Cooperating for better care.

Bob Harrington

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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 (, 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



Showing system ‘how to deal with new payer world’



Vineyards in Jackson County, Ore.  Jackson Care Connect serves many low-income agricultural workers.

It took considerable courage and enthusiasm three years ago to launch Jackson Care Connect (JCC), a Coordinated Care Organization in Oregon created to serve mostly low-income people on Medicaid.

In the past year, Cambridge Management Group (CMG) has participated in a nationally watched project to help JCC accelerate its mission to improve care and medical outcomes for its population while saving money as the U.S. healthcare system moves toward payment for value from fee for service.

Jackson Care Connect has brought together many organizations and other constituencies – some of them economic rivals of each other — to improve how it uses its limited resources.

A key part of Cambridge Management’s JCC engagement,  which included Bob Harrington, Marc Pierson, M.D.,  and Annie Merkle, was to study the individual parts of the healthcare-related environment in which Jackson Care Connect operates and then to explain, in part through mapping, the linkages among providers and a wide range of other community players — many not healthcare institutions per se — and the social determinants of health. CMG’s research is richly presented in graphics and a report.

(Biographical sketches of the CMG team may be found at this link to the “Professional Staff” page of CMG’s Web site.)

CMG had to understand the function of each part of the JCC universe before it could propose ways to make all players mesh their operations for the benefit of the entire population being served.

Cambridge Management suggested how JCC could best coordinate all these moving parts to meet the Triple Aim of improving the individual patient experience (including quality and satisfaction); improving the health of populations — of particular importance to an organization like Jackson Care Connect — and cutting the per-capita cost of healthcare.

Informing all this work has been the need to address the social determinants of health (which experts consider account for up to 90 percent of health, with direct contact with the healthcare system accounting for the rest). These determinants include, among many other factors, family income, family stability or lack thereof, environment, transportation and education.

Dr. Pierson, we should note, is a former emergency physician and hospital executive who is longtime expert on the social determinants of health and how to reform the healthcare system to address them. His work on addressing these determinants of health in Washington State has drawn national attention.

Jackson Care Connect’s chief executive, Jennifer Lind, said that the CMG team found “areas where things didn’t work,’’ helped determine where operations and attitudes could be most quickly improved, and then facilitated more efficient “interactions between the moving parts.’’

“Cambridge Management broke down what everyone was doing and then convened different constituencies together to try to fulfill larger vision. They worked with us to align the different groups to create a community vision of improving outcomes and capturing savings – not just adding more services upstream.’’

“Bob and Marc as conveners got excitement for change going in the various groups by helping them see what they could do better individually and, especially, together.’’

Cambridge Management’s engagement with JCC — informed by CMG’s decades of working with physicians to align their interests and work with their institutions — sparked new thinking about how clinicians and others could make the new value-based payment systems work better. Ms. Lind said that “clinicians, especially, were inspired by Bob {Harrington} and Marc {Pierson} to help develop new initiatives.’’ These included, Ms. Lind said, “improving care transitions between hospitals and nursing homes and between primary-care physicians and specialists.’’

She noted the complexity of the move to fee for value. “We asked people to do really complex stuff. Some people just don’t like being thrown into complex projects.’

But of course transforming American healthcare is complex stuff: The U.S. system is by far the world’s most complicated and among the most inefficient.

Further, she said, improving Medicaid at the provider and user end is particularly difficult because it doesn’t have the much more powerful economic and political constituencies of Medicare and private insurers. Further, there’s no central authority with statutory power to impose the sort of coordination that Jackson Care Connect and similar regional groups seek to help their populations.

Still, that JCC’s initiatives so far have shown all its constituencies the value of care coordination, and that a wide range of important constituencies are represented on its board, should over time increase its ability to implement new clinical and payment models.

Ms. Lind said: “With Cambridge Management’s help, we’ve been showing the system how to deal with the new payer world.’’

By explaining the linkages through a “system and process lens,’’ CMG helped them make order out of the seeming “chaos’’ of the community health environment.

Here’s a poster describing the linkages of Jackson County’s healthcare entities and related information: OHA Summit 2015 Jackson Poster am.ppt (PowerPoint file will download).

A report, with graphics, on the findings and recommendations of the CMG engagement is linked here (PDF) and appendix here. (PDF)

Read the description by Marc Pierson, M.D., of Cambridge Management Group’s convening and mapping process.

An Ore. county maps its way out of healthcare ‘chaos’

Leaders from four of Jackson County, Oregon’s health institutions asked Cambridge Management Group (CMG) to help them formalize a community-wide collaborative approach to health-system improvement. Before starting, the sponsors rated the chances of success at “less than 50 percent”. Upon hearing this assessment, Marc Pierson. M.D., a member of the CMG team, pointed out that the strength and duration of leaders’ commitment would trump probability projections.

The CMG team  also included Bob Harrington and Annie Merkle. (Biographical sketches of all CMG staff members may be found at this link to the CMG Web site’s “Professional Staff” page.)

Participation and commitment grew as members of 13 institutions, along with 6 patients, documented the key parts of their county’s healthcare system. As they went along, they noted where and how they could improve the connections among their organizations—for stronger operational efficiencies as well as to better serve their shared patients.

These collaborating clinicians, administrators and patients developed a clearer understanding of the opportunities to work together to improve patients’ journeys among emergency rooms, inpatient hospitals, post-acute outpatient care and social-service agencies. It became clear to all that these improvements would help achieve the “Triple Aim’’ goals — better care, lower cost and improved care experience.

In the second joint meeting they prioritized a set of improvements and defined the criteria for measuring success. The collaborative two-day process of mapping the county’s healthcare-related parts and connections, priority-setting and defining specific improvement programs was a new experience. But as participants saw the emerging picture and practical opportunities, they became optimistic and committed to proceed with improving their institutional interactions. “People were delighted when they saw the practical work they could do together,’’ Dr. Pierson said.

Jackson Care Connect, a not-for-profit regional insurance organization, thus took the opportunity to invest some of the savings from the preceding year’s improvements (One such improvement was to improve the efficiency of “handoffs’’ – when patients move from one healthcare institution or clinician to the next).

This community program began with in-depth listening by CMG to the perspectives of institutional stakeholders and patients who would be participating in the system mapping and program definition. Midway through the project, 30 institutional leaders and 6 patients met for a day to map the community’s overall system and note the key linkages and interactions that support patients and institutional operations. This information was organized, shared, clarified and used to define seven initial system-improvement programs.

By explaining the linkages through a “system and process lens,’’ CMG helped them make order out of the seeming “chaos’’ of the community health environment.

Here’s a poster describing the linkages of Jackson County’s healthcare entities and related information: OHA Summit 2015 Jackson Poster am.ppt (PowerPoint file will download).

A report, with graphics, on the findings and recommendations of the CMG engagement is linked here (PDF) and appendix here. (PDF)

For  a look at this ambitious project by  Jennifer Lind,  Jackson Care Connect’s chief executive, hit this link















Funding cliff for health centers; CMG at a FQHC


See the news below on the federal funding cliff for community health centers. Below it is an article on Cambridge Management Group’s successful engagement at  a  Federally Qualified Health Center in Massachusetts that had been in crisis.

From the National Association of Community Health Centers Web site:

”Health and Human Services (HHS) Secretary Sylvia Mathews Burwell on Feb. 26 warned a House panel that unless addressed this year by Congress, the health center funding cliff will lead to more than 7 million patients losing access to care and 40,000 jobs lost with over 2,000 health center site closures.”

”Burwell’s testimony before the Subcommittee on Health focused on 2016 HHS Budget Request, which requests funding for, among other programs, Community Health Centers and the National Health Service Corps (NHSC) – two key healthcare programs that ensure people in underserved communities have life-saving primary and preventive care when and where they need it.”


Here’s the article on Cambridge Management Group’s successful work to help turn around a large Federally Qualified Health Center — Community Health Connections, based in Fitchburg, Mass:


CMG helps turn around CHC

By Yvonne C. Acquafredda, MBA, and Lillian J. LeBlanc, MBA

Today’s healthcare organizations face increased pressure to deliver high-quality and cost-effective care. A key element in enabling them to do this is creating work environments that encourage teamwork on all levels, from board members to all employees.

The Great Place to Work Institute, which studies organizations around the globe, notes the importance of collaboration in the workplace. Great enterprises of all sizes structure their operations to encourage employee cooperation to achieve their organizations’ goals.

Fitchburg, Mass.-based Community Health Connections (CHC), a system of outpatient clinics providing medical, dental and behavioral-health services to thousands of mostly low-income residents in 20 communities, achieved an operational turnaround through a new focus on cross-functional cooperation and clearer and more consistent management.

This was accomplished in partnership with the healthcare-sector consultancy Cambridge Management Group (CMG) and the executive-search firm ZurickDavis (ZD).

CHC is a Federally Qualified Health Center (FQHC). With changing demographics and healthcare reform, such institutions play an increasingly important role in the U.S. healthcare sector. CHC’s experience has lessons for a wide range of healthcare and other organizations across America.

Established just 10 years ago, CHC grew rapidly as it responded to urgent needs to provide primary care in north-central Massachusetts. As patient volume increased, clinicians and administrators worked diligently to meet the demand. But CHC’s organizational structure and culture acted as barriers to examining and improving business processes even as clinical demands surged. By 2013, CHC found itself near receivership. As CHC board member Gregg Buckman put it, “the financial issues were staggering.” In addition, employee morale fell to an all-time low.

Would CHC collapse in the face of the demands being put on it?

Cambridge Management Group Transforms the Organization

Fortunately, CHC’s forward-thinking board recognized the broad range of issues facing the organization and contacted CMG to find ways to stop the losses and then stabilize, focus and grow the organization.

Crucial parts of the engagement that followed were to emphasize collaboration at all levels and to clarify the institution’s needs and goals.

CMG typically operates as a partner of management, providing guidance, expertise and best practices learned over the company’s three decades. As Lia Spiliotes, a CMG partner and senior adviser, explained: “We don’t do what you do; we help you do what you do better.”

However, due to the depth of the challenges at CHC, the board and CMG agreed that interim leadership was needed. Thus Ms. Spiliotes became interim CEO and her CMG colleague Kevin Ward interim CFO.

CMG brought its corporate philosophy of servant leadership to CHC, emphasizing executive approachability and openness without all the traditional boundaries of organizational hierarchy. For example, before CMG’s arrival, CHC executive offices were in an area of CHC headquarters removed from most employees and patients. The interim leadership team established its base in a former gift shop called “The Fishbowl,” in the middle of CHC’s main building. All employees were welcomed to come by.

Another example of this approach was that Ms. Spiliotes invited CHC billing people to meet with the interim leadership team, to give the latter perspective on CHC’s billing processes and present ideas for improvement.

In the initial meetings, all employees were quiet, seemingly afraid to speak up. But over time, as staffers observed, and regularly interacted with, the interim leaders, candid discussion helped to reveal several core operational challenges. One, identified by the billing team, was a communication breakdown between the clinical and billing departments, resulting in many claims being denied. Absent cross-functional teams, the communication changes needed to capture lost revenue would never have been identified.

Over the months of CMG’s leadership, through regular communication and increased collaboration, employees identified many administrative, financial and clinical concerns. Workable solutions were designed in response as the newly collaborative process led employees to feel more empowered, energized and invested in CHC’s success.

ZurickDavis Leverages Collaboration for the CEO Search

As a new culture took hold, the CHC board turned considerable attention to recruiting a long-term leadership team. Sustaining CHC’s turnaround would require leaders with the same understanding of servant leadership that CMG brought, able to relate to employees at all levels and willing to invest the skills, time and energy needed to support organization-wide collaboration to achieve operational success.

So CHC’s board reached out to a trusted business partner, the executive-search firm ZurickDavis. CMG and ZD had been familiar with each other’s work for years.

In the spirit of collaboration, so much a hallmark of the CMG-ZD engagement, the latter’s staff invested considerable time to understand the needs of the organization, including requirements for new leadership. ZD went beyond standard job descriptions and the conventional executive-search process; it approached the engagement with few assumptions. It intensely interviewed several CHC board members and the interim leadership team, letting ZD come to fully understand the organization’s evolution and needs.

Armed with this information, ZD developed a profile of the ideal CEO to maintain CHC’s momentum. Through careful listening to the stakeholders, ZD recognized that certain qualities of character would be even more important than very job-specific skills. The new leader must be someone “committed to serve, unpretentious and genuine,” ZD found. He or she should possess a “naturally respectful, consultative, collaborative and accessible leadership style,” but also show “a willingness to lead decisively, to energize and inspire.”

ZD was a full partner throughout the process. According to ZurickDavis’s Ellen Mahoney, who worked closely in the search, steady openness and collaboration informed the whole process. “Everyone was transparent. We were a part of all meetings and fully utilized as a resource.”

Jeff Zegas, ZD’s chief executive officer, said that this level of cooperation and candor, especially in hiring a new leader, is crucial to any organization wishing to strengthen its culture and thus achieve and maintain operational success over the long term.

Building a Collaborative Organization: The ROI

Although CHC’s transformation is still a work in progress, outcomes show the positive impact of the CMG-ZD engagement. CHC achieved a positive fiscal 2013 cash flow (before depreciation) of nearly $190,000, compared with a negative $1.2 million for fiscal 2011. Eligibility denials involving erroneously entered insurance claims were reduced by almost 65%. And the organization enjoyed unprecedented public support for its $20 million project to build a new Fitchburg Family Health Center.

However, much still remains to be done. CHC’s board chair, Mary Giannetti, offers this advice to other organizations that need to effect profound change. “It takes commitment at all levels, but you don’t have to do it alone. Call in the experts and place trust in those you hire.” CMG co-founder Bob Harrington sums up the process at CHC: “Give employees some autonomy and expectation of accountability and you will motivate them to succeed.”

Yvonne Acquafredda has provided broad-based marketing and communications support to several companies in consumer services and healthcare. She has extensive experience in multi-site organizations. Ms. Acquafredda has a bachelor of science degree in communications from the University of Miami, a master of business administration degree from Northeastern University and a certificate in digital marketing from Rutgers University.

Lillian LeBlanc has more than 30 years of experience in the healthcare industry, assisting organizations with cultural transformation and boosting organizational effectiveness. She has worked with healthcare systems in Boston, Maine and South Florida. Ms LeBlanc holds a bachelor of science degree in economics, summa cum laude, from Boston State College and a master of business administration degree from the University of Massachusetts. She is a guest blogger for the Great Place to Work Institute, which produces Fortune’s annual list of 100 Best Places to Work For in America.

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