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Webinar: How to design bundled-payment systems for maximum clinical and financial success

 

In this audio/video webinar, “Physicians Design Success With Bundles,’’ George Beauregard, D.O., Chief Physician Executive of St. Luke’s Health Partners/Idaho, previously Chief Clinical Officer, Pinnacle Health, Harrisburg, Penn.; Jack Frankeny, M.D., CEO of the Orthopedic Institute of Pennsylvania, Harrisburg, and Bob Harrington, a director and senior adviser at Cambridge Management Group (cmg625.com), discuss how physicians and healthcare organizations can prosper in the bundled-payment world through collaboration-driven, physician-enabled change to meet new reimbursement challenges posed by public- and private-sector payers.

CMG has been heavily involved in assisting hospitals and physicians to redesign their bundled episodes of health services to hold and then grow market share.

This webinar demonstrates how physicians and hospitals can avoid being hurt in a race to the bottom of pricing in a newly commoditized market and how to meet the challenges posed to regional healthcare players by the entry of national brands, the shift to outpatient work and winner-take-all faceoffs.

The webinar shows how, among other things:

  • Physicians and hospitals can work together for common goals.
  • Orthopedic surgeons can play nice on a teamJ
  • Perfecting parts of bundles is not good enough.
  • Success depends on managing interactions among the parts of healthcare episodes.
  • Patient experience is at the center.
  • Effective physician leadership depends on activated colleagues.
  • To realign incentives and restore physicians’ enthusiasm.

Readers should push the arrow at the lower left to start the show, which we think you will enjoy.


Free webinar: How to prosper in a bundled-payment world

Physician leaders,  hospital administrators and payers are among  those who will benefit from listening to the webinar “Physicians Design Success With Bundled Payments” on Tuesday, April 5, at 1-2 p.m.  EDT.  The program is hosted by the Society for Healthcare Strategy and Marketing Development, part of the American Hospital Association.

The session will explain how to make bundled-payment programs work to improve outcomes and  to address the intensifying demands of public- and private-sector payers for stronger cost controls. Much of healthcare is moving toward bundled payments. This webinar will help speed  you on your way in this new value- and evidence-based reimbursement world.

Speaking will be Dr. George Beauregard, chief physician executive at St.  Luke’s Health Partners, Boise, Idaho; Dr, Jack Frankeny, CEO of the Orthopedic Institute of Pennsylvania, in Harrisburg, Pa., and Bob Harrington, partner and senior adviser at Cambridge Management Group, Belmont, Mass.

Viewers may secure free access to this session by sending a request to rwhitcomb@cmg625.com.

 

 


More health systems move into social initiatives

 

Herewith a  national look at how some hospitals systems  are working to promote social initiatives to improve population health and cut the astronomical cost of healthcare.Cambridge Management Group has long been working in the field of social determinants of health, most  recently in its recent engagement with Jackson Care Connect, in Oregon.

As Modern Healthcare notes: “A small but growing group of not-for-profit hospitals and health systems is spending more money on nontraditional community benefit programs designed to address social determinants that affect health, including crime, education, housing, hunger, jobs, poverty and violence.

“Many of these projects fall outside the conventional range of community benefit activities, such as free clinics and health screening events. Instead, their focus is on building healthier communities by bettering people’s lives. ”

There are some high hopes, but some public-health experts say that community health improvement initiatives might take as long as a generation to make a significant impact, and get a good return on investment for health systems.

As Modern Healthcare noted: “{S}ome researchers question whether these efforts by health systems will be big enough to dent broad societal problems such as poverty and income inequality, and whether the systems are willing to step into controversial political fights that could involve government spending and regulation. Health systems are still trying to gather the evidence that their programs are having the intended impact.”

“Increasing access to medical care is less important to health outcomes than addressing social factors such as income inequality and support for parents during the first year of a child’s life, Stephen Bezruchka, M.D., a senior lecturer in the health-services department at the University of Washington, told Modern Healthcare. “You have to recognize that nonmedical factors are what produce health. {But} I don’t see any hospitals trying to advocate for social change.”

 


Curadux CEO looks at overtreatment and undertreatment

We were pleased to read this essay in Modern Healthcare by David L. Brown, M.D., chief executive and co-founder of Curadux, a healthcare decision-support firm that’s partnering with Cambridge Management Group in some projects.

Americans dealing with advanced illness are at risk of overtreatment and undertreatment of their conditions because powerful and silent incentives are often driving their healthcare, rather than their own unique values and goals. After 38 years of practicing medicine inside the world’s elite healthcare institutions, and as a survivor of my own advanced illness, this is my foremost concern for current and future generations of patients and their families.

For those serving inside modern medical institutions, these risks are well known. As one caregiver recently told the Institute of Medicine, “When you take the time to find out what’s most important to patients and families, they make very reasonable choices. The challenge is that our healthcare system does not encourage these conversations, our professional providers frequently do not have the time or training, and treatment measures default to those that are health system centered.”

Healthcare is not always patient-centered because our third-party payer system disrupts the normal buyer-seller relationship we often take for granted. In healthcare, for reasons of public policy, the consumer isn’t always the paying customer for the services they consume, which distorts incentive structures throughout healthcare (and not always for the patient’s benefit).

Overtreatment — treatment that is unnecessary or futile for improving a person’s quality of life—is the dominant problem today. It may cause unwanted, invasive and expensive care, as well as unnecessarily prolonged and painful deaths. Health systems are subtly incentivized to overtreat patients because they generate more revenue based on the volume of services provided. Physicians are incentivized to recommend more services because they want to minimize perceived risks to patients and their own legal liability. Without clear guidance to the contrary, physicians default to treating a condition, often no matter how futile or painful for the patient.

Undertreatment — the lack of necessary treatment for improving a person’s quality of life — is the emerging problem. Policymakers are seeking ways to control healthcare costs as governments bear more financial responsibility for healthcare due to an aging population, the expansion of government programs, and increased consumption of healthcare by individuals. Since policymakers can’t change demographics and since a policy decision has been made to expand programs and subsidies, the primary option left for policymakers is to limit consumption of services.

Like most service industries, healthcare providers have traditionally been paid fees for the services they provide. Healthcare is unique, however, because the third-party payer system eliminates the natural market mechanism for limiting consumer demand and optimizing the quality and quantity of services around the perceived value to the consumer. At present, without a meaningful limit on consumer demand, providers act in their self-interest and deliver higher volume of services, which generates more revenue and increases costs.

To control costs, whether wise or unwise, policymakers opted against moving toward a market-based model whereby consumers assume more responsibility for healthcare and, instead, expanded the current system. They are now testing an artificial mechanism for controlling demand by simply capping payments to providers through population-health concepts. While this may reduce costs, it creates the risk that providers may discourage healthcare services for people who may legitimately benefit from them.

To permanently realign healthcare incentives around the individual would require overhauling the entire system so market forces could naturally optimize consumption. This is unlikely because of legitimate public policy issues and the practical difficulty of overhauling established commercial, financial, and regulatory frameworks in a polarized political environment.

Today, patients must educate themselves and stay actively involved in aligning their values and goals with their healthcare decisions. Primary-care physicians traditionally led this process through end-of-life conversations, but as clinical production pressures and demands have increased, physicians have less time to thoroughly discuss and analyze each patient’s unique values and goals. Instead, physicians now often rely more on other staff to perform this function. While these staff can be useful, the rich expertise provided by experienced physicians is often lost. True patient-centered care for patients and families facing an advanced illness is clearly ready for further innovation.

Dr. David L. Brown has practiced medicine for 38 years. He recently retired as chairman of the Anesthesiology Institute at the Cleveland Clinic. He has also led the anesthesiology departments at the University of Texas M.D. Anderson Cancer Center, University of Iowa Hospital and Clinics, and Virginia Mason Medical Center, as well as serving as professor of anesthesiology at the Mayo Clinic. 

 


Crowdfunding to pay for treatments is growing fast

crowd

 

Crowdfunding is letting more and more patients cover the cost of expensive, experimental treatments in America, which has, of course, far and away the world’s most expensive healthcare system even exclusive of experimental treatments.

One way is to use  GoFundMe.com.

Internationally, “medical crowdfunding campaigns on GoFundMe have jumped from just over 8,000 in 2011 to more than 740,000 this year, ” reports The Sacramento Bee.

“Some people donate a few dollars, some a few hundred. And patients’ loved ones often use social media to spread the word.

“It’s an easy site to use,” Mary Hyatt, a Sacramento multiple sclerosis patient whose sister started a campaign for her, told The Bee. “You can just put your story out there and you’re going to have a friend tell a friend. … If it’s a lot of people and a little money (per person), it’s easier to swallow for everybody.”

The campaigns range from  funding to “help pay for potentially lifesaving experimental treatment, to smaller campaigns to pay for expensive medicine and related treatments not covered by insurance or time off from work.”

We at Cambridge Management Group are curious as to how much healthcare providers themselves are directing patients and their families toward crowdfunding, both out of sympathy and out of the desire to get paid.

 

 


Heart Assn. focuses on social determinants of heart health

 

heart

The American Heart Association  is urging public- and private-sector healthcare policymakers to pay  more attention to the social factors that influence heart health, such as race, education and location.

This all comes under what we at Cambridge Management Group have long worked to understand  and address — the social determinants of health.

“What we’re discovering is that this is a very complicated space and there may be a number of variables beyond people’s control that have an impact on their health,” Dr. Clyde Yancy, an author of the report, told Reuters. Dr. Yancy  is chief of cardiology at Northwestern University’s Feinberg School of Medicine, in Chicago.

He gave as an example  new research suggesting that local pollution levels are tied to the risk of high blood pressure, among an area’s population.

The AHA group  notes that deaths from cardiovascular disease have declined since the 1970s thanks to advances in prevention and treatment.

But the group noted  that not all groups have benefited equally across economic, racial and ethnic groups. “Overall population health cannot improve if parts of the population do not benefit from improvements in prevention and treatment,” it wrote.

They cited social and economic status, race, ethnicity, social support, culture and language, access to care and place of residence as determining factors of health.

 

 

 


Cambridge Management Group at 30

Cambridge Management Group is (quietly) celebrating its 30th anniversary this month. Since 1985, our firm, composed of senior professionals with many years of business and clinical experience from across America — has been privileged to help organizations adapt to healthcare-sector-wide changes while addressing individual organizations’ often unique challenges.

The sector has seen vast changes since 1985! Consider the arrival of various forms of managed care, the rise of big hospital chains and the surge in hospital employment of once-independent physicians. Then there are the stunning new technologies that can turn patients into amateur doctors and new government insurance programs aimed at expanding coverage while controlling costs. The Affordable Care Act has, of course, accelerated the sector’s transformation in the past several years.

During the past three decades, CMG has expanded from consulting at hospitals to also work for a wide range of other healthcare organizations, such as Federally Qualified Health Centers and statewide Medicaid programs as “population health’’ becomes a mantra.

Whatever the challenges along the way, we’re always energized by our mission, as summarized in our motto “Cooperating for Better Care’’. To us at CMG, healthcare remains the most exciting – and, arguably, the most important — place to work. We’re grateful to have had the opportunity to do so for three decades, and look forward to continuing for years to come.


Cambridge Management Group at 30

 

Cambridge Management Group is (quietly) celebrating its 30th anniversary this month. Since 1985, our firm, composed of senior professionals with many years of business and clinical experience from across America — has been privileged to help organizations adapt to healthcare-sector-wide changes while addressing individual organizations’ often unique challenges.

The sector has seen vast changes since 1985! Consider the arrival of various forms of managed care, the rise of big hospital chains and the surge in hospital employment of once-independent physicians. Then there are the stunning new technologies that can turn patients into amateur doctors and new government insurance programs aimed at expanding coverage while controlling costs. The Affordable Care Act has, of course, accelerated the sector’s transformation in the past several years.

During the past three decades, CMG has expanded from consulting at hospitals to also work for a wide range of other healthcare organizations, such as Federally Qualified Health Centers and statewide Medicaid programs as “population health’’ becomes a mantra.

Whatever the challenges along the way, we’re always energized by our mission, as summarized in our motto “Cooperating for Better Care’’. To us at CMG, healthcare remains the most exciting – and, arguably, the most important — place to work. We’re grateful to have had the opportunity to do so for three decades, and look forward to continuing for years to come.


Physicians and marketers must better align themselves

 

Competition for patients is at an all-time high and reimbursement systems are rapidly changing, which makes healthcare institutions, physicians and marketers increasingly nervous. So it’s more important than ever for physicians and marketers to align around a common agenda for business growth.

However, marketers and physicians too often struggle to understand each other’s objectives and constraints, as we at Cambridge Management Group (CMG) have  found again and again in our work across America.

“Physicians wonder why the marketers’ efforts aren’t getting them more appointments. And marketers complain that the physicians’ focus on complex cases doesn’t produce good blogs,” said corporate anthropologist Andrea Simon, Ph.D., founder and chief executive of Simon Associates Management Consultants (SAMC). “Rather than butting heads, these two groups need to team up, so that they can effectively acquire new healthcare customers.”

With that goal in mind, a webinar will outline a process to help create much more productive physician-marketer partnerships.

The free, hour-long session — How The Physician-Marketing Partnership Leads To New Patients — starts at noon, EDT, on Friday, June 12. It’s just the latest webinar in the Healthcare Innovation: Trends from the Trenches series, created by Simon in 2013. To register now, please click here.

Besides Ms. Simon, the hosts will be Linda MacCracken and Timothy Crowley, M.D. Both are national leaders in physician and healthcare institution alignment and marketing. Ms. MacCracken has collaborated closely with  Cambridge Management Group on various projects, as has Dr. Crowley, who has been a CMG senior adviser.

Ms. MacCracken is a strategist focused on physician-aligned patient engagement. She is heading innovation for Accenture Provider Health’s Customer Relationship Management program and teaches marketing to physician executives at Harvard University’s T.H. Chan School of Public Health.

She has worked in and with health systems to increase patient volumes, open networks and boost customer engagement, as an independent consultant and as chief marketing/strategy officer at Solucient/Thomson Reuters/Truven Health Analytics. Ms. MacCracken has led teams to achieve such results as boosting market share by 15 percentage points, lifting a health system to #1 in its market from #3, boosting physician-engagement ratings to the top 10 percent nationally and launching profitable services that exceed targets.

She is a frequent speaker at such national forums as those run by the Society of Healthcare Strategy and Marketing.

Dr. Crowley, an internist and expert in physician-network development and management, is president of Pinnacle Health Medical Group, in Harrisburg, Pa.

Healthcare organizations call upon Dr. Crowley to turn around and optimize the financial performance of struggling employed physician groups suffering unsustainable losses. His extensive experience in both the fee-for-service and capitated-risk-reimbursement systems is valuable to organizations trying to manage the “pivot” from fee for service to capitated risk reimbursement in their nascent Accountable Care Organization development efforts.

Since taking the Pinnacle post last year, his achievements there have included raising the average percentage of physicians’ contract work hours actually spent in front of patients to 90 percent from 59 percent; increasing new-patient visits by 20,000, and cutting the “loss’’ per physician to zero from $100,000.

Dr. Crowley’s experience in creating and developing the Cardiovascular Institute at the Beth Israel Deaconness Medical Center, in Boston, helps systems contemplating similar models with their high-margin specialists.

As senior vice president at Caritas Christi HealthCare, Tim Crowley was directly responsible for more than 400 employed physicians and a total of 1,200 practitioners in the system. In a single year, his leadership and innovative methods significantly contributed to turning around the system from a $50 million loss to a $30 million operating gain.

 


A series on Medicare at 50

 

sign

President Johnson signs Medicare into law in 1965, with former President Harry Truman, 81, the first Medicare card holder, looking on.  Mr. Truman had long pushed for national health insurance.

As we approach the 50th anniversary of Medicare, MedPage Today starts a fascinating series looking at the achievements and problems — especially its spiraling costs — of the program.

Some of us at Cambridge Management Group well remember how the American Medical Association tried to stop the program from becoming law in the ’60s, asserting that it was “socialized medicine.”

It wasn’t but it did make many doctors and hospitals rich. Only in recent years have its reimbursements lagged physicians’ costs (and/or their financial expectations), leading to  major initiatives  aimed at bringing  its many wasteful aspects under control before it bankrupts America.

Meanwhile, even  many of the most ardent Tea Party conservatives like to talk about how evil would be cuts in Medicare benefits. But then, many Tea Party people are over or approaching Medicare age.

The original idea for Medicare goes back at least to Theodore Roosevelt in the sense of a national insurance plan. But Republican opposition has prevented a real universal, single-payer plan from being implemented.

Since the elderly vote in high numbers and because  age-related illnesses make it very difficult for most to get private insurance, they got what liberals  have wanted for the whole population. Politicians have generally worried more about old voters than, say, kids.

It will continue to be politically impossible to kill Medicare. Like Social Security, it’s too much a part of American life. But the flood of aging Baby Boomers and other factors ensure that it will continue to undergo change, some of them  wrenching.


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