First Case of Coronavirus Lands in U.S.

https://www.medpagetoday.com/infectiousdisease/publichealth/84458?xid=NL_breakingnewsalert_2020-01-21&eun=g885344d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=VirusUpdateAlert_012120&utm_term=NL_Daily_Breaking_News_Active

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The first travel-related case of the novel coronavirus has been detected in the U.S. in a man from Washington state, CDC officials said on Tuesday.

The man tested positive for the novel coronavirus via laboratory testing, CDC officials said. According to Washington health officials, he arrived without symptoms on an “indirect” flight into Seattle-Tacoma International Airport on Jan. 15, prior to implementation of the new screening procedures at other U.S. airports. Described as “an astute gentleman,” the passenger was aware of the virus and promptly shared information with his provider when his symptoms developed.

Currently, the patient is hospitalized “out of an abundance of caution,” but not because of severe illness. He reported he did not visit any of the implicated markets in the Wuhan area.

A statement released by the CDC details how the man sought care at a nearby medical facility, where health professionals suspected novel coronavirus, and based on the patient’s travel history and symptoms, sent specimens out for testing. CDC confirmed the diagnosis on Monday.

Washington health officials emphasized that this was one of the hospitals that had “done a drill” about this type of illness, including how to transport a patient in an ambulance and what type of isolation is needed. They said that the patient here is “isolated and poses low risk to staff or to the general public.”

Julie Fischer, PhD, of Georgetown University in Washington, D.C., told MedPage Today that this looks to be a similar pattern for human-to-human transmission as SARS, where currently most cases of this novel coronavirus “are probably close contacts,” including healthcare workers. Chinese health officials announced that 14 healthcare workers had been infected.

“This is a big heads up to the rest of the world to go ahead and start preparing your healthcare workers and make sure they have proper equipment,” she said. “It’s a reminder of what we already knew was a risk.”

Fischer said that in addition to taking precautions to avoid infection (such as personal protective equipment), clinicians should “pay attention to evolving guidance.”

The CDC had already decided to step up screening at two additional U.S. airports prior to this case being reported, with additional screening being added at both Hartsfield-Jackson Atlanta International Airport (ATL) and Chicago O’Hare International Airport (ORD) this week. In addition, passengers from Wuhan will be “funneled” into airports with enhanced screening measures, CDC officials said.

“The long incubation period [for the virus] also makes early detection much harder, especially as we do not know how many passengers have flown abroad and how many will do so in the coming weeks,” Stratfor Senior East Asia analyst Zhixing Zhang said in a statement.

Fischer added that screening will be especially challenging, given that this is in the middle of increased flu activity in the U.S. and that clinicians must rely on a “non-specific, place-based case definition” (based on travel) until new diagnostics emerge.

She emphasized the importance of “a good diagnostic test,” saying that only a handful of labs are capable of testing for the virus now. Once molecular testing is available, such as a polymerase chain reaction (PCR) test, the CDC will figure out how best to optimize it and share it more widely, Fischer said.

Indeed, CDC officials said that they are having “active conversations” about diagnostics, as well as research into vaccines.

Over the weekend, the case count for the novel coronavirus rose to over 300, with 6 deaths, according to news reports. The World Health Organization (WHO) is scheduled to meet on Wednesday about whether this virus constitutes an international health emergency.

 

 

MedPAC: 340B hospitals spent more on lung, prostate cancer drugs compared to other facilities

https://www.fiercehealthcare.com/hospitals-health-systems/medpac-340b-hospitals-spent-more-cancer-drugs-compared-to-other-facilities?mkt_tok=eyJpIjoiTTJaaE5EY3lZMlEzTVdZdyIsInQiOiI1UEZJUjBpbldUSVBteFl3OGpnd0FPRnIxMFJFUXIzSjE1YUJDMVdDSSsrdDlibDI1KzU5bXZsU1RIUjBZUWNPR2s1OTdwQXV5ZVY2cUhuWXkzYnpDWE55akhCczMxOVEyRWdpdkNYK1hKcjdIV01qNTdPemxyWkFVK1pDUmNzNyJ9&mrkid=959610

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Hospitals in the 340B drug discount program spent more on drugs for prostate and lung cancers compared to facilities not in the program, a new analysis found.

But the preliminary analysis from the Medicare Payment Advisory Commission (MedPAC) couldn’t find that the controversial program incentivizes hospitals to pursue higher-priced drugs. The analysis, released Friday as part of MedPAC’s monthly meeting, was requested by Congress on the program, which has faced major cuts by the Trump administration.

Some lawmakers have argued that 340B, which offers safety-net hospitals discounts on drugs, has not worked as intended and led to hospitals specifically choosing higher-priced drugs to get a big discount.

So MedPAC looked at the spending from 2013 to 2017 of 340B and non-340B hospitals as well as physicians’ offices for five types of cancers: breast, colorectal, prostate, lung and leukemia and lymphoma.

MedPAC’s analysis found that 340B hospitals spent between 2% and 5% higher on average on cancer drugs than non-340B hospitals. But there were mixed results when 340B hospitals were compared to physicians’ offices, with 340B facilities spending 1% lower to 7% higher than physicians’ offices on cancer drugs.

The reason 340B hospitals spent more on cancer drugs than hospitals not in the program was linked to two types of cancer: lung and prostate.

For lung cancer, a possible reason for the higher spending is that a larger share of patients in 340B hospitals received new immuno-oncology therapies that are more expensive, MedPAC said. Prostate cancer also had higher drug prices per unit for both drugs in Medicare Part B, which reimburses for physician-administered drugs, and Part D.

However, MedPAC staff cautioned they couldn’t conclude 340B is incentivizing the spikes in spending.

The reason is “we lack access to the discount data,” said MedPAC staffer Shinobu Suzuki at the commission’s meeting Friday in Washington, D.C.

MedPAC also didn’t find that gaining 340B status led to a spike in average cancer drug spending, suggesting that 340B discounts “may not have had any effects on them,” the report said.

The analysis also found that the higher cancer spending would likely have a small, if any, impact on cost sharing for Medicare patients depending on the type of cancer and supplemental coverage.

The study will be finalized and likely included in MedPAC’s March report to Congress. It comes with some caveats, including a small sample size and that it did not examine the impact of a 22.5% cut to 340B payments that went into effect in 2018.

The hospital industry has been fighting the Trump administration in court over the cuts, which the industry claims are unlawful.

Despite the caveats, MedPAC’s findings could play a major part in lawmaker deliberations on the program, which some Republicans claim has gotten too big and led to hospitals bilking the federal government.

The pharmaceutical industry has also led an extensive campaign to shed more light on the program. 340B requires pharmaceutical companies to provide discounts to safety-net hospitals in exchange for participating in Medicaid.

The Government Accountability Office has also called for greater oversight of 340B.

340B industry group 340B Health praised the findings.

“The thoughtful analysis MedPAC presented today sheds important light on the role 340B hospitals play in treating people living with cancer,” said Maureen Testoni, 340B Health president, in a statement.

 

MARTIN LUTHER KING JR.’S HEALTHCARE JUSTICE ADVOCACY MAKES AMERICA’S HOSPITALS BETTER TODAY

Martin Luther King Jr.’s Healthcare Justice Advocacy Makes America’s Hospitals Better Today

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Every January, the United States celebrates the lasting legacy of Dr. Martin Luther King Jr. Not widely known is how his civil rights advocacy made a lasting impact on modern-day hospitals, including children’s hospitals.

Today in 170 Children’s Miracle Network Hospitals, every young patient is treated regardless of their race or background. CMN Hospitals are deeply committed to offering world-renowned treatment to all kids in need and that’s why donations to your local hospital can make such a difference for families facing health crises.

Unfortunately, certain hospitals in America were still segregated in the not too recent past. When Brown vs. Board of Education passed in 1954, schools began to desegregate, and this paved the way for institutions like hospitals to follow suite. King’s healthcare justice advocacy advanced health care access in particular for the African American community.

A History of Unequal Healthcare

When patients enter a hospital, they expect to receive a standard of care that will improve their lives regardless of who they might be. That expectation, unfortunately, has not always been backed up by medical institutions across the United States. African Americans, in particular, experienced a history of receiving substandard care and outright abuse within the framework of medical science.

Notable examples of this include:

While the details of those specific examples weren’t publicly known in the 1960s, African Americans were certainly aware that they received care that was inferior to white patients. Doctors and hospitals continued perpetuating this double standard even after the passage of the Civil Rights Act in 1964. The disparity in treatment quality was so egregious that Dr. Martin Luther King Jr. spoke out against it, calling for an awakening in the conscience of the United States.

Desegregating Hospitals

King uttered his famous words on healthcare while addressing the press before attending the annual meeting of the Medical Committee for Human Rights, an organization formed because the American Medical Association was segregated at the time. “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death,” said King.

The Civil Rights Act of 1964 isn’t typically associated with healthcare. However, at that point in history, it was well known that some hospitals and medical institutions were resisting the push for desegregation, a practice which hospitals used to provide less than adequate care to African American patients. Hospitals would continue to hold onto such discriminatory practices unless something was done.

Legal Gains for Equality in Hospitals

The reason King spoke out so vehemently in 1966 was due to the passage of Medicare and Medicaid in 1965, something that was only possible due to the efforts of the Medical Committee for Human Rights and its head, W. Montague Cobb. The organization made use of the non-violent protest strategies of King and the Civil Rights Movement. The passage of the Social Security Act, which created Medicare and Medicaid brought federal funding into every hospital and medical institution in the United States, forever binding each facility to the Civil Rights Act, a stipulation of which was that any organization receiving federal funding could not discriminate on the basis of race.

From that point onward, hospitals that clung to the old ways of discrimination were subject to lawsuits from mistreated African Americans and pressure from activists like King and the Medical Committee for Human Rights. This gave King the legal ground to stand on when calling on hospitals to abandon the evil practice of systemic discrimination in 1966 with those now famous words from that 1966 conference.

While we know there’s more work to be done to promote equal healthcare access to every child in need across North America, we’re proud that our non-profit children’s hospitals can be a part of the solution.

Thank you, King.

 

 

 

 

MedPAC recommends 3.3% payment boost for hospitals in 2021

https://www.beckershospitalreview.com/finance/medpac-recommends-3-3-payment-boost-for-hospitals-in-2021.html?utm_medium=email

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The Medicare Payment Advisory Commission voted unanimously Jan. 16 to recommend a 3.3 percent raise in Medicare payments for hospitals next year.

The commission said it wants to give hospitals a 2 percent boost overall and tie the other 1.3 percent to quality metrics to motivate hospitals to reduce mortality and improve patient satisfaction.

CMS has scheduled a 2.8 percent increase in 2021 Medicare payments.

MedPAC said it is recommending the payment boost to reduce the disparity in payments at different care sites and is part of a larger effort to introduce site-neutral payments.

Congress is not required to implement the recommendation.

 

 

 

The health care debate we ought to be having

https://www.axios.com/what-matters-2020-health-care-costs-7139f124-d4f7-44a1-afc2-6d653ceec77d.html

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Americans worry a lot about how to get and pay for good health care, but the 2020 presidential candidates are barely talking about what’s at the root of these problems: Almost every incentive in the U.S. health care system is broken.

Why it matters: President Trump and most of the Democratic field are minimizing the hard conversations with voters about why health care eats up so much of each paycheck and what it would really take to change things.

  • Instead, the public debate focuses on ideas like how best to cover the uninsured and the relative virtue of health care “choice.”

The U.S. spent $3.6 trillion on health care last year, and almost every part of the system is pushing its costs up, not down.

 

Hospitals collect the biggest piece of the health care pie, at about $1 trillion per year.

  • Their incentive is to fill beds — to send as many bills as possible, for as much as possible.
  • Big hospital systems are buying up smaller ones, as well as physician practices, to reduce competition and charge higher prices.
  • And hospitals have resisted efforts to shift toward a system that pays for quality, rather than volume.

 

Drug companies, meanwhile, are the most profitable part of the health care industry.

  • Small biotech companies usually shoulder the risk of developing new drugs.
  • Big Pharma companies then buy those products, market them aggressively and develop a fortress of patents to keep competition at bay as long as possible.

 

The money bonanza is enticing some nontraditional players into the health care world.

 

Insurers do want to keep costs down — but many of their methods are deeply unpopular.

  • Making us pay more out of pocket and putting tighter restrictions on which doctors we can see create real and immediate headaches for patients.
  • That makes insurers the most convenient punching bag for politicians.

 

The frustrating reality: Democrats’ plans are engaging in the debate about possible solutions more than the candidates themselves.

  • It’s a tacit acknowledgment of two realities: That controlling the cost of care is imperative, and that talking about taking money away from doctors and hospitals is a big political risk.

 

What they’re saying: The top 2020 Democrats have actually released “insanely aggressive” cost control ideas, says Larry Levitt, executive vice president at the Kaiser Family Foundation. “But they don’t talk about that a lot.”

  • Medicare for All, the plan endorsed by Sens. Bernie Sanders and Elizabeth Warren, would sharply reduce spending on doctors and hospitals by eliminating private insurance and paying rates closer to Medicare’s. Estimates range from about $380 billion to nearly $600 billion in savings each year.
  • Joe Biden and Pete Buttigieg have proposed an optional Medicare-like insurance plan, which anyone could buy into. It would pay providers less than private insurance, with the hopes of putting competitive pressure on private plans’ rates.
  • The savings there would be smaller than Medicare for All’s, but those plans are still significantly more ambitious than the Affordable Care Act or most of the proposals that came before it.

 

Yes, but: The health care industry has blanketed Iowa with ads, and is prepared to spend millions more, to defend the very profitable status quo.

  • The argument is simple: Reframe the big-picture debate about costs as a threat to your doctor or your hospital. It’s an easy playbook that both parties, and the industry, know well. And it usually works.

 

The bottom line: “Voters want their health care costs reduced, but that doesn’t mean they would necessarily support what it would take to make that happen,” Levitt said.

 

 

 

 

The top 10 questions from the 2020 J.P. Morgan Healthcare Conference that every CEO must answer

https://www.beckershospitalreview.com/strategy/the-top-10-questions-from-the-2020-j-p-morgan-healthcare-conference-that-every-ceo-must-answer.html

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As we enter a new decade, everyone is searching for something to truly change the game in healthcare over the next 10 years. To find that answer, an estimated 50,000 people headed to San Francisco this week for the prestigious J.P. Morgan Healthcare Conference. Every one of them is placing big bets on who will win and lose in the future of healthcare. The shortcut to figuring this out is actually a question — or 10 questions to be more precise. And what matters most is whether or not the right people are asking and answering those questions.  

While the prophets are ever present and ever ready to pitch their promises in every corner of the city, the pragmatists head up to the 32nd floor of the Westin St. Francis Hotel to hear from the CEOs and CFOs of close to 30 of the largest and most prestigious providers of care in the country. Why? Remember, this is an investor conference and if you want to understand any market, the first rule is to follow the money. And if you want to understand the future business model of healthcare, you better listen closely to the health providers in that room and take notes. 

What providers are saying matters to everyone in healthcare

Healthcare is the largest industry in our economy with over $4 trillion spent per year. Healthcare delivery systems and healthcare providers account for over $2 trillion of that spend, so that feels like a pretty good place to start, right? For that reason alone, it’s critical to listen closely to the executives in those organizations, as their decisions will affect the quality, access and cost of care more than any other stakeholder in healthcare.

Some will say that what they saw this year from healthcare providers was more of the same, but I encourage you to ignore that cynicism and look more closely. As the futurist William Gibson once said, “The future is already here — it’s just not evenly distributed.” The potential for any health system to drive major change is certainly there and the examples are everywhere. The biggest blocker is whether they are asking the right questions. One question can change everything. Here’s proof. 

The stunning power of and need for good questions 

Last year I titled my summary The #1 Takeaway from the 2019 JP Morgan Conference – It’s the Platform, Stupid.” The overwhelming response to the article was pretty surprising to me  — it really resonated with leaders. One example was Jeff Bolton, the chief administrative officer of Mayo Clinic, who told me that the article had inspired their team to ask a single question, “Does Mayo need to be a platform?” They answered the question “yes” and then took aggressive action to activate a strategy around it. Keep reading to learn about what they set in motion. 

Soon after, I had a discussion with John Starcher, CEO of Cincinnati-based Bon Secours Mercy Health, one of the largest health systems in the country, who shared with me that he is taking his team off site for a few days to think about their future. It occurred to me that the most helpful thing for his team wouldn’t be a laundry list of ideas from the other 30 healthcare delivery systems that presented, but rather the questions that they asked at the board and executive level that drove their strategy. Any of those questions would have the potential to change the game for John’s team or any executive team. After all, if you’re going to change anything, the first thing you need to do is change is your mind. 

The wisdom of the crowd 

So, I set out to figure this out: If you were having a leadership or board retreat, what are the 10 questions you should be asking and answering that may change the future of your organization over the next 10 years? I didn’t have the answers, so I decided to tap into the wisdom of the crowd, listening to all 30 of the nonprofit provider presentations, spending additional time with a number of the presenters and reaching out to dozens of experts in the market to help define and refine a set of 10 questions that could spark the conversation that fires up an executive team to develop to the right strategy for their organization. 

A special thank you to a number of the most respected leaders in healthcare who took their time to contribute to and help think through these questions: 

  • Mike Allen, CFO of OSF Healthcare (Peoria, Ill.)
  • Jeff Bolton, CAO of Mayo Clinic (Rochester, Minn.)
  • Robin Damschroder, CFO of Henry Ford Health System (Detroit)
  • JP Gallagher, CEO of NorthShore University HealthSystem (Evanston, Ill.)
  • Kris Zimmer, CFO of SSM Health (St. Louis) 
  • Wright Lassiter, CEO of Henry Ford Health System (Detroit)
  • Mary Lou Mastro, CEO of Edwards-Elmhurst Health (Warrenville, Ill.)
  • Dominic Nakis, CFO of Advocate Aurora Health (Milwaukee and Downers Grove, Ill.) 
  • Dr. Janice Nevin, CEO of ChristianaCare (Newark, Del.)
  • Randy Oostra, CEO or ProMedica (Toledo, Ohio)
  • John Orsini, CFO of Northwestern Medicine (Chicago)
  • Lou Shapiro, CEO of Hospital for Special Surgery (New York City) 
  • John Starcher, President & CEO, Bon Secours Mercy Health (Cincinnati)
  • Vinny Tammaro, CFO, Yale New Haven Health (New Haven, Conn.)
  • Bert Zimmerli, CFO of Intermountain Healthcare (Salt Lake City)

Here are the top 10 questions from the 2020 J.P. Morgan Healthcare Conference

Based on the wisdom of the crowd including the 30 nonprofit provider presentations at the 2020 JP Morgan Healthcare Conference, here are the Top 10 Questions that every CEO needs to answer that may make or break their next 10 years.

1. Business model: Will we think differently and truly leverage our “platform?” As referenced earlier in this article, this was the major theme from last year — health systems leveraging their current assets to build high-value offerings and new revenue streams on top of the infrastructure they have in place. Providers are pivoting from the traditional strategy of buying and building hospitals and simply providing care toward a new and more dynamic strategy that focuses on leveraging the platform they have in place to create more value and growth. Mayo Clinic is an organization that all health systems follow closely. Mayo adopted the platform model around their ‘digital assets’ into what they refer to as Mayo Clinic Platform, which initially targets three game-changing initiatives: a Home Hospital to deliver more health in the home even for high acuity patients, a Clinical Data Analytics Platform for research and development and an Advanced Diagnostics Platform focused on predictive analytics, using algorithms to capture subtle signals before a disease even develops. Children’s Hospital of Philadelphia, one of the top pediatric hospitals in the world, is leveraging their platform to drive international volume, where revenue is 3.5x more per patient. They are also making investments in cell and gene therapy, where their spinoff of Spark Therapeutics returned hundreds of millions of dollars back to their organization. Both organizations were clear that any returns that they generate will be re-invested back into raising the bar on both access to care and quality of care.

 

2. Market share: Are we leveraging a “share of cup” strategy? Starbucks had dominant share in the market against Caribou Coffee, Peet’s Coffee and Dunkin’ Donuts. Instead of solely focusing on how to grab a little more market share, they reframed the definition of their market. They called it “share of cup” meaning that anywhere and any time a cup of coffee was consumed, they wanted it to be Starbucks. In that definition of the market, they had very little share, but enormous growth potential. Hospital for Special Surgery in New York is the largest and highest volume orthopedic shop in the world. Their belief is that wherever and whenever a musculoskeletal issue occurs, they should be part of that conversation. This thinking has led them to build a robust referral network, which 33 percent of the time leads to no surgical treatment. So instead of fighting for share of market in New York, they have a very small share and a very big opportunity in a “share of cup” approach. NorthShore University Health System in Illinois has taken a similar approach on a regional level, converting one of their full-service hospitals into the first orthopedic and spine institute in the state. The results have exceeded expectations on every measure and they already have to increase their capacity due to even higher demand than they originally modeled. 

 

3. Structure: Are we a holding company or an operating company? There has been a tremendous amount of consolidation over the last few years, but questions remain over the merits of those moves. The reality is that many of these organizations haven’t made the tough decisions and are essentially operating as a holding company. They are not getting any strategic or operational leverage. You can place all health systems on a continuum along these two endpoints — being a holding vs. an operating company — but the most critical step is to have an open conversation about where you’re at today, where you intend to be in the future, when you’re going to get there and how you’re going to make it happen. Bon Secours Mercy Health’s CEO John Starcher shared, “It makes sense to merge, but only if you’re willing to make the tough decisions.” His team hit the mark on every measure of their integration following their merger. They then leveraged that same competency to acquire the largest private provider of care in Ireland, as well as seven hospitals in South Carolina and Virginia. Northwestern Medicine has leveraged a similar approach to transform from a $1 billion hospital into a $5 billion health system in a handful of years. Both of these organizations prioritized and made tough decisions quickly and each has created an organizational competency in executing efficiently and effectively on mergers and acquisitions. 

 

4. Culture: Do we have employees or a team? Every organization states that their employees are their most important asset, but few have truly engaged them as a team. Hospitals and healthcare delivery systems can become extraordinarily political, and it’s easy to see why. These are incredibly complex businesses with tens of thousands of employees in hundreds of locations and thousands of departments. Getting that type of organization to move in the same direction is incredibly challenging in any industry. At the same time, the upside of breaking through is perhaps the most important test of any leadership team. JP Gallagher, CEO of North Shore University Health System, shared his perspective that, “Healthcare is a team sport.” The tough question is whether or not your employees are truly working as a team. Christiana Care provides care in four states — Delaware, Maryland, Pennsylvania and New Jersey. They have taken a unique approach that they frame as “for the love of health,” incorporating the essence of what they do in every communication both internally and externally, in their values and in their marketing. In a multi-state system, it is tricky to create a caring and collaborative culture, but it’s critical and they’ve nailed it. Their CEO shared that, “If you lead with love, excellence will follow.” That’s not only well said but spot-on. Creating a world-class team requires not only loving what you do, but the team you’re part of.

 

5. Physicians: Are our physicians optimistic or pessimistic? There’s a lot of concern about “physician burnout” with a reflex to blame it on EHRs, cutting off the needed conversation to dive deeper into where it really comes from and how best to address it. The challenge over the next decade is to create an optimistic, engaged and collaborative culture with physicians. In reading this, some will react with skepticism, which is exactly why leadership here is so important. One suggestion I was given was to make this question edgier and ask, “Are our physicians with us or not?” However the question is asked, the bottom line is that leadership needs to find a way to turn this into a dynamic, hyper-engaged model. A little while back I spent the day with the leadership team at Cleveland Clinic. At the end of the day, their CEO Dr. Tom Mihaljevic was asked what he would tell someone who was thinking of going to medical school. He said he would tell them that, “This is absolutely the best time to be a doctor.” His answer was based on the fact that there has never been a time when you could do more to help people. He wasn’t ignoring the challenges, he was simply reframing those issues as important problems that smart people need to help solve in the future. Those who adopt that type of optimism and truly engage and partner with their physicians will create a major competitive advantage over the next decade.

 

6. Customer: Do we treat sick patients or care for consumers? Words matter here – patients vs. consumers. Most hospitals are in a B2B, not B2C, mindset. Patients get sick, they try to access care, they check into an ER, they get admitted, they are treated, they get discharged. People get confused, anxious and concerned, then they seek not only care, but simplicity, compassion and comfort. With half of America coming through their stores every week, Walmart is already the largest provider organization that no one thinks of as they provide ‘consumer’ care, not ‘patient’ care. But they are starting to broaden their lens, and health systems will need to make moves as well. Competing with Walmart, CVS and other consumer-centric models will require a different mindset. I think Dr. Janice Nevin, the CEO ChristianaCare, captured this really well when she said, “Our mindset is that our role is to ensure everything that can be digital will be digital. Everything than can be done in the home will be done in the home.” Henry Ford Health System CEO Wright Lassiter commented, “Trust is the fundamental currency in healthcare.” Building that trust will require a digital experience in the future that is just as compassionate and caring as what health systems strive to deliver in person in the past. 

 

7. Data: Will we make data liquid? The most undervalued and misunderstood asset of health systems may be their data. While some at the conference refer to this as having the economic equivalent of being the “oil of healthcare,” the real and more practical question is whether or not your organization will make data liquid, available and accessible to the right players on your team at the right time. Jeff Bolton from Mayo commented that, “The current model is broken. Data and tech can eliminate fragmentation.” In a recent Strata survey, we asked leaders in health systems whether they had access to the information they needed to do their job, and 90 percent said no. For many health systems, data is a science project, hidden behind the scenes primarily used for research and impossible to access for most stakeholders. The call to action is activating that data to improve clinical outcomes, operations and/or financial performance. 

 

8. Cost: Are we serious about reducing the cost of care and delivering value? Affordability is a hot topic, and for good reason, as high deductible plans, price transparency and other factors have accelerated its urgency. As Intermountain Healthcare CEO Dr. Marc Harrison shared, “We have an absolute responsibility to make healthcare affordable.” While the consumer side will be a moving target for some time, the No. 1 challenge for hospitals right now is to lower their cost structure so they can compete more effectively in the future. Advocate Aurora HealthBaylor Scott & White Health, CommonSpirit Health and many others are targeting cost reductions of over $1 billion over the next few years. As most hospitals are now in a continuous process to reduce cost in order to compete more effectively in the future, organizations like Yale New Haven Health in Connecticut have implemented advanced cost accounting solutions to better understand both cost and margins. Yale is using this data to understand variation, supporting an initiative that drove over $150 million in savings. Additionally, they have combined cost data with clinical feeds from their EHR to understand the cost of harm events, which turn out to be 5x more expensive. As more providers take on risk, having a “source of truth” on the cost of care will be essential. Advocate Aurora Health CFO Dominic Nakis shared that, “We believe the market will continue to move to taking on risk.” Many of the presenting organizations shared that same perspective, but they won’t be able to manage that risk unless they understand the cost of care for every patient at every point of care across the continuum every day.

 

9. Capital: Do we have an “asset-light” strategy? Traditional strategy for health systems was defined primarily by what they built or bought. Many hospitals still maintain an “if you build it, they will come” strategy at the board level. Yet, Uber has become the biggest transportation company in the world without owning a single car and Airbnb has become the biggest hospitality company in the world without owning a single room. These models are important to reflect upon as healthcare delivery systems assess their capital investment strategy. Intermountain Healthcare CFO Bert Zimmerli refers to their overall thought process as an “asset-light expansion strategy.” In 2019, they opened a virtual hospital and they have now delivered over 700,000 virtual interactions. The number of virtual visits at Kaiser Permanente now exceeds the number of in-person visits at their facilities. With that said, there will be a balance. I really like how Robin Damschroder the CFO of Henry Ford Health System framed it: “We believe healthcare will be more like the airline and banking industry, both of which are fully digitally enabled but have a balance of ‘bricks and clicks’ with defined roles where you can seamlessly move between the two. Clearly, we have a lot of ‘bricks’ so building out the platform that integrates ‘clicks’ is essential.” 

 

10. Performance: Do we want our team to build a budget or improve performance? The most significant barrier to driving change that many organizations have baked into their operating model is their budget process. The typical hospital spends close to five months creating a budget that is typically more than $100 million off the mark. After it’s presented to the board, it is typically thrown out within 90 days. It creates a culture of politics, entitlement and inertia. According to a Strata survey of 200 organizations, close to 40 percent are now ditching the traditional budget process in favor of a more dynamic approach, often referred to as Advanced PlanningOSF HealthCare leverages a rolling approach, radically simplifying and streamlining the planning process while holding their team accountable for driving improvement vs. hitting a budget. When it comes to driving performance, SSM Health CEO Laura Kaiser captured the underlying mindset that’s needed: “We have a strong bias toward purposeful action.” Well said, and it certainly applies to all of the questions here among the top 10.

 

5 additional questions to consider

As you would imagine or might suggest, the questions above can and in some cases should be replaced with others. Additional critical questions to answer that came from the group included the following:

  1. Competition: Who else will we compete with in the future and are we positioned to win?
  2. Digital health: Are we going to be a “digital health” company, providing tech-enabled services?
  3. Affordability: How are we making care more affordable and easier to understand and access?
  4. Social determinants: Is this a mission, marketing or operations strategy?
  5. Leadership: Have we made the tough decisions we need to make, and will we in the future?

 

Start asking questions

The point here isn’t to get locked into a single list of questions, but rather to force your team to ask and answer the most important and challenging ones that will take you from where you are today to where you want to be in the future. After reviewing these questions with your team, the one additional question you need to consider is one of competency: Do you have the ability and bandwidth to execute on what you’ve targeted? In the end, that’s what matters most. While there are many interesting opportunities, too many teams end up chasing too much and delivering too little.

The next 10 years can and should be the best 10 years for every health system and every healthcare provider, but making it happen will require some really tough questions. “The current path we’re on will leave us with a healthcare delivery model that is completely unsustainable,” stated Randy Osstra, CEO of ProMedica Health System. “We need to take meaningful action toward creating a new model of health and well-being — one that supports healthy aging, addresses social determinants of health, encourages appropriate care in the lowest cost setting, and creates funding and incentives to force a truly integrated approach.”

Strong leaders are needed now more than ever. The rest of healthcare is watching, not just professionally but personally. We are all grateful to you for the extraordinary and often heroic care that you deliver without hesitation to our family and friends every day both in our communities and across our country. But now we all need you to not only deliver care, but a new and better version of healthcare. So, ask and answer these and other tough questions. We know you will do everything that you can to help make healthcare healthier for all of us over the next 10 years.

 

 

 

U of Iowa Hospitals & Clinics CEO: ‘Everything in healthcare doesn’t need to be done by a hospital CEO’

https://www.beckershospitalreview.com/hospital-management-administration/u-of-iowa-hospitals-clinics-ceo-everything-in-healthcare-doesn-t-need-to-be-done-by-a-hospital-ceo.html

Despite branching out through nearly 60 outpatient clinics, the University of Iowa Hospitals & Clinics in Iowa City — which includes the only comprehensive university medical center in the state — by and large remains a healthcare destination.

As such, demand for inpatient services hasn’t waned, but has kept on par with the surge in outpatient demand that the entire industry is seeing, Suresh Gunasekaran, the CEO of University of Iowa Hospitals & Clinics and associate vice president for the University of Iowa Health Care, told Becker’s Hospital Review.

That’s not to say strategic threats don’t exist. The biggest ones threatening the University of Iowa Hospitals & Clinics are retail medicine providers that cherry-pick services but aren’t able to provide coordinated care, Mr. Gunasekaran said.

“It’s great that today there’s more convenient care being provided by retail providers. The biggest threat, though, is if healthcare consumers start believing that getting disconnected care is worth it,” he said. “We’re in the business of connected care.”

Tackling this challenge will require input from all parties, not just the hospital CEO, he said. Here, Mr. Gunasekaran expands on how University of Iowa Hospitals & Clinics is facing the threat of uncoordinated retail medicine, and answers questions on board oversight and the changing role of the hospital CEO.

 

Question: What do you consider your biggest strategic threat?

Suresh Gunasekaran: Major threats are those healthcare services that don’t believe in team-based care, that focus on cherry-picking a corridor of healthcare without thinking about the health of the whole person.

There’s unmet demand in communities for [accessible healthcare]. If Walmart is willing to offer a clinic, they may be the only clinic for 20 miles. What I’d hope is these kinds of Walmart and CVS providers look at how they partner with players like us. In that sense, we don’t view retail medicine as a threat as much as an opportunity. But when they’re not collaborative, that’s a threat to us. It’s only good if the care is coordinated.

Q: U of Iowa Hospitals & Clinics has its own retail clinics. How do they play into the larger consumerism trend healthcare is seeing?

SG: We’re in our fifth year of offering retail urgent care clinics. We offer a setting that’s lower cost and very competitive with other retail clinics. We’ve seen a lot of uptake and growth within this model, but it’s our ability to say: Hey, urgent care and retail healthcare absolutely have a place, but they need to be connected to our lab in radiology and to our specialists.

The next frontier for us is how to partner with other retail clinics. It’s easy to partner with yourself, but it’s more challenging to make it work with others.

Q: U of Iowa Hospitals & Clinics is a state agency, so your board is really the board of regents of the state of Iowa. Have you faced increased pressure from the board to take up any initiatives?

SG: The board of regents has asked we keep a couple issues front and center. There continues to be inadequate maternal healthcare resources for the young moms of Iowa, with more and more hospitals unable to recruit staff to deliver babies. Data shows maternal death is increasing in Iowa, which is a very, very troubling statistic. So we are bringing the full strength of the University of Iowa together on this. We just got a huge research grant from the federal government to create better models for maternal health across the state.

Mental health is another area, and a huge area of priority for our governor. We are looking at expanding our residency program to rural areas that are underserved for mental health. Other things we’re looking at is the workforce shortage and social determinants of health.

Q: How do you think the CEO role will evolve over the next decade? Will we see more hospital CEOs take stances on bigger public issues?

SG: Hospitals within the healthcare industry have [historically] been very insular. You almost could run your business without worrying about the rest of the system. Now with healthcare reform and greater governmental and employer scrutiny of healthcare costs, folks are asking hospital systems to answer for what’s going on in a broader industry. And of course, CEOs have to embrace that journey.

Are we going to get involved in those multiple different steps? Not just access to care, not just the pricing of care, not just care coordination, not just how to get the community to get engaged in their own health. The CEO of the future has to have a stance on all of these, because it’s impossible to go where we need to go without being involved.

Perhaps the CEO is not that important. At the end of the day when you look at these issues, it’s important that we’re at the table, but the community needs to come first. It’s an opportunity for employers to take the lead. It’s an opportunity for the government to take a lead. Everything in healthcare doesn’t need to be done by a hospital CEO, and in the future, probably isn’t best done by a hospital CEO. We need to be one part of the team.

Q: You’ve been leading the University of Iowa Hospitals & Clinics for a little over a year now. Is there any piece of advice you would go back and give yourself on day one?

SG: Never lose the voice of the patient. I got that at the end of my first year, and I think that beginning with the voice of the patient would’ve been very, very powerful. It’s somewhat impractical that you show up to a new job, and of course, you’re going to meet the people within your organization first. But never forgetting the voice of the patient and being able to hear who you are in their eyes and in their words would have been very powerful [on day one]. But I’m making up for lost time.