Lansing, MI-based Sparrow Hospital has eliminated 23 managers' positions as part of a plan to cut costs. The move follows an announcement in November that Sparrow would seek an undisclosed number of buyouts from nonunion staff. Officials said 72 workers have accepted that offer. The hospital is facing a declining economy, rising costs for people unable to pay their bills, and a reduction in elective procedures, officials said.
Lee Memorial Hospital in Fulton, NY, has confirmed that layoffs are on the way at the facility. A state commission had previously recommended closing the hospital.
The top administrator at Blue Hill (ME) Memorial Hospital has announced an undetermined number of staff layoffs in an effort to stave off bankruptcy. In a letter, interim administrator Erik Steele, MD, said a number of belt-tightening measures, including staff reductions, must be undertaken if the hospital is to continue serving patients. In the letter, Steele said some cost-saving measures were put in place, including a hiring freeze, a ban on unnecessary travel, and other steps. But in order to avoid financial disaster, he said, staff reductions are unavoidable and will be announced Jan. 19 or 20. About 340 people are employed at the hospital.
The second interim report of the Medicare Health Support (MHS) project, released to Congress just before the new year, brings into better focus why CMS ended the disease management project last year.
Looking back at the first 18 months of the three-year MHS pilot, the report found that DM programs did not save money, improve beneficiary self-management, and physical and mental health functioning, or cut acute care utilization or mortality. None of the companies involved in the pilot reached the targets that would warrant program expansion as the programs did not improve clinical quality of care and beneficiary satisfaction, or achieve budget neutral spending targets, according to CMS.
Ouch.
MHS was created as the first test of DM in the Medicare fee-for-service (FFS) population, and as these interim results show, it was not a success. In fact, when I asked a CMS official what was learned from MHS, she said CMS did not find much that actually worked. Double ouch.
DM struggled in its first foray into the Medicare FFS population after growing into a more than $2 billion business in the commercial and Medicare Advantage populations, but DM leaders hope the industry can learn from the pilot.
The eight Medicare Health Support Organizations (MHSOs) used the call-center foundation of DM as the primary model in MHS, and supplemented different approaches, such as physician outreach and face-to-face interactions with beneficiaries. So far, through its two interim reports, CMS has not broken down the projects to highlight the MHSOs' different approaches and their affect on quality, self-management, and outcomes.
Gordon K. Norman, MD, MBA, executive vice president, science and innovation, at Alere, a DM company in Reno, NV, and chairman of DMAA: The Care Continuum Alliance, which represents the DM/population health industry, says the industry needs to know: What worked? What didn't work? When it did work, why? When it didn't work, why not and for whom?
"We can ill afford to reject looking at any promising solution just as we can ill afford to throw out any favorable baby with the undesirable bathwater from MHS. There has to be some valuable learnings hidden by this sort of blanket up or down evaluation bias that I think has been portrayed in the first two reports," says Norman.
Though the DM industry as a whole remains in the dark about the answers to Norman's questions, the MHSOs did learn from the project and tweaked programs to better serve both the FFS population and their larger patient population.
I talked to two Health Dialog officials about the project and they provided three takeaways the Boston-based DM company learned from participating in MHS:
Target the right people for interventions and support those patients with the appropriate services. Those involved in the project say the FFS beneficiaries selected to take part were from a much broader health status than initially expected. Instead of including only those who would benefit most from a DM program, MHS included individuals from the either health extreme: those who were healthy but suffered a brief health setback when CMS created MHS and those who were at the end of life and institutionalized. Neither of these groups are the typical people who gain from DM programs. Healthier individuals do not need intensive programs, while the sickest are not able to reverse their conditions. To take this to the larger DM population, companies must remember to target the right people with the proper individualized program. Otherwise, the intervention will be too costly and wasteful.
Get timely information so you can reach at-risk and recently discharged patients as soon as possible. Reaching patients shortly after discharge or diagnosis (or even better during hospitalization or when they are at-risk of disease) plays an important role in whether you can change a person's behavior. The MHS project was hampered by a claims lag with MHSOs not receiving timely hospitalization and medical claims data. Not connecting with beneficiaries promptly meant some beneficiaries' health slipped further, making effective change difficult. Waiting until after that window of opportunity is closed means the person most likely won't be at their highest level of activation and you have lost your best chance.
Providers are an important part of the healthcare team. On its surface, this seems like a no-brainer, but it's a fairly new concept in DM. The industry has learned that in order to achieve lasting behavioral change DM must work together with a patient's physician. This is a key tenet in the medical home model, which CMS will test with its own demonstration starting in 2010. Collaborating with physicians and supplementing patient care with DM programs can close gaps in care, and create a complete healthcare team rather than segments not working together and potentially relaying varied messages to patients. If DM is to remain an active part of healthcare, its future is in supplementing provider care through a sort of medical home model. It can no longer expect to improve patient outcomes and lower health costs without physicians on board.
Those three learnings are exactly what DM needs to hear, but so far CMS has not included that information in its interim reports. MHS' final report will analyze all three years of MHS. It isn't expected until February 2011, which gives CMS two years to develop a report that delves into each of the interventions and provides specifics about what each MHSO offered and how it affected care, outcomes, and costs.
That doesn't mean DM should wait for CMS though. This bump in the road should show the industry that it needs to fund research to test its offerings so the healthcare system as a whole can see what works best for particular disease states.
As I wrote in my column last week, if DM expects to play a role in healthcare reform, the industry must look critically at its programs. MHS' interim results show that questions remain about DM.
The industry can't wait for the final MHS report and hope that the results are better. It must take action now.
Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com.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.
Many brands didn't live to see 2009. Some of the casualties of 2008 included Linens N' Things, Sharper Image, KB Toys, and Mervyns. But this is a good thing, writes Laura Ries, president of Ries & Ries, an Atlanta-based marketing strategy firm. "It is brand Darwinism at its best, survival of the fittest," Ries writes.
Health plans have been on a journey of leveraging process and technology to improve access to high quality, affordable healthcare.
Until recently, emphasis has been on optimizing care management and claims processing. Now, there's compelling evidence that the next generation of care and cost improvements will come from innovative provider management approaches.
Provider management is the common success enabler behind health plan initiatives, such as consumer-directed health plans, patient centric medical homes, pay-for-performance, the introduction of new products, and geographic expansion. Leveraging an integrated approach to provider management is the innovation that is propelling health plans forward.
What is Integrated Provider Management (IPM)?
IPM is a three-pronged approach to deliver the next generation of care and cost improvements through:
End-to-end provider process simplification
Collaborative and coordinated patient care
Transparent provider performance and incentive management
Fundamental to this approach is the ability to bring together the provider network view, patient clinical view, and claims view. By harnessing this integrated view, health plans will take the initial critical steps that allow them to facilitate holistic member care planning, innovative network design, and cost reduction. This approach represents an opportunity for a new collaborative relationship paradigm between health plans, providers, and members.
How does IPM reduce medical costs?
A logical first step in managing medical costs is to ensure that providers are reimbursed at the right level. Current barriers include the quality of provider data within the health plan system and the complexity of provider contracts. It's estimated that 2-3% of claims must be re-processed because they are priced incorrectly. The process simplification used in the IPM approach significantly improves provider data quality through automated data integrity enforcement.
The IPM approach promotes the standardization of provider contracts. Having one consolidated view of the provider allows health plans to have more streamlined provider contract negotiations, leading to better contract terms and conditions. There is market evidence of a 1-5% reduction in medical costs driven by improved contract terms and conditions.
Effective provider incentive programs could have a measurable impact on quality and cost of care. However, transparency of quality measurement methods and data is essential to alignment between health plans and providers. The integrated provider view leveraged by the IPM approach enables health plans to both measure and report on quality.
The provider and patient collaboration envisioned by the IPM approach also facilitates better compliance with evidence-based care planning. Connectivity and health information exchange with provider offices, under the IPM approach, enables a single view of patient clinical data and suggested intervention opportunities. Early intervention has been shown to increase the health of patients while reducing their medical costs.
How does IPM reduce operational costs?
The process simplification prescribed by the IPM approach reduces operational costs by increasing staff productivity, eliminating redundant processes, minimizing manual handoffs, and decreasing re-work. This process simplification is largely enabled by workflow automation and data integration.
Once the internal processes have become systematized, it enables the health plans to take those processes and extend them to the providers through self-service portals. Self-service capabilities are heavily sought after from both health plans and providers because they reduce the amount of time both parties need to carry out simple administrative activities.
The systematic recording of the process steps and information under IPM enables analytics. These analytics allow health plans to measure provider workforce performance and proactively identify process bottlenecks. The IPM approach incorporates tools to rapidly re-configure processes and eliminate bottlenecks.
How does IPM reduce provider IT costs?
As with the introduction of most of the innovative technologies on the market today, IPM solutions are allowing health plans to do more with less infrastructure and resources. For example, IPM solutions empower users to make selective changes to workflows, create new business rules and create ad-hoc reports. All of these actions, either in the past or with the existing legacy systems, could not take place without significant internal IT or external consultant intervention. Additionally, once IPM solutions are deployed, health plans have the ability to sunset redundant provider systems.
IPM can achieve savings
IPM enables health plans to turn provider networks into strategic corporate assets. By modernizing the health plan's provider environment through IPM, health plans can achieve greater medical, operational and IT cost savings.
At the same time, the innovative provider management approach allows health plans to execute new programs that answer the demand stemming from new market trends. While the health plan's mission is to ensure members have access to affordable, high-quality care, focusing on the systems and processes that directly affect the agents of care—the providers—is an important next step.
Sam Muppalla is COO of Portico Systems, a Blue Bell, PA-based healthcare technology company that specializes in integrated provider management solutions.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
In order to get your marketing message through to your listener, you have to get past the thousands of other messages bombarding her during the day. Once you break through that noise surrounding your message, you can effectively reach your listener. But how?
Known to many as "the baby hospital," Hillcrest Hospital in Mayfield Heights, OH, had a positive, recognizable image in a competitive market. But Hillcrest wanted to expand its offering beyond OB/GYN services and it needed a way to communicate that fact. A sophisticated service line campaign was just the thing it needed to rally the community behind its efforts and create a new brand image.
"We wanted to position Hillcrest as a place that people perceive to be [for] serious medicine," says Jennifer E. Davis, director of marketing and community relations for Hillcrest. In order to achieve its goals, the team looked to the expertise of the people who truly matter: current patients within the community.
"We took the time and spent the resources to do focus groups," says Davis. "And we did a lot of planning before we started the creative. Talking to patients, doctors, talking to the administration . . . we really wanted to make sure that the direction we were taking was the right one."
At the focus groups the team at Hillcrest alongside the team from Hillcrest's agency, Cleveland's Adcom Communications Incorporated, asked patients to talk about why they chose a provider. They were also asked to look at three different campaign messages and choose which most appealed to them. What came out of the focus groups was a strong appeal for a 'slice of life' type message as opposed to one that focused primarily on technology.
They developed the campaign theme, "Behind Me, Ahead of Me," based on the feedback. The multi-integrated campaign carried a message with two meanings. One was that the hospital could help patients to put their ailments behind them so they could heal and look forward to their future. The other was that Hillcrest was behind its patients, there to support their every need.
A strong call-to-action included a contest hosted on a microsite developed specifically for the campaign. The microsite offered health information to the community, risk assessment evaluations, and also acted as a tool for gathering patient information for future marketing endeavors.
"This really was a multi-step campaign," Davis says. "We went steps further than just putting media out there. We offered a service, which is the right thing to do to evaluate risk for heart disease, and we built a very targeted mailing list for future initiatives."
After only a few months, the site has received more than 1,800 unique visitors, which Davis attributes to the planning and time that went into the initiative. "I know a lot of time marketers are anxious to get out there because of competitive things or because people like to see the facility out in the community. It's invaluable to take the time and resources to plan, to make it as effective as possible."
Kandace McLaughlin Doyle is an editor with HealthLeaders magazine. Send her Campaign Spotlight ideas at kdoyle@healthleadersmedia.com If you are a marketer submitting a campaign on behalf of your facility or client, please ensure you have permission before doing so.
Joe Paduda, principal at Health Strategy Associates, talks about healthcare reform, the top healthcare issue for the government to tackle, and what he expects will happen to Medicare Advantage this year.
In the spirit of the New Year, I'm reading three—that's right, three—self-improvement books that I hope will help me be better organized and more efficient at home and at work. I'm learning how to manage paperwork and e-mail, make to-do lists that don't end up crumpled in the bottom of my purse sans checkmarks, and master time management once and for all. Most of all, I want to learn how to get more done in less time, so I have more time to enjoy my life.
These days—with staff dwindling and budgets disappearing—doesn't everybody?
One of the common themes in these sorts of books is that of identifying your priorities and figuring out what's important and what's not. One book has a page-long list of items the average person might aspire to: Be more spiritual, have a fulfilling career, spend more time with friends and family, give more to your community, spend time doing what you love—the list goes on and on. Everything on it seems important. But the author says you can only choose five.
Before you undertake any activity, the author says, you must ask yourself if it is one of your five priorities. For example, as it turns out, washing the dishes thoroughly with soap and water before loading them into the dishwasher is not one of my five personal priorities. So I stopped doing it.
Wouldn't it be lovely if we could do the same at work? You could tell the director of the money-losing service line that you're very sorry, but creating his or her brochure is simply not one of your five marketing priorities. You could choose which three-year project you're going to focus on and give it everything you've got—really make it a success—rather than scrambling to keep up with seven different projects all at once.
Well, maybe that's not going to happen. But play along with me for a minute. If you had to choose, which of the following would you pick:
Direct-to-consumer marketing? Or marketing to physicians to increase referrals?
A multi-year, multi-integrated branding campaign? Or an internal communications plan that will improve quality of care and the patient experience at your hospital?
Marketing your most profitable service line? Or propping up one that's not doing as well as it could?
Throwing your organization full-force into social networking and new media? Or going old school with television, radio, and print spots?
Reaching out beyond your market to find new customers? Or building a better relationship with your local community?
Once you are forced to make a choice, suddenly your priorities become much clearer. And if you keep them in mind, it will help you make the 100 decisions you face every day. You can choose to put the most energy into projects that matter. And, perhaps more importantly, stop obsessing about those are not mission-critical.
You should be able to quickly evaluate everything you do—forming or joining one more committee, attending or organizing yet another meeting, adding your two cents to a never-ending e-mail discussion, or agonizing over every single tiny little last detail of every last marketing task—to determine if it is a priority that warrants your time and effort (and your organization's money).
I'm not saying you won't have to do the tasks that are not high-priority. But perhaps you could avoid getting caught up in minutia and trying to make everything perfect. You're not doing yourself any favors. And you're not doing your hospital any favors, either.
If you're the boss, tell your employees (or remind them) what the organization's marketing and strategic priorities are. In return, you'll get more focused and productive employees who produce better quality work.
If you're not the boss and you don't know what the organization's marketing and strategic priorities are, then ask. The benefit to you is a more satisfying and less frustrating work day—and maybe even a little of that elusive work-life balance that I hear folks talking about.
