Cooperating for better care.

Robert Whitcomb

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COVID-19 and the new practice of medicine

A new article in NEJM Catalyst discusses some ways in which medicine will be dramatically affected by the COVID-19 pandemic.

The authors write: “Covid-19 changed everything. Suddenly it is time to move past reimagining and begin recreating. In this article, we provide insights into the perceived impediments that led to slow adoption of telemedicine, the changes that came with the Covid-19 pandemic, and advice on how to most easily implement a telemedicine program rapidly if you do not have one. We also caution that established telemedicine programs should not embrace the short-term easing of federal restrictions and divert from best clinical practices unless absolutely necessary.”

To read the article, please hit this link.

‘Social innovations’ are needed to transform care

From NEJM Catalyst:

“Hopelab’s CEO outlines an approach to innovation that takes into account the systemic and social factors that individuals and communities face as they try to achieve and maintain good health, an approach that builds bridges between sectors and takes risks to think big about human-centered design at scale — especially for those the current health care system doesn’t do a great job of reaching or engaging.

“When getting ready for {last fall’s} NEJM Catalyst event,’Care Delivery Innovation: Why, How, and the Impact,’ Margaret Laws, MPP, President and Chief Executive Officer of Hopelab, a San Francisco-based nonprofit, reviewed lists of innovations. One list from Cleveland Clinic in 2018 predicted the top 10 medical innovations for 2019, such as artificial intelligence, robotic surgery, and immunotherapy. But while those medical innovations are important, ‘they don’t have a lot to do with most people’s experience of the health care system,’ Laws says. ‘I got to thinking, what if we put this much focus on addressing some of the areas in which our health system and the people it serves are desperate for innovation, areas where we see glaring disparities in access and outcomes?”’

“’What if we also asked what social innovations will transform care?’ Laws suggests to the audience. She outlines the need for an approach to innovation that takes into account the systemic and social factors that individuals and communities face as they try to achieve and maintain good health. These challenges call for an approach that focuses on more than the ‘silver bullet’ drugs, devices, and technologies, an approach that thinks about human-centered design, how innovations get to and are used by people — including and especially those people our current health care system doesn’t do a great job of reaching or engaging.”

To read the whole article, please hit this link.

Pointers in developing physician leaders

In a Medical Economics essay, Steve Quach, M.D., CEO of  CarePoint Health and author of The DNA of Physician Leadership, writes about how to develop physician leaders of health-care organizations.

 Among the factors he cites are the need for an appetite to take risks; the need to rigorously prioritize tasks and do heavy delegation, even leaving some low-priority things undone;  understanding the difference between being authoritative and influential, and avoiding a short-term mindset.

To read his essay, please hit this link.


Report looks at why rural hospitals are closing

FierceHealthcare reports:

“The number of U.S. rural hospitals that shut their doors reached a record-setting 19 last year, according to a new report that aims to pinpoint why hospitals are closing.

“The Chartis Center for Rural Health and iVantage Health Analytics released a report (PDF) … that found 120 rural facilities have shut their doors since 2010. The study also explored indicators that can lead to a rural hospital’s demise.

“’The accelerated rate at which rural hospitals are closing continues to unsettle the rural healthcare community and demands a more nuanced investigation into rural hospital performance,’ the study said.”

“The report identified nine indicators to measure whether a hospital is ripe for closure. Some of the indicators include occupancy rates, age of the facility, system affiliation, total revenue and case mix index, which is the ability to handle a broad mix of services.”

“Another key indicator is whether the state expanded Medicaid under the Affordable Care Act.”

To read the whole article, please hit this link.

CEOs had expected more progress on value-based care

FierceHealthcare reports:

“Healthcare CEOs admit they thought they’d be farther along in the transition to value-based care than they are today, a new survey shows. 

“Consulting firm Deloitte polled 25 hospital CEOs and 6 payer CEOs, all running companies with at least $1 billion in annual revenue, on their perspectives on a slew of industry issues and found that they’re shifting investment focus to consumer tech and improving care coordination, including through virtual health. 

“Many CEOs in our prior studies predicted that they would be much further along in adopting value-based payment models than they are today,” the analysts wrote. “They admit now that progress was much slower because efforts were much harder than they anticipated.” 

To read the full article, please hit this link.

Leadership development needs ‘mentors-of-the- moment’

In a Harvard Business Review article, W. Brad Johnson and David G. Smith argue that an organization’s culture, not specific mentoring programs, is most important in developing leaders.

Among their observations:

“Here is the problem: Mentoring programs typically rely on single mentor-mentee matches, pairings that by nature are quite formal and hierarchical, when all the evidence shows that many employees — especially women — prefer mentorships with a more reciprocal and mutual character. Single mentors are also less career-enhancing than robust developmental networks or mentoring constellations. What’s more, even the best mentoring programs are unlikely to achieve intended outcomes when the surrounding workplace is competitive and individualistic, and when senior members of the organization only engage in developing junior talent when pursued by a prospective mentee or “voluntold” to participate in formal program.”

“Mentoring programs alone won’t sufficiently engage or develop your junior talent, especially if your culture doesn’t encourage mentoring on a regular basis. What your company needs instead are mentors-of-the-moment.”

Among their conclusions:

“Genuine mentoring values and daily mentoring behaviors must be embedded in the workplace DNA. Not only can mentor-of-the-moment exchanges offer a less-threatening alternative to an assigned ‘relationship,’ they also fuel inclusion. Actively engaging colleagues with diverse experiences in frequent, transparent, affirming conversations may be less daunting than a formal assignment, especially when it is a clearly articulated performance expectation.”

To read the whole article, please hit this link.

Providence St. Joseph Health’s’ ‘tight, loose, tight’ management style

In an NEJM Catalyst article, Amy Compton-Phillips, M.D., executive vice president and chief clinical officer for Providence St. Joseph Health, based in Renton, Wash., and serving large parts of the western U.S., describes how her organization’s simple model has led to substantive change there in managing complex, seemingly intractable health-care problems.

Among her remarks:

“Since 2015, Providence St. Joseph Health has employed a simple model for leading complex change at scale. The simple concepts that we used to achieve meaningful change can be summarized into five essential foci: Vision (the ‘Why’), Trust (the ‘Who’), Data (the ‘What’), Capacity (the ‘How’), and Alignment (the ‘What’s In It For Me?’). PSJH has applied this change model along with a ‘tight, loose, tight’ management style, which serves to standardize a few critical elements across the system while allowing each local group to customize implementation based on their context, environment, and innovation.”

To read her article, please hit this link.

Many organizations lag in physician-leadership training programs

An article in NEJM Catalyst by Gary S. Kaplan, M.D., and Stephen Swensen, M.D., about training physician leaders, says that “Leadership is teachable, and leadership development and training are important, according to NEJM Catalyst’s recent Insights Council survey on the topic. Yet the same survey reveals that more than half of respondents think their organizations’ efforts to develop and train leaders are lacking in quality and time commitment.”

Dr. Gary Kaplan, chairman and CEO at Virginia Mason Health System in Seattle, finds these results concerning, especially as the complexity of delivering health care continues to increase. ‘Leadership doesn’t just happen,’ he says. ‘We need strong leaders for greater focus and to execute improvement work in organizations and the health care industry overall.”’

“Internal leadership training programs are the top approach used at Insights Council members’ organizations, by a wide margin, ” the article says.

To read the article, please hit this link.

More ACO’s, fewer small practices

From FierceHealthcare:

“Researchers examined changes in physician practice sizes associated with ACO market penetration three years after the launch of the Medicare Shared Savings Program, which began in 2012 and is one of the country’s largest ACO programs. In counties with more ACOs, they found more large practices and fewer small practices, according to a study published in Health Affairs.

“And they found evidence suggesting that ACO-driven physician consolidation is accelerating. ‘These patterns suggest that the consolidation concerns initially raised regarding ACOs were warranted and that gains from care coordination facilitated by ACOs will have to be balanced against higher prices and possibly lower-quality care that could result from consolidation,’ the study authors said.

“The catch is that while ACOs are associated with higher quality and lower costs, consolidation of physician practices is associated with lower quality and higher prices in some settings.”

To read the whole article, please hit this link.

How will AI affect health-care delivery?

Authors of an article in NEJM Catalyt look at how artificial intelligence will affect health-care delivery. Among the conclusions:

“{H}umans still will be required to sustain the core doctor-patient relationship, and several universal obstacles could hinder the pace of AI adoption in health care delivery for the foreseeable future. For example, development of AI technology requires access to data sources that accurately and equitably reflect the general patient population. However, medical AI is likely to emerge in high-resource settings, such as academic medical centers, leading to contextual bias when it is deployed in lower-resource settings such as community health centers or rural areas. Additionally, developers must attain physician and staff buy-in regarding using AI in clinical practice. Despite great promise, some digital health tools have faltered at the stage of clinical adoption and diffusion.

“Finally, questions remain about reimbursement, liability, and regulation. In the U.S., the FDA has been establishing regulatory policies and guidelines around software and digital health. The agency has, for example, built a pre-certification program aimed at making sure consumers have access to high-quality digital health products.”

To read the article, please hit this link.

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