What Got Us Here, Won’t Get Us There: Strategic Planning for the Transition

Information and technology is becoming pervasive in all aspects of clinical care delivery and financial management of the health care enterprise.  Healthcare business, clinical and information technology leaders agree that IT is critical to population health management and value based reimbursement.  Yet, for many, day to day problems often keep IT leadership in a fire-fighting mode.  Many CIOs and healthcare business and clinical leaders find it difficult to find time to focus on the future.

Traditional healthcare information technology strategic plans were primarily consisted of a list of vendor applications and infrastructure to be deployed.  The bottom line for most healthcare organizations is that tactical IT road maps will not position the organization for tomorrow.  Segmentation of the IT strategic plan and portfolio into four primary programs can be useful in transitioning IT from a “keep the lights” on functional role to a strategic partner for the transition from volume to value.  Each quadrant has a unique role in maximizing the value IT contributes to the organization.

4 Strategic Plans

See below our thinking on each quadrant and key take-always for senior leadership

1 – Rethinking IT Organization Design & Operating Model:  Traditional IT organization structures, processes and operating models should be reconfigured to consider the healthcare enterprise of tomorrow.  Many IT organizations were founded within hospitals and those models no longer work given the level of consolidation, the requirements to support clinical integration networks, and the expectations of affiliates and partners.  New customer support functions, shared services centers and economies of scale are needed for today’s contemporary information technology services.  Collaboration with informatics, analytics, quality and security professionals is challenging traditional IT cultures and operating practices.

Key Take-Aways:  Have you redesigned the IT, Informatics, Analytics and Quality leadership and organization structure?  Do you have a plan for building new competencies?  What is the 2.0+ operating model?

2 –  Support Performance Improvement in Acute, Ambulatory & Post-Acute Care:  As pressure on healthcare costs increases and margins become more dependent of value, not volume, clinical and operations leaders will increase their collective focus on the Triple Aim, or care, health and cost.  Health systems will critically examine the clinical process, patient experience, outcomes and efficiency of care each with financial implications.  A myriad of reimbursement programs and contracts from payers will create new incentive and penalty structure for hospitals, physicians and post-acute providers.   From shared savings contracts, to bundled payments to direct to employer, each year additional measures and programs will be added.  Health systems need to improve their capabilities in business intelligence, real-time data access, and effective chronic care management

Key Take-Aways:  Have you transitioned from departmental or point enterprise performance improvement systems?  Do you have a plan for creating an analytics center of excellence?  What distinct business intelligence strategies are in place for enterprise performance improvement and population health management?

3 – Enable Health System Growth:  Consolidation, New Markets & Partnerships

Horizontal and vertical consolidation, new geographies, service lines and points along the continuum, and partnerships with other health systems, payers and new market entrants such as retail health are blurring the lines of what it means to be a health system.  Each market is different and each enterprise is different.  One size fits all strategies, or rip and replace with one core vendor are no longer viable strategies.  HFMA’s Value-Based Payment Readiness Survey ranks interoperability readiness as the weakest competency for most respondents.  Yet, it also indicates that 70 percent of financial executives anticipate their organizations will need to be extremely capable in data exchange to support value based reimbursement requirements and new market strategies in the next few years.

Key Take-Aways:  Have you developed an interoperability strategy based on the unique makeup of your enterprise, affiliates and partner readiness? Do you have a plan for identify management, access and referral management, and care coordination?  What is IT’s role in extending the enterprise and connecting the community?

4 – Drive Innovation & Transformation

Cloud computing, mHealth, patient activation and consumer engagement all come to mind when Digital Health Strategy is mentioned.  Billions of dollars have been invested in innovative start-ups and new transformative tools.  Yet, security risks are increasing daily.  Well beyond portals, initiatives such as virtual visits, home monitoring, self-service scheduling and bill payment, open notes, wearables, social health communities, and the list goes on.  A recent Surescripts Survey finds “patients prefer digitally savvy doctors and demand a connected healthcare experience.”

Key Take-Aways:  Have you developed an integrated patient and consumer engagement strategy?  Do you have a patient advisory council?  What are the unique characteristics of key patient populations that could drive innovation?

7 Factors to Consider Before Investing in an Analytics System

In the recent article, “7 Factors to Consider Before Investing in an Analytics System,” on Hospitals & Health Networks, Pam Arlotto advises hospital leaders on the issues they should consider before they begin to evaluate data analytics vendors.

Read the full article here.

Population Health Management and The Care Management Platform Briefing

In partnership with Kaufman Hall, Maestro Strategies presented an Issue Briefing and webinar, Technology for Population Health for the California Hospital Association. The Care Management Platform will power the future delivery and financing of care. Care management includes both the clinical components, such as care coordination and disease management and the business components such as network optimization and contracting arrangements. The Issue Brief begins with a discussion of HIT’s role in the healthcare industry’s transformation to a value based business model for PHM. It takes a close look at the three stages of readiness for future “connected health,” the progress made by hospitals and physician practices and the envisioned future for investments in HIT. The Care Management Platform includes five building blocks: Foundational Systems, Health Information Exchange, Knowledge Management & Analytics, Advanced Care Management, Consumer & Patient Engagement.

To download your copy of the white paper, click here Population Health Management and The Care Management Platform Briefing

From CMIO to CHIO: Information, Integration and Innovation


Presented by the Scottsdale Institute, Luke Webster, MD, Chief Medical Officer at Jvion, and Pam Arlotto, President and CEO, Maestro Strategies discussed the topic “From CMIO to CHIO: Information, Integration and Innovation.” This presentation explores the evolving role of the CMIO. Dr. Webster shared his personal story and role as a CMIO. Initially focused on meaningful use and EHR adoption, he described the pivot his team has made in the leadership of Health Informatics and Clinical Intelligence. And based on research conducted at over 60 progressive IDNs, Pam described new leadership structures and operating models for IT, Informatics, Analytics and Quality. The concept of the Chief Health Information Officer was discussed and the role defined.

Access the presentation here.

How to Surmount Health Care’s Interoperability Challenge

In the recent article, “How to Surmount Health Care’s Interoperability Challenge,” on Hospitals & Health Networks, Pam Arlotto was quoted on the challenges of interoperability and how health systems should move forward to provide clinical integration and care coordination.

Read the full article here.

Interoperability Is a C-suite Issue

Pam Arlotto was quoted in the recent article, “Interoperability is a C-suite Issue,” on Hospitals & Health Networks discussing how leaders need to steer the course.

Read the full article here.

Why The Lack of Interoperable Interfaces Costs Health Systems So Much

In the recent article, “Why the Lack of Interoperable Interfaces Costs Health Systems So Much” in Hospitals & Health Networks, Pam Arlotto shares her thoughts on the costs of dealing with interfaces.

Read the full article here.

Organizational Competencies in Informatics & Analytics for High Performing Health Systems

Maestro interviewed CEOs from UHC, the alliance of the nation’s leading not-for-profit academic medical centers, Quality Award winners regarding leadership structures, organization design and operating models for IT, Informatics, Analytics and Quality.  From these discussions with twelve leading UHC CEOs, five emerging themes were identified as health systems make the transformation from volume to value.  The executives agreed that there is much work to do to leverage investments in information and technology, by creating “smart” systems, hardwiring quality goals and using information to design new processes and care delivery models.  According to one leader leader, “In academic healthcare, we have historically focused research on esoteric innovation which is about 5% of the opportunity and we were ignoring the 80-90% of health services that would transform access, quality and cost but we kept doing them the same old way. Let’s reinvent that. We need a culture of yes – care, deliver, innovate and serve.”

To download your copy of the white paper, click here:  Organizational Competencies in Informatics Analytics for High Performing Health Systems

The Pivot: From Compliance to Strategy

HIMSS16 – billed as the largest and most important healthcare IT conference in the United States occurred last week in Las Vegas.  The message was loud and clear – something is different; the government mandate is over.  Strategy is the new, new.

For years the HIT world has encouraged alignment of enterprise strategy and the IT plan.  Alignment suggests two distinctly different things creating a linkage or connection.  Healthcare enterprise strategy decisions such as which markets do we enter, who do we acquire, which service lines do we emphasize, and what capital investments do we make are explored at executive and board levels.  Operations and financial decisions to support our hospitals and physician practices are made within organizational silos.  Sometimes IT is at the table, but more often than not information systems professionals are called in after the fact to “implement” selected systems and tools.  Sophisticated IT organizations have created IT Strategic Plans, IT Governance structures, IT Road Maps, and IT Champions/Customer Relationship Managers.  Our challenge – separate, sometimes aligned but rarely one.

Uncertainty is the new normal.  Strategies that take years to implement, vendor partners who are all vying for the same space and the challenges of mergers and acquisitions are driving us from 1.0 healthcare – where business as usual no longer is sustainable.  We are at a cross roads.  Those of us in transition must “pivot” our viewpoint from 1.0 volume based thinking to 2.0 and beyond.


We need fresh, new perspectives regarding the relationship between enterprise direction and the digital strategies required for the future.  New harmonized strategies will:

  • Vary by geographic market and depend on community progress toward clinical integration
  • Necessitate partnerships, alliances and consolidations – no one can fund the investment alone and no one vendor will have all the solutions
  • Require governance models that address horizontal, vertical and virtual decisions making and integrate change across multiple systems of care
  • Move from an applications focus which emphasizes feature, functionality to a platform focus, producing highly configurable systems which will drive standardization and enable business strategies simultaneously
  • Redesign our organization structures, leadership competencies and operating models in IT, Informatics, Analytics and Quality
  • Acknowledge our work to create systems of documentation was foundational but not the end goal; systems of insight and behavioral change are the next stages in the evolution
  • Result in convergence of people, process, information, change and technology to rationalize costs, manage risks, realize value and activate patients to become involved in their care


Next Generation Clinical Integration Networks: Lessons Learned

Rob York is a Senior Vice President of Kaufman, Hall & Associates, LLC, and leader of the Population Health Management division in the firm’s Strategy practice. He provides strategic services for a range of healthcare industry clients, including payers, physician organizations, academic health centers, large healthcare systems, public/safety-net providers, and community hospitals. 

Mature clinical integration networks (CINs) are moving beyond basic performance improvement activities to develop contracting strategies with multiple payers, achieve scale across larger populations and geographies, and assume greater financial risks for outcomes.  These advanced value networks or “Super-CINs” are also moving beyond many commonly held beliefs.  As more CINs come on board, lessons learned by startup and early stage CINs are propelling the conversation to focus on care delivery transformation.  Three of those lessons learned along the journey to population health follow.

Adopting a Successful Case Study Isn’t Enough:  What has succeeded in one market will not necessarily succeed in your market.  In some cases, the approach of pioneering CINs such as Advocate, along with FTC requirements, have been used as blueprints.  What we have learned, however, is that business and clinical readiness, state laws, payer role and agreements, partner responsibilities, information and technology capabilities and many other factors vary significantly by market and CIN.  Many of the “Super-CINs” are operating across a variety of regions and must develop unique approaches in each market.  Requirements for payer contracting strategies, care standardization and care management infrastructure will look very different depending on the progress of clinical integration and the specifics of the local market.

Pop Health GraphicNo One Can Do it Alone:  While there continue to be stand-alone hospitals and independent physician practices, most are creating partnerships at some level.  Historic views of the payer-provider relationship are changing on both sides.  There is more willingness to have an open conversation because payers and providers need each other to make population health management work.  The relationship varies by market – in some, payers are driving the design of the value network, and in others providers are taking the lead.  Rather than staying in their traditional siloed roles, both are coming to the table to design new approaches to care management.  Payers have tools and information sets, and providers need to enhance care management. In addition, nontraditional players are becoming part of the landscape, such as DaVita HealthCare Partners, which operates medical groups and specializes in care management, and which has sought to partner with payers for population health management.

This Is More than an Experiment; Success Means Making a Commitment to Go the Distance:  Many of the more advanced value networks are recognizing that upside, shared savings are short lived and that the real opportunity is associated with the assumption of risk.  Early on, some providers chose not to assume risk because of challenges such as capital requirements and the need for cultural change.  However, the urgency has been ramped up by external forces such as the intention of the Centers for Medicare & Medicaid Services (CMS) to move 50 percent of its payments into value-based arrangements by 2018.  CINs and accountable-care organizations entering the market today must realize that a commitment to go the distance is essential. For example, organizations need to develop a contracting strategy that encompasses a variety of commercial, CMS and direct-to-employer agreements; define a care management model; and invest in a care management platform with key partners.  Success will be driven by hyper focus based on your market characteristics and your organization’s capabilities, chosen role in population health management, and level of clinical integration.