Medical informatics is playing a significant role in a unique, newly-launched partnership between Durham-based Duke University and the Durham, NC, community. The goal of the partnership, known as Durham Health Innovations (DHI), is to improve the health of everyone living in Durham County by using medical informatics to identify interventions for community members whose needs aren't being met successfully by conventional methods.
"The informatics side of this project is deeply embedded," says Lloyd Michener, MD, chair of the department of community and family medicine at Duke. "The entire project requires a very robust backbone and system. This is an example of what you can do with really good information systems and analytic tools. You're basically doing real-time epidemiologic studies."
The data the partnership uses comes from Duke University's electronic medical records (EMR) system, which is a variation of the system developed by San Francisco-based McKesson. Duke has implemented the system in all of their office practices.
The university collects the data from the EMR and runs customized software on it that assigns geographic locations to the data, also known as geocoding. This process, which is HIPAA-compliant, allows them to look at areas of disease clustering in order to treat specific diseases or disorders prevalent in areas within the community.
"What we're doing that's unique is that, rather than looking at one disease or one subpopulation, we're doing this as a system experiment of how we can look at the health needs of our entire quarter-million people in Durham County and redesign how the system works to improve health," says Michener.
The plan includes 10 individual projects aimed at reducing death or disability from specific diseases or disorders prevalent in the community. The focus of the teams on particular health problems was determined by the community, not by Duke University.
The projects include: adolescent health, asthma, cancer, heart disease, diabetes, HIV and sexually transmitted diseases, maternal health, pain management, substance abuse, and seniors' health.
Each project team receives $100,000, which is distributed among team members to help them accomplish the work. Funding for the projects comes from grants from the National Institutes of Health (NIH) and Duke Medicine. One surprising aspect of the project is that they are not asking for new money to implement the projects. According to Michener, all the teams must reallocate existing money to achieve better outcomes.
A model project
Communities currently track their health status through periodic health department or Centers for Disease Control and Prevention (CDC) surveys. These surveys typically rely on data that comes from individual practices, hospitals, and emergency rooms, which aren't aggregated to look at disease patterns or clusters.
By the time the survey results are released, they may no longer contain timely and relevant information. By comparison, Michener says that Duke has primary data that they can aggregate to look at disease frequency pattern, and severity, so that they can intervene immediately.
According to DHI, the health of Durham county residents is comparable to that of most other residents in other parts of the state. However, North Carolina still ranks in the bottom 20% of all states in terms of life expectancy and functional status.
Michener believes that the project could become a model for the entire country. While health systems such as Kaiser and Intermountain have conducted similar projects, Michener says that they only benefit those seen by that particular health system.
"We're trying to do it for the whole county, including folks who aren't primarily our patients," he says. "We don't know of anyone else who's tried to do a scale experiment for a quarter of a million people. You have to be a big enough healthcare provider that you can affect the whole community."
Data helps project members impact ER rates
The data has already been used to implement successful changes in the community. Recently, the data revealed that there were children with asthma who were visiting the emergency room once or twice every couple of years. However, when they viewed the information in aggregate form, the numbers were much larger in Durham than in other communities.
When researchers ventured out into the community to find out why, they discovered that families were being given different asthma control by different healthcare providers, causing confusion. As a result, they were visiting the emergency room more often.
"We came to an agreement across all the practices, both Duke and non-Duke, on common management plans for asthma that we all use now," says Michener. "And ER rates dropped."
In another example, Michener says researchers looked at low-income senior citizens in Durham County and discovered that they, too, were visiting the emergency room far too frequently. He says the elderly residents were putting things off and weren't getting their medications refilled; therefore, they were getting sick and visiting the ER more often.
To remedy the situation, Duke put teaching assistants and nurse practitioners armed with laptops into elderly apartment buildings to conduct door-to-door health visits. The laptops allowed them to communicate with a patient's primary care provider.
According to Michener, inpatient utilization dropped 68% in one year as a result.
"Every one of these folks had doctors," says Michener. "But they couldn't get to the office."
The project did not save money, because the elderly patients started getting their medications refilled. But, Michener says that for the same amount of money, they now have people who are much healthier and not visiting the ER nearly as often.
A true partnership
According to Michener, the project is unique in that team members include members from the Duke health system and members of the Durham community. His theory is that they can be more successful together than they can be separately. Each team has one project manager, nurses, health administrators, primary care providers, researchers, health department members, social services representatives, and community members.
"We tried to include a spectrum of folks from our wonderfully diverse county," says Michener.
Both Duke and non-Duke physicians have embraced the project and some serve on the project teams as members. "There are very few doctors who don't want to see their patients get better care," says Michener. "And there are very few patients who don't think the system couldn't be improved."
"A difference can be made if you can get people behind it."
Sharon Elliott-Bynum, RN, PhD is a Durham resident and co-founder of CAARE, Inc., a community-based service organization. She volunteers with several groups to work to diminish health disparities in Durham. The organization offers education as well as prevention, screening, and treatment through their newly-opened free clinic, which is staffed by volunteer nurses and physicians.
"What I've done is created a community model that has everything under one roof," she says. "My goal was to enhance the services available and to fill in gaps—sort of become a safety net provider."
The DHI steering committee invited Elliott-Bynum to participate in their project based on her experience working on healthcare issues in the Durham community. She is contributing her talents to the cardiovascular, cancer, HIV, diabetes, and maternal and child teams.
The partnership will allow project team members from Duke and the community to work together to share best practices and learn from one another. For example, Elliott-Bynum says she looks forward to the research data that she will have access to during the project. Before, volunteers for non-profit organizations have relied on their instincts and what they have seen in the community in order to pinpoint their interventions.
"We see what poverty is and we've seen what it looks like," she says. "We've never been able to truly see it from a geo-spatial standpoint. If you have the ability to retrieve the data, you could paint a full picture. You have a broader sense of what it really looks like. Community partners have always done good work, they've always been very passionate, but they've never been able to put in a research based, evidence-based model so that people could really respect it."
At the same time, she says that Duke will also learn a great deal from the community members involved in the project. While their research teams have had access to money for their projects, she says that they have accomplished a great deal with little or no money.
"I think there is a seasonal change happening in Durham where the institutions realize that in order for them to perform effective research, they have to connect with the community," she says. "That's a totally new approach to doing things. I think the outcomes are going to be so much better because you've got the buy in at the front end."
According to Elliott-Bynum, when the research money comes and goes, the community must be able to sustain the interventions put in place. She also believes that institutions should disseminate outcomes from their research findings so that communities can use them to improve their health.
"I think it's going to be a paradigm shift," she says. "A difference can be made if you can get the people behind it. We'll make it work, especially if it's going to benefit our community as a whole."
Planning a new model to help Durham battle obesity
David Reese, MBA is the chief operating officer of the Inter-Faith Food Shuttle. He also vice-chairs the Partnership for a Healthy Durham and co-chairs their obesity and chronic illness committee.
Reese describes the partnership between Duke and the community as "very significant." He says Duke is looking to create a healthier community, not just a healthier demographic of patients that they want to serve. He believes this attitude will improve the relationship between Duke and the community as a whole.
He is a member of the DHI obesity team. His team is using a socio-ecological framework and focusing on the chronic care model. By helping Durham residents reduce obesity, Reese believes the team will be able to affect a lot of the chronic illnesses that are associated with it, particularly diabetes.
Although they are still in the planning phase of their interventions, Reese says that one of the goals that the team has is to standardize the messages that patients get from their providers.
"We realize that with lower income folks, you have transient populations," he says. "People will move from provider to provider. But, hopefully, if they are getting the same consistent messaging, it will eventually work well with the intervention and the loss of body mass as a whole."
Like Elliott-Bynum, Reese is impressed at the resources and data that Duke has made available to project team members. "I'm actually overwhelmed by the amount of information that's being made accessible," he says. "Never before has all of this information and all of these technical services been made available to come to a common goal."
The city and its residents have been the focus of many research studies in the past, so they are no strangers to the process, says Reese. The team is gathering information by conducting focus groups with the community to help them determine what barriers they face when it comes to obesity. Reese says they are going to be watchful that the project teams do not ask the same questions and duplicate efforts, which could result in research fatigue.
"With this model, we really want to engage the community in the process," he says. "Everyone gets told what they should do and if that was working, we would have conquered obesity as a whole."
The teams, which began meeting at the end of April, have to work together to determine what sort of changes they wanted to try to accomplish to improve health outcomes. They also have to determine what it is going to cost to make the changes. They have eight months to complete their design work and financial analysis before presenting their plans. Once the planning stage is complete, the teams will put their changes in place to evoke long-term changes in the community.
DHI Project Teams
The DHI includes 10 individual projects aimed at reducing death or disability from specific diseases or disorders prevalent in the community. The projects are as follows:
Adolescent health
Asthma
Cancer
Heart disease
Diabetes
HIV and sexually transmitted diseases
Maternal health
Pain management
Substance abuse
Seniors' health
Cynthia Johnson is the editor ofMedicine On The 'Net, a monthly newsletter from HealthLeaders Media.
Reducing administrative red tape by just 10% could remove as much as $500 billion over 10 years from the nation's healthcare costs, a Healthcare Administrative Simplification Coalition report released today estimates.
The report, Bringing Better Value: Recommendations to Address the Costs and Causes of Administrative Complexity in the Nation's Healthcare System, issued by the Healthcare Administrative Simplification Coalition, found that about 25% of healthcare spending in the United States goes toward administrative functions. Much of that paperwork is duplicative and little of it has been standardized. While conceding that some administration is needed to manage a healthcare system, the report found that current levels of complexity divert too much time and money from clinical care to administrative processes.
"Every dollar spent on a convoluted, redundant or unnecessary administrative process is a dollar poorly spent," says William F. Jessee, MD, president/CEO of the Medical Group Management Association, an HASC member. "We spend more on healthcare than any nation in the world, but we're getting far less than full value for our investment, partly because of unnecessarily complex administrative processes."
HASC, which includes physician and hospital organizations, health and benefits plans, employers, government agencies, and other groups, has called for voluntary and nationally coordinated changes to reduce red tape in healthcare billing and payment processes.
Today's report recommends:
Credentialing physicians and other clinicians – A universal credentialing form would eliminate hundreds of hours of repetitious paperwork that physician practices now devote to completing multiple credentialing forms for insurance payers, hospitals, and others.
Determining and verifying patient eligibility for health insurance – Adoption of an industry-wide standard for interchangeable electronic data would help hospitals and physician practices determine each patient's insurance coverage more quickly and accurately.
Standardizing healthcare patient identification cards – Standardizing the design and content of patient ID cards, and ensuring they are machine-readable, would significantly reduce costly errors and delays in the medical claims billing process.
Improving coordination of prior authorization processes for radiology and pharmacy services – A voluntary, standardized approach to how providers request and receive determinations of patient eligibility for pharmacy benefits and radiology services would reduce treatment delays and reduce costly paperwork.
Congress recently authorized the Department of Health and Human Services to release $350 million in preparedness grants to help public health officials and healthcare systems with their H1N1 flu preparedness efforts. To help plan for a 2009 H1N1 flu vaccination program, the Centers for Disease Control and Prevention has issued general guidance to help state and local governments, assuming that a safe and effective vaccine is available.
The CDC's Advisory Committee on Immunization Practices will provide specific vaccination recommendations that will target specific populations and priority for limited or phased vaccine supply.
Based on the populations most affected by H1N1, targets for the initial vaccination include: students and staff at schools and child care centers; pregnant women; children between six months and four years old; new parents and household contacts of children less than six months old; adults under the age of 65 with medical conditions that increase the risk of flu complications; and healthcare workers and emergency services sector personnel.
Elizabeth DiGiacomo-Geffers, RN, MPH, CSHA, from Di Giacomo-Geffers and Associates, praises the HHS for its handling the H1N1 epidemic.
"If one looks at Joint Commission standards they have been advocating for year-round assessment of organization influenza vaccination program," says DiGiacomo-Geffers. "There is some seasonal variation in the fall and winter months. However, to assess compliance as to education, sites, rates, one has to assess and evaluate on an ongoing basis."
It is imperative to initially target healthcare workers, such as nurses and physicians, as well as supply organizations with more specific information on how to apply for such grants, says DiGiacomo-Geffers.
Key areas that organizations should evaluate are the: influenza vaccination program; whether it includes all licensed independent practitioners and staff; access to getting their vaccinations; and what education has been provided and to who and what are the vaccination rates, says DiGiacomo-Geffers.
"What actions may need to be taken to increase rates? Offering vaccination days, nights, weekends, after key meeting with medical staff?" says DiGiacomo-Geffers. "Some hospitals have a portable vaccination cart for example. Look at how education is provided for visitors, patients, staff, and physicians, and be creative—and note, is the information being provided in a language understandable to the patient?"
As wonderful as your hospital's leadership may be, it alone cannot implement facility-wide change. Often times, it needs the help of the organized medical staff. The key is finding the right technique to achieve your medical staff's buy-in.
Benjamin F. Call, M.D., FACC, a past medical staff president, and current chairman of the Board of Trustees of Portneuf Medical Center in Pocatello, ID, says there are a number of techniques for achieving buy-in.
"Our hospital's gone through a series of transitions in its administrative style of management. There are several things we have done that have really made a big difference," he says.
The following are buy-in strategies his hospital has used successfully:
Every change initiative needs a champion, someone who's willing to take some personal risk to make it go forward. Be passionate about your cause, or find a champion for the cause who will share his or her passion for the cause with others to help grow support for it.
Educate yourself as much as possible about the issues you're speaking about so your audience sees you as an expert.
Encourage your medical staff leadership to become fully trained. Encourage them to approach learning the skills of medical staff leadership as they would learning a new medical subspecialty. Facilitate attendance at training courses, preferably off-site, on how to be an effective MS leader. It will open their eyes to a vision of what medical staff leadership is all about.
Show others specific data that backs up your point. It is hard to argue with hard data.
Help redefine the meaning of the environment. Inspire others with a vision that redefines the status quo as a stepping-stone to a desired future.
Build a link of trust and understanding
One of the ways Call's organization implemented the last strategy was by establishing monthly, two-hour long dinner meetings with physicians and hospital leadership. The administration selects a panel of about 15-18 physicians that meets every month.
Although the leadership usually has some topics in mind that they'd like to discuss at the meetings, the practitioners are free to bring up anything they'd like to talk about from medical records to the nursing staff's quality of care. "The physicians know they'll always have a voice," he says.
By meeting with a variety of practitioners rather than those in medical staff leadership roles, the hospital better gauges the opinions of all medical staff members. In theory, the medical staff leadership is supposed to represent the view of the entire medical staff, but sometimes it is hard for the medical staff president, who may be an OB doctor, for example, to know about the needs of cardiologists, radiologists, general surgeons, and other diverse practitioners. By using a roundtable, dinner meeting approach, the hospital is able to access their views directly.
When the hospital administration is considering implementing a new project, first they'll take it to their management team and then to the physician's roundtable. At the roundtable, the administration seeks physicians' input on various matters understanding that unless there is physician buy-in, any change initiative will likely not be successful. In so doing the administration recognizes the importance of seeking first to understand, then to be understood. Only then can a proposal advance to the hospital board for final approval.
Building the physician roundtable into that process is an essential step that helps foster medical staff support for hospital initiatives, as well as create a foundation of communication and trust.
Gary Kaplan, MD, chairman and CEO of the Virginia Mason Medical Center, says that nearly half of the $2.6 trillion spent on healthcare in the U.S. is waste. Kaplan's thoughts are part of a blog series where healthcare CEOs sound off on reform. The series is sponsored by The New America Foundation, a nonprofit public policy think tank.
The more years I accumulate as a healthcare reporter, the more I admire the hospital C-suite's doggedness to take on challenge after challenge while providing better care with less money. Of course, in business outside of healthcare, there is the normal ebb and flow of financial success. But, in healthcare, hospitals have had a lot more ebb than flow, experiencing a string of difficulties that have eroded profitability.
When I first began my reporting career, the Balanced Budget Act of 1997's negative impact on reimbursement was a huge focus throughout the industry. Since then, hospitals have endured increased regulatory action, on top of myriad issues, such as, most recently, the struggling economy. Now, the BBA will most likely be bookended by comprehensive reform that pretty much guarantees that the reimbursement trajectory will continue on the downward slope.
While, it is easy, like the rest of the nation, to become consumed by what happens in Washington day to day, numerous other issues are more likely to affect hospital profitability in the near-term than a reform bill, such as Medicare inpatient payment rate updates.
In this week's Finance forum, Scott Clay, senior principal at Noblis Health Innovation, points out that with Medicare being the single, largest payer to hospitals, any rate change, especially in inpatient payments, can significantly affect revenue. The 2010 inpatient prospective payment system proposed rule published in May, says Clay, could result in a total estimated reduction of -0.5%.
"One year of flat or slightly negative updates from Medicare would be difficult but not devastating for hospitals," says Clay. However, he adds, included in the comments for the proposed 2010 update, CMS indicated a need for an additional 6.6% of negative adjustments over the next two years, resulting in a total three-year reduction of 8.5%. "The inescapable implication of these trends is that hospitals will need to focus in the short term on continuing the work of reducing their underlying cost structure," he notes.
Not only that, hospital ratings, or, rather the reasons behind them, are another short-term problem. A rating downgrade has the more immediate ramification of less access to capital or access to capital that is more expensive. According to the July 2009 quarterly rating report from Moody's Investor's Service, Q2 2009 was the third consecutive quarter in which nonprofit hospital downgrades exceeded upgrades at 17 to four, respectively. Out of the 17, two large regional hospital systems and one multi-state system received downgrades as the result of weak financial performance and a decline in liquidity, according to the report's authors. Moreover, twice as many outlooks went in the negative direction. A total of $4.6 billion of debt was downgraded vs. $733 million in upgraded debt.
This news was eclipsed in the headlines last week by healthcare reform legislation introduced in the House and Senate. However, as hospitals struggle to reduce costs and increase their liquidity, pressure from rating agencies is more likely to affect the bottom line in the near term than a reform package from Washington, which may take several years to be rolled out.
In Moody's April 2009 Not-For-Profit Healthcare Rating Roadmap report, analysts said they expected "all rated hospitals to report weaker financial performance in 2009," due to higher unemployment and restricted access to capital among other issues. The report's authors issued 14 red flags that could trigger a rating review, including decline in total operating revenue, a 30% decline in operating cash flow, and an unexpected increase in debt. One analyst I spoke to recently said Moody's is doing an enhanced analysis of liquidity of nonprofit hospitals and peeling back the layers to understand what is cash vs. what is liquidity.
So, it seems that while Washington threatens to overhaul the entire healthcare system by October, healthcare leaders know that one of the most important activities they can do today is find ways to trim excess fat, and build cash reserves to brace for both the near and long-term financial hits.
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These are heady days for the healthcare industry. The likelihood of national healthcare reform is greater than any time in recent history. There is a growing consensus that new payment models such as medical home and bundled payments will shape the industry towards a more "value based" purchasing model focused on managing chronic disease and improving preventive care. Demonstration projects and bold statewide initiatives, such as the one in Massachusetts are field testing the theories. There is no shortage of conjecture about which models will prevail and how health care providers should be prepared to succeed in the new landscape.
But amidst the dizzying array of healthcare reform proposals and revolutionary demonstration projects, let's be clear about one thing: over the next three years the financial performance and viability of hospitals and health systems will be more affected by one measure than any other: Medicare inpatient payment rate updates.
Remember the importance of annual Medicare updates
It is common knowledge that Medicare is the single largest payer source for hospitals nationwide. Nationally, over half of acute-care patient days are Medicare patients and more than 80% of hospital Medicare payments are for inpatients. As a percentage of revenues, hospitals are more dependent on Medicare than many other healthcare providers, including physicians and freestanding outpatient centers. So changes in Medicare payments, particularly inpatient payments, have the greatest single impact to hospital revenues.
There is no dispute that healthcare reform changes are important and will have a significant effect on hospitals. But these changes will take time to implement and ramp-up through national efforts. Many of the proposed changes will take several years or more to fully impact hospitals. In the meantime, the federal government will continue to manage expenditures by paying close attention to annual updates on the current system.
In its 2009 industry survey, HealthLeaders Media confirmed the importance of this issue. According to the respondents of the Finance Leader segment, "reimbursement cuts" are by far the trend that is expected to have the greatest impact on their organizations in the next three years. Furthermore, roughly 85 percent of respondents indicated that Medicare reimbursement was of "primary importance" to their revenue streams over the next three years?a far greater percentage than any other trend, including third-party payer negotiations.
A highly sensitive variable
Since Medicare represents such a large portion of hospital revenues, seemingly small changes can have a big impact. Historically, annual Medicare updates averaged around 3%, which was enough to offset 0% updates common for Medicaid programs as long as private insurers increased payments by an average of 4% or 5% annually. In other words, combined revenue inflation of 3.5% to 4% was sufficient to offset similar increases in expense inflation, with Medicare being heavily weighted in the revenue average. If net Medicare updates drop to 0% or worse for three years running, this alone could easily take a hospital from a 3% operating margin to a negative one. Even dropping Medicare updates to 2% annually can turn a 2% operating margin negative in three year's time unless expense inflation can be controlled. In the current economic climate, it is unlikely that commercial payers would agree to increases greater than those given in recent years, and Medicaid programs are more likely to reduce payments over the next three years than increase them, so additional cost shifting is not a likely solution.
Near term prospects
So, if Medicare reimbursement updates (particularly inpatient) serve as a cornerstone to short-term financial success, what are its prospects? In summary, the crystal ball does not paint a rosy picture.
The wake-up call came in the form of the 2010 inpatient prospective payment system proposed rule published in May. The proposed update included a market basket increase of only 2.1% and a behavioral offset of -1.9% for coding changes from the MS-DRG transition. Additional budget neutrality adjustments reduce the market basket update by another -0.7%, resulting in a total estimated reduction of -0.5% for 2010. The final rule (due August 1) could differ from the proposed rule, but even if 2010 payments are rescued, the longer term pressures to reduce Medicare costs remain.
One year of flat or slightly negative updates from Medicare would be difficult but not devastating for hospitals. However, included in the comments for the proposed 2010 update, CMS indicated a need for an additional 6.6% of negative adjustments over the next two years, resulting in a total three year reduction of 8.5%. Even with normal inflationary market basket updates, this would effectively wipe out payment rate increases for three years straight, and possibly result in a net three-year reduction in Medicare updates.
The issue at hand is the "behavioral adjustment" to offset estimated upcoding from the transition to MS-DRGs, which capture more precise data regarding severity of care. Essentially, CMS contends that, even with behavioral offset reductions already taken, hospitals were overpaid for 2008 and are being overpaid for 2009. So the 2008 and 2009 revenues already booked need to be recovered in addition to further offsets in the base rates for 2010 and 2011.
Comments to the proposed 2010 rule have been sent by the American Hospital Association, the Medicare Payment Advisory Commission, which advises Congress on Medicare expenditures, and others. The AHA disputes CMS' findings and provided an alternative analysis which supports the contention that no unearned upcoding occurred. MEDPAC, on the other hand, wrote a letter confirming CMS' findings and supporting the proposed reduction in payment updates by a total of 8.5% over three years with the additional recommendation to take a larger reduction than proposed in 2010. Alternative views and positions on this important subject will continue, but the prevailing economic and political winds seem to be blowing in the direction of cost reductions for Medicare.
Given the magnitude of the impact on hospitals, these changes have been politically unpalatable in the past, but the health reform debate currently underway has highlighted the unsustainable growth rate in government healthcare spending and proposals for a larger government role in healthcare have created more pressure to find funding by reducing existing costs. In general, the Administration has put cost reductions front and center in this round of healthcare reform and is highly focused on "bending the cost curve."
A prime example of this is the recent report that President Obama is pushing to move Medicare payment authority away from Congress and put it in the hands of non-elected officials. The rationale is that Medicare payments have served as an effective constituent service tool for many in Congress, and that "bending the cost curve" in Medicare is impossible if politicians are unwilling to play hard ball with local doctors and hospitals. The Administration has sent two proposals to Congress to address this problem. The first would put the authority for payment updates in the hands of MEDPAC (and their comment on the proposed 2010 IPPS rule clearly outlines their general position on payments). The second proposal would create a new advisory council which reports directly to the President, with limited provisions for Congress to overturn decisions.
Implications for healthcare leaders
The inescapable implication of these trends is that hospitals will need to focus in the short term on continuing the work of reducing their underlying cost structure. These efforts have begun during the recent economic downturn, but sustained pressures on revenue growth will require further discipline in identifying opportunities to operate more efficiently even while making adjustments for the long-term impact of healthcare reform initiatives.
Without a doubt, there are many moving parts in the healthcare reimbursement puzzle, and some changes will be positive for healthcare providers. However, during these times of intense debate over the long-term future of healthcare financing and delivery, it is important to keep an eye on those changes which will impact financial performance in the next two to three years, and perhaps no other single variable is more important than the annual update to the Medicare inpatient prospective payment system.
Scott B. Clay is senior principal at Noblis Health Innovation. He can be reached at scott.clay@noblis.org.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
Anne Jamieson has been named CEO of HCA's Portsmouth Regional Hospital effective Aug. 1, replacing the retired Bill Schuler. Jamieson has served as CEO of HCA's Parkland Medical Center in Derry, NH, since January of 2005. Before that, she was the COO and general counsel of Anna Jacques Hospital in Newburyport, MA; held several positions at Cerner Corp. in Kansas City, MO; and worked at Burbank Hospital, Worcester Memorial Hospital, Marlboro Hospital and Clinton Hospital—all in Massachusetts—as well as Florida Hospital in Orlando.
Harvard Pilgrim Health Care CEO Charles D. Baker will leave his job and seek the Republican nomination for governor of Massachusetts in the 2010 election. Baker said he would run in the mold of former Gov. William Weld, who was a fiscal conservative but held more liberal stances on social issues. He deflected several questions about Democratic Gov. Deval Patrick, but said he would focus on jobs and the economy and retaining young workers.
Paula Friedman, SSM Health Care corporate vice president-strategy and systems improvement, will assume the post of senior vice president-strategic development. She succeeds Bill Thompson, who was recently named president/CEO of SSM Health Care. Both appointments are effective Aug. 1. Friedman, 46, has 26 years of healthcare experience, including 17 of them with SSMHC.
