United Auto Workers members have voted to approve a new, three-year contract with Blue Cross Blue Shield of Michigan. The union announced the contract covering the health insurer's 2,700 UAW-represented employees was approved 1,399 to 509. It includes 3% wage increases in each year of the contract, a $2,500 ratification bonus, lower prescription copays, and increases in retirement benefits.
Resurrection Health Care, one of the Chicago area's largest hospital operators, has hired Sandra Bruce as a successor to longtime chief executive Joseph Toomey, who is retiring after 16 years. Resurrection officials said Bruce, president and CEO of St. Alphonsus Regional Medical Center in Boise, Idaho, will run the Catholic-owned operator of eight hospitals in Chicago and suburbs. Bruce begins at Resurrection Nov. 3.
Providence Medical Center in Kansas City, KS, and St. John Hospital in Leavenworth, KS, will host its second annual "Think Pink" event next month. The event, meant to teach women about mammograms, self-breast exams, and healthy lifestyles, was developed last year, as breast cancer mortality rates continue to increase in the region.
Cerner Corp. of Kansas City, MO, can now add Clinica Las Condes, a 220-bed private hospital in Santiago, Chile, to its roster of clients. The hospital will be using Cerner's Millennium healthcare software, for nursing and emergency service, and is the first in Latin America to do so.
Large managed care companies saw their shares drop by more than 2% as the stock market tumbled Monday. Shares of UnitedHealth Group Inc., the largest health insurer based on revenue, dropped more than 3% after the news of Lehman Brothers Holdings' bankruptcy plans and Merrill Lynch's forced sale to Bank of America for $50 billion in stock.
The findings from 130 initiatives in 48 states continue to make the case that health information technology has the capability to improve patient care while reducing costs, but also points to significant problems that continue to plague start-up HIOs, most notably, and perhaps predictably, interoperability and funding.
The funding dilemma
About 80% of HIOs say that finding the seed money to get started was their greatest challenge. The biggest financial contributors are hospitals and the federal government. About half of operational efforts received up-front funding from hospitals with the other half receiving funding from the federal government. Hospitals also topped the list for providing financial support for continuing operations. Sixty-two percent of operational health information exchange initiatives are receiving funds from hospitals to support ongoing operations, followed by physician practices (38%), the federal government (36%), private payers (29%), state government (26%), and public payers (24%).
It was a non-profit organization that provided the seed money for what is considered a model of success for other HIOs. At its inception, CareSpark faced many of the challenges other HIO start-ups say they are facing now. The Kingsport, TN-based exchange sees about 750,000 patients from five different states, and therefore has to contend with five different state Medicaid programs, five different state health plan systems, and innumerable health information systems. "You could say we were the perfect storm of collaboration and consistency. We realized it is very important that we would have to be able to coordinate and communicate with many others in the country," said Liesa Jenkins, executive director of CareSpark during a briefing held by the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics.
Now, after five years in operation, CareSpark is being used as prototype for HHS's National Health Information Network program, which will perform a technical and interoperability and standards demonstration on September 23, according to Rob Kolodner, MD, national coordinator for health information. "We will demonstrate NHIN using standards and agreements that form the integrated delivery networks, and when these NHIN networks go into production in 2009, we will make a true network that will evolve into a network of networks. It's by matching that innovation with consensus-based standards that we will foster the forward movement of the nation to transform healthcare," he said during the Telehealth and Healthcare Informatics briefing.
The growth of a movement
There is some proof that that "network of networks" is on its way to forming with 42 operational health information exchange initiatives. That number includes 18 new health information exchange initiatives, which the study's authors say is evidence of the increased interest in the use of health information exchanges. The number of health information exchange initiatives in each phase of development is evenly dispersed. Thirty-nine of the initiatives included in the 2008 survey are just getting started with health information exchange, 36 are in the process of implementation, and 42 are operational.
Reporting ROI
A majority of the operational HIOs said stakeholders were getting positive financial return on the investment in the exchanges. Thirteen said they could quantify a return on investment for hospitals, nine reported ROI for medical practices, six reported ROI for health plans, and five reported ROI for independent laboratories. In some cases, more than one class of stakeholder was getting ROI, the findings show.
Janet Marchibroda, chief executive officer of the eHealth Initiative and eHealth Initiative Foundation, says part of the reason that some of the HIOs are seeing positive ROI is a better understanding of health IT among the various stakeholders. "The field is maturing. These initiatives are now operationalizing their services, which makes achieving ROI attainable. Also, the notion of health IT adoption and health information exchange across various stakeholders in the system is more accepted than it was two or three years ago. Bipartisan support within Congress, the federal government's leadership in supporting trial implementations of health information exchange, and efforts in the private sector related to health information exchange—including those supported by eHI and others, such as the National Governors' Association, are helping to bring stakeholders to the table to engage, to trust, and to begin to utilize ‘services' from these initiatives that deliver value, and ROI to various stakeholders," she says.
So what are the challenges?
The most significant challenge for all 130 efforts in the study continues to be the development of a sustainable business model, with 50% of respondents characterizing this as a very difficult challenge, followed by securing up-front funding, with 47% saying this is a very difficult challenge. Marchibroda says both of these challenges are related to the current reimbursement system, which provides disincentives for the sharing of health information to support improvements in care.
Overall it was a mixed bag of results for the HIOs in this year's study. There were some clear advances made, but there were just as many, if not more, challenges reported. As a panel of speakers at a Capitol Hill Steering Committee on Telehealth and Healthcare Informatics briefing to discuss the study was quick to point out, we are still miles away from the reality of creating a National Health Information Network. "We're making a lot of progress, but the federal government must stay active and provide the leadership for health IT," Kolodner said.
Kathryn Mackenzie is technology editor of HealthLeaders magazine. She can be reached at kmackenzie@healthleadersmedia.com.
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Here's a medical travel story that, in hindsight, was inevitable.
The Wall Street Journal reports that U.S. employers are leveraging the deals they have with global healthcare providers to get substantially lower rates from providers in the States.
Hannaford's Peter Hayes has seen his name in print a lot this year since his company struck a deal that could send the Scarborough, ME, supermarket chain's employees to Singapore for select elective procedures. Now Hayes tells the Journal that U.S. providers are lining up to match that deal, and Hannaford has already put Aetna to work vetting them.
Now one case study hardly makes a trend, but nonetheless this is a development worth following. If that report from earlier this year by the Deloitte Center for Health Solutions that says American providers stand to lose billions of dollars in outbound medical travel is even close to reality, did you think the U.S. healthcare system would just sit back and watch as Americans get their knees, hips, spines, and hearts worked on overseas?
Nope. There are plenty of healthcare entrepreneurs in America who are more than happy to take half the pie over nothing at all. Plus, there are some out there that don't mind the idea of cutting out insurers to negotiate directly with self-insured employers, like Hannaford Bros.
Mike Taylor, a principal at Towers Perrin, says much that has been written about medical travel is hype over reality, but he expects that we might begin to see some U.S. providers react to the threat of outbound medical travel.
"It's the old bluffing game we've had with managed care," says Taylor. "If I hold out the threat that I'll send my employees overseas, you have to react to that."
Still, reports from Deloitte, McKinsey, and others point to the 45 million-plus Americans that are uninsured and underinsured as the best growth opportunity for medical travel. True enough that awareness of medical travel is on the rise, but one company is trying to turn the medical travel model on its head.
Healthplace America is working to build a network of U.S. providers as an alternative to outbound medical travel. Darren Tomey, executive vice president of sales and marketing, says employers and employees can save 30% to 50% on select elective procedures without the barriers of extended travel, passports, and medical liability issues.
Right now Healthplace America is focused on offering value-based health benefits to self-insured employers, but once it has developed a provider network and price structures, what's stopping the firm from becoming an in-country facilitator for the uninsured?
Nothing. And if Healthplace America doesn't do it, someone else will. "Our biggest emphasis is on the self-insured market," says Tomey, but he also acknowledges that working with uninsured individuals is a "wide-open opportunity" that his firm is exploring.
On Physician Leadership
I will be facilitating a C-suite peer panel at this year's Top Leadership Teams in Healthcare conference called "New Medical Staff Models for Strategic Growth." In the conversations I've had with the panelists—including Edward Murphy, MD, president and CEO of Carilion Clinic; Kelby Krabbenhoft, president and CEO of Sanford Health; and James Leonard, MD, president and CEO of Carle Foundation Hospital—I expect this will be a lively discussion that covers many of today's hot issues between hospital executives and physician leaders. Visit topleadershipteams.net to find out more about this year's program, which will be held at the Drake Hotel in Chicago, Oct. 16-17, 2008.
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The Center for Connected Health's Symposium 2008 at The Conference Center at Harvard Medical is scheduled for October 27-28, 2008. The Symposium will concentrate on bringing MDs and nurses into a conversation about information technology and practical economics that is always about them but not always welcoming to them, according to Center for Connected Health representatives.
IBM has announced new services to help healthcare organizations implement wireless mobility solutions. IBM Enterprise Mobility Services for healthcare providers give clinicians and nursing staff wireless communications and real-time access to patient records anywhere on the facility premises, according to an IBM release.
Hewlett-Packard Co. announced five months ago it was acquiring technology-services firm Electronic Data Systems Corp., and Wall Street expected big layoffs from the combined company. But when HP announced the size of the job cuts—24,600 jobs over the next three years, nearly 8% of HP's 320,000-employee work force—it came as a shock. The surprise could provide a lift for HP's stock price because of the potential cost savings from the dramatic reduction in staff and HP Chief Executive Mark Hurd's track record for wringing more profits out of lean operations.
