Friday, November 20, 2015

Physicians navigate challenging environment as focus on value drives change

Guest blog by Michelle La Vone, / 16 November, 2015 As hundreds of healthcare professionals took their seats for the the 2015 NAMCP Managed Care Forum in Las Vegas, the opener ended his introduction with a sentiment that elicited subtle nods: “We are in a challenging, yet interesting, time for the healthcare industry.”

Providers across the spectrum are seeing rising costs and demand for accountability paired with an increasingly difficult patient population, which wants care when it wants it, in the shortest amount of time, for the fewest dollars.

The goal of the transition from fee-for-service to value-based care is to lower costs and improve patient health while also ensuring a provider’s bottom line remains sustainable in the long-term. But how is this best executed?

ACOs and clinically integrated networks are key, the speakers agreed, but so is not jumping the gun. Organizations need to think about operations first, said Lillian Lee-Chun, a manager at ECG Management Consultants. They need to research and understand their local market dynamics, technological platforms, and opportunities for reimbursement. Reducing utilization of high-cost services through disease management, nurse navigators, preventive wellness, and other strategies could eventually hit a group’s bottom line, said Chun, so providers should plan appropriately to seek fair and valuable reimbursements.

To see successful models, one could look at Banner Health in Arizona, Memorial Hermann in Texas, or Care4Texans, also in Texas. Banner Health bills itself as a clinically integrated organization (CIO) co-owned and co-governed with two physician groups: Banner Medical Group and Arizona Integrated Physicians. It has a statewide presence, which Jacque Sokolov, M.D., chairman and CEO of SSB Solutions, thinks is invaluable. “A total state presence gives you state employees and a whole lot of markets,” he said.

Memorial Hermann also considers itself a CIO, and a large part of its success comes from its broad reach. It has more than 200 locations in a 60 by 60 mile primary service area in Houston and has been taking advantage of synergies in retail health and satellite emergency departments. Sokolov believes health systems need alternative delivery sites like these to ensure patient reach without breaking the bank.

A driving factor of success for the Care4Texans (C4T) is its physician-led approach, something that did not initially come easy. Brett Esrock, CEO of Providence Health Network who sits on the Board of Directors for C4T, said getting physicians to be main drivers in the C4T strategy elicited eye rolls.

“Essentially we had to develop a vision for the organization instead of just guiding principles. There were more eye rolls than you could shake a stick at. We distributed vomit bags for people who really didn’t want to participate.”

Eventually, physicians saw that C4T could contribute to real cost-savings, and they established their vision. Today, more than 300 physicians are part of C4T.

Overall, speakers seemed to agree on one thing: Adaptation to new modes of care, whether it be telemedicine, partnerships with retail clinics, or clinically integrated networks, will soon be imperative to staying financially successful and socially relevant. Keeping an open mind and being willing to change is what will differentiate the best from the average. Evolution of healthcare is here, and unavoidable.

View DRG blog.

Tuesday, November 17, 2015

Fall Managed Care Forum 2015 in Las Vegas

 Keynote Sessions/Business Track

As Director of Member Services for AAMCN, it was wonderful to meet our members and get the chance to talk face to face at our biannual Fall conference. It is an important part of the association growth for me to be able to hear comments and opinions on how we are currently serving our nurses and to also get ideas for innovation. When I hear how much our members enjoy the services that we have to offer and that our conferences provide the education they were looking for along with captivating and interesting subject matter, it really makes my job fulfilling.

Health Management Track

Breaking the conference down into 3 concurrent tracks really provided an opportunity to be able to attend the sessions that you wanted to. The Business Track, Health Management Track, and Oncology Track all presented at the same time, which allowed you to switch tracks and always have a choice of 3 different speakers and subjects.

Oncology Track
The receptions held gave everyone a perfect chance to mingle and meet new people. On Wednesday evening, the nurses attended their own reception while the Medical Directors Meet and Greet occurred next door. This gave each specialty a focused time for networking. The following night, a general reception was held for every guest to attend.
Chihuly Glass Sculpture in the Bellagio Lobby
The award for the Managed Care Nurse Leader of the Year was given to Stefany Almaden for her great example of leadership qualities, mentoring achievements, and contributions to managed care.
 Stefany Almaden, MCNLOY Award Winner
The three nurses who took their Certified Managed Care Nurse (CMCN) exam at the conference Wednesday morning all passed and received their certificates. Congratulations to Janice Perry, Lorie Hoekstra, and Joan Patrick-Morris!
                   Janice Perry, RN, CMCN                                     Lorie Hoekstra, RN, CMCN

Innovation awards are given to 3 companies or organizations that improve quality and reduce costs using innovative methods.The AAMCN Innovation award focuses on managed care nursing and was awarded to Priority Health's Coordinating the Coordinators.  

Jacquelyn Smith, AAMCN President (left) and Mary Cooley with Priority Health (right).

The NAMCP Innovation award focuses on managed care and was awarded to NorthStar Alliance Anesthesia for its Enhanced Recovery Program. Unfortunately they couldn't be there to accept the award. And lastly, the AAIHDS Innovation Award was given to Ochsner Health System’s Center for Innovation for the Ochsner Hypertension Digital Medicine Program.

Jonathan Wilt with Oschner Health System (left) and Doug Chaet, co-founder of AAIHDS (right).
The exhibit hall was thoroughly decked out with fancy booth lighting and eye-catching graphics. And who doesn't love the opportunity for free nic-nacs? In the process, you could learn about new products and methods. There really were some interesting inventions for treatment that I never would have learned about outside of the conference.

Let's also take a minute to appreciate the conference location. The Bellagio itself is a beautiful hotel with views that dazzle at night with the dancing fountains, the lighted Eiffel tower and strip just across the street. On my first morning, I was blown away by the majestic mountains just outside the city. If gambling isn't your thing, there's still so much to do and see. I'm looking forward to next year's Fall Forum and I hope you are too!