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Sylvia Mathews Burwell

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Vt. will move to voluntary all-payer ACO in Jan.


The CMS has announced that in January, Vermont will become the first state  to move to a voluntary all-payer Accountable Care Organization model.

While Vermont’s program is somewhat modeled after a similar one in Maryland,  the Maryland program covers only hospitals while Vermont’s will cover close to all providers. The Vermont ACO will include Medicare, Medicaid and commercial payers, requiring those who participate to pay similar rates for all services.The CMS is giving Vermont $9.5 million in start-up funding to support the transition. The demonstration project is supposed to last  five years.

“This model is historic in terms of its scope, aiming to include almost all providers and people throughout the state in an all-payer ACO model to drive improved quality, better care coordination, healthier people, and smarter spending,”  Patrick Conway, M.D., the CMS’s chief medical officer, said.

“We will become the first state in America to fundamentally transform our entire health care system so it is geared towards keeping people healthy, not making money,” said Vermont Gov. Peter Shumlin, who negotiated a deal with HHS Secretary Sylvia Mathews Burwell.

The state seeks to have 70 percent of its insured residents covered by an ACO by 2022. The model will be considered an advanced Alternative Payment Model under the new Medicare reimbursement program, making participants eligible for a performance bonus.

Vermont will limit  per-capita  annual spending growth for major payers to 3.5 percent and Medicare growth to at least 0.1 to 0.2 percentage points below projected national Medicare growth.  In recognition of the role of behavioral health in other health, state officials also said they will seek to improve access to primary care and treatment for substance abuse, mental health and chronic disease as part of the ACO project.

The Vermont Legislative Joint Fiscal Office said that better care and an improved  state economy might well come out the initiative. However, it also  warned of such risks as uncertainty that the federal funding would cover transition costs and whether all providers will be adequately represented.

To read a Modern Healthcare article on this, please hit this link.

HHS official looks at healthcare-policy future


Video and text: Leslie Dach, a former Wal-Mart executive, is a senior counselor to Health and Human Services Secretary Sylvia Mathews Burwell. He discussed with The Wall Street Journal how  how healthcare policy is evolving.

Among his remarks:

“{W}e want to incentivize the system to pay for quality and not quantity. We want to incentivize care to be integrated and organized.

“The hip-and-joint bundle is a perfect one announced in final form yesterday. Billions of dollars are spent every year in America under Medicare and private insurance on hip and joint [replacement]. These are operations that can be quite painful. Recovery takes time. Under the old system, we would reimburse for the operation. The concept here is to ask the provider to be responsible for a 90-day period, an episode of care, so that they integrate the care down through rehab. If they do that well, they make more money. If they don’t do it as well, they have an economic risk. And that’s been welcome, frankly, by the hospital system and others.”

In search of a co-op rescue plan


The Obama administrative is remaining remarkable cryptic about how it plans to fix the healthcare co-op program created by the Affordable Care Act now than nearly half the 23 consumer-owned and -operated co-ops have announced that they will shut because of financial woes.

“Right now, that is what we are doing, is exploring our options,”  Health and Human Services Secretary Sylvia Mathews Burwell told The Hill. “We are continuing to examine what, if any, options we have.”







Computer program cutting Utah hospital’s costs


Panoramic view of Salt Lake City.

University of Utah Health Care is trying to determine what  the goods and services provided by a hospital really cost and while doing so, the institution says, it’s cutting expenses and improving care.

As this very important New York Times article says: “Most businesses know the cost of everything that goes into producing what they sell — essential information for setting prices. Medicine is different. Hospitals know what they are paid by insurers, but it bears little relationship to their costs.”

But now, thanks to a project led by Vivian Lee, M.D., “the hospital is getting answers, information that is not only saving money but also improving care. The effort is attracting the attention of institutions from Harvard to the Mayo Clinic. The secretary of health and human services, Sylvia Mathews Burwell, visited last month to see the results”

While the costs of other medical centers in the Salt Lake City area have increased an average of 2.9 percent a year over the past few years, the University of Utah’s have declined by 0.5 percent a year. “We have bent the cost curve,” Dr. Lee told The Times.

The paper says that the  “linchpin of this effort at the University of Utah Health Care is a computer program — still a work in progress — with 200 million rows of costs for items like drugs, medical devices, a doctor’s time in the operating room and each member of the staff’s time. The software also tracks such outcomes as days in the hospital and readmissions. A pulldown menu compares each doctor’s costs and outcomes with others’ in the department ”


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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