses at all of the nation's nearly 5,000 non-federal hospitals. HealthGrades estimates that 152,666 lives may have been saved and 11,772 major complications avoided during the three years studied, had the quality of care at all hospitals matched the level of those in the top 5%.
Robinson's methodology for quality care reads like a how-to manual for hospital success. The community hospital has emphasized collaborative management of patient care and evidence-based medicine across all disciplines. "We have a strong service excellence program, and the service starts at the front door. We work at discharge planning at the beginning of your admission," Small says.
That service includes a proactive approach to providing care. "We work a lot with community and preventive medicine," she says. "Our patients may not be as sick as someone else who comes in because they've done all the right things. They've taken all of their medications. They understand what they are taking and what to take it with and how to take it."
A chronic pulmonary patient, for example, would be given a planning guide to manage their daily activities so they don't exhaust themselves and trigger a respiratory event. "We provide very good education up front," Small says.
Robinson, which is also recognized as a magnet hospital by the American Nurses Credentialing Center, encourages dialogue and communication with its staff of approximately 1,600. "Because we have so many disciplines providing care at the bedside, it's important to communicate efficiently and effectively and get the right message across every time," Small says.
Robinson's staff uses the military's SBAR method (Situation, Background, Assessment, Recommendation) for communicating patient information. The hospital's physicians have been asked to develop standardized hand-off communication procedures to expedite and improve the transition among caregivers. "That takes a little more time because physicians communicate differently," Small says.
Professional development is also emphasized at Robinson, where employees are recognized for their strengths and not just reminded of their weaknesses. "Everybody brings something to the table, and finding out what that something is is a challenge. But when you find it, it's amazing what people do with those talents," Small says. "We're not always looking for the things that aren't done well, but looking for the things that are done very well. You tell the housekeepers what a great job they're doing with the rooms and all of a sudden the rooms look even better."
When Robinson finds talented patient-care technicians, for example, they're offered professional development opportunities that can include training to become a registered nurse. The community hospital offers tuition reimbursement for healthcare-related continuing education.
Robinson's hospital foundation holds an annual gala, with the funds used to send staff to professional conferences and seminars. "We ask them to bring back to our environment what they've learned and share it with the rest of the staff," Small says. "You don't generally find your staff going to outside seminars and conferences—first, because they can't afford it or afford to take the time off, and second, no one tells them that they are good enough to go."
The emphasis on communication and employee development has also positively affected turnover, which was 5.1% among nursing staff in 2008 and 9.3% hospitalwide.
Despite the organization's achievements, Small says Robinson Memorial can't afford complacency. "You continually raise the bar. Good is never good enough," she says. "We are constantly looking for improvement processes in everything we do."
John Commins is the human resources and community and rural hospitals editor withHealthLeaders Media. He can be reached atjcommins@healthleadersmedia.com.
Note: You can sign up to receive HealthLeaders Media Community and Rural Hospital Weekly, a free weekly e-newsletter that provides news and information tailored to the specific needs of community hospitals.
Health insurance companies lose $40 billion each year—and it has nothing to do with cost containment.
Instead, the problem stems from health insurers losing 3% of its group members annually because they aren't retaining members who retire or lose group coverage. Insurers could reverse that trend by simply tweaking communication processes and improving training that would nudge these members into individual or Medicare plans when the time comes. Retaining members is particularly important in the face of the current global economic crisis and a shrinking employer market. Instead, health insurers are focused on reducing spiraling costs and putting more responsibility on individuals. Those are both important initiatives, but as health insurers look to cut costs, converting existing members to other plans could provide a cost-effective solution.
Insurers should expect the situation to get worse. Health insurance companies will lose members at a rate of between 4% to 8% annually over the next five years because of employers dropping coverage, layoffs, and baby boomers reaching retirement age, according to McKinsey & Company, which recently released a report called The missed opportunity for U.S. health insurers. Insurers don't tell members about their myriad offerings so those who move from employer-based coverage to Medicare have no idea that their health plan offers a Medicare Advantage or Part D program.
The solution to this problem would be fairly simple to implement. McKinsey & Company suggests the financial-services industry should inspire health insurers. For instance, Fidelity Investments captures 50 to 60% of workers who move from employer-managed 401(k) accounts to personally owned rollover Individual Retirement Accounts.
"There are a lot to be learned in how a health insurer can work with sponsors, the employers, in making it a much smoother process and making a fairly simple transition project," says Shubham Singhal, principal at McKinsey & Company.
Singhal provides three ways that health insurers can improve member conversion:
Standardize your communication processes so companies provide insurers will employee information at the time of a life-changing event and make converting members a priority in your organization. For example, promote different options to members so when they go through a life-changing event, such as losing a job or retiring, they will know their insurer offers health plans that suit their new needs. Another example is if a member who recently lost coverage calls the call center asking a question about COBRA, inform the person about your company's individual insurance offerings.
Simplify processes for the consumer. When you send out information on COBRA to a recently laid off member, include information about individual insurance options and enrollment forms. Don't make them take three steps when you can combine processes into one.
Incorporate conversion strategies into your training. One way is to train call center employees so they can pick up on cues to transform an issue into a sales opportunity. For instance, if a parent calls to ask whether her ineligible 20-something child is still covered under her plan, the call taker could provide tell the caller "no," but also provide information on individual insurance options. Insurers could perform similar strategies to convert people of retirement age to join one of their Medicare Advantage or Part D offerings. Here's one easy change for a health insurer: when a member turns 60, send the person information about your Medicare options. As the person moves closer to retirement age, make sure that the Medicare offering is displayed prominently on communication with that individual.
"I think it's a set of what at the end of the day seems like reasonable things, but the collective executive of those makes a big difference," says Singhal.
Singhal says most executives haven't figured out how to provide conversion solutions, while maintaining a profit and offering products that can pertain to any life situation.
"I think it's a mindset of understanding that the consumer is actually a customer and they have a set of real needs we need to meet. That is really an important element to have if health insurance is to move up in the ranking of industries that consumers show high satisfaction with," says Singhal.
Note: You can sign up to receiveHealth Plan Insider, a free weekly e-newsletter designed to bring breaking news and analysis of important developments at health plans and other managed care organizations to your inbox.
Fewer than one in 10 jobless workers extends their former employer's medical coverage, according to a study by the Commonwealth Fund. The analysis found that while two-thirds of working adults would qualify to extend health-insurance coverage under a federal law after losing a job, only 9% of the unemployed do so. Workers are guaranteed the right to extend their medical benefits for a limited period under the Consolidated Omnibus Budget Reconciliation Act. The law generally covers group health plans of private and government employers with 20 or more workers, according to the Labor Department. The Commonwealth Fund analysis, based on 2007 health-insurance survey data, found that most workers can't afford to pay for COBRA coverage, however.
The redundancy and rigor that a company like Disney has is amazing, especially on its cruises. In the stage productions they put on the boat, each actor has two microphones and two batteries. If that's not enough, their voices are recorded for each part so they could lip synch if everything failed. Why don't we have that type of redundancy (without adding cost) in the healthcare system?
The Jewish Hospitality Rooms at Aventura Hospital in New York cater to Jewish visitors who need a place to pray, eat kosher food, or rest while waiting to see a friend or relative. The rooms are open to all Jews, observant or not, and are filled with everything from prayer books to prayer shawls, known as Tallit. The room's amenities also include copies of the Torah and a fridge stocked with kosher food.
