Maestro Insights – Page 3 – Maestro Strategies

Beware Best Practices

Almost twenty years ago, in 1996 after publishing “America’s Health in Transition: Protecting and Improving Quality” the Institute of Medicine launched a long term, ongoing concerted effort on assessing and improving the quality of healthcare. “To Err is Human” further galvanized the national movement to improve the quality and safety of our healthcare practices by putting the spotlight on how tens of thousands of Americans die each year from medical errors. The “Quality Chasm” report underscored the importance of a dramatically improved information technology infrastructure to support a 21st century health system. Building blocks for such a system include an electronic health record system and national standards. Progress has been made, the federal government has paid out over 30 billion dollars in Meaningful Use incentives as of March 2015 and impressive examples of quality improvements are frequently quoted in the literature. Yet, most would agree that the results to-date have been underwhelming.

It is important to recognize that most implemented EHRs with a “check-the-box” mentality order to comply with Meaningful Use. When Meaningful Use was initially launched, our team suggested that we were “enabling the dinosaur”. And while not prehistoric, the design of today’s healthcare system does have ancient roots. The Romans constructed buildings called valetudinaria for the care of sick slaves, gladiators, and soldiers around 100 B.C. (Heinz E Müller-Dietz, Historia Hospitalium, 1975). In the U.S., the number of hospitals reached 4400 in 1910, when they provided 420,000 beds (U.S. Bureau of the Census, Historical Statistics of the United States 1976). So clinical information technology was about automating existing clinical processes in hospitals (Stead 2005) rather than transforming clinical decision-making and work processes across the care continuum” (Brown, Patrick, Pasupathy 2013).

Separately, quality and performance improvement departments focused on deploying best practice – a method or technique that has consistently shown results superior to those achieved with other means, and that is used as a benchmark. (Wikipedia). While best practices have their place, it is important to recognize the risks associated with emulating others when the practice depends on an antiquated business model such as hospital care.

As health systems transition from 1.0 – Bricks and Mortar Healthcare to 3.0 – Digital, Value Driven Connected Health and Healthcare, we encourage a focus on emerging practice. A concept born in “systems thinking”, emerging practice assumes:

We cannot copy other organizations, use it in our organization and expect it to work given the number of variables at play
Intentional design of care management and business models will result in disruption of today’s best practices
Collaboration and integration of clinical teams, business leaders, information technology experts and data analyst will create new value
Big bang, long term projects are giving way to agile, experimentation where we learn to work in new and different ways
Rather than using our intuition or past experience to drive improvement, data driven innovation can often have more remarkable results and new practice will emerge

So, the next time someone mentions “best practice” challenge their thinking.

Business Plans for Affiliated Provider Solutions & Services

Despite the healthcare consolidation trend and the health system strategy to build a “System of Care” across the healthcare continuum, affiliated providers continue to be an essential element of the care delivery process in most communities. Even with strong referral management processes and systems, physicians will still refer patients to providers outside the “owned assets” of the IDN, patients will self-refer and primary care providers and specialists will create orders to be delivered outside the integrated delivery network. While most health systems are developing strategies to actively manage referral practices, even the most horizontally integrated health systems will be on a constant search for high-quality and low-cost affiliated providers to compete effectively in a value-based environment.

Affiliated provider programs at many health systems have struggled, even with the relaxation of the Stark Laws through the Safe Harbor provisions. Simply offering a donated EHR often fails to address the expanding scope of provider organizations (e.g., practices, skill nursing facilities, home health agencies, etc.) and often ignores the evolving demands of clinical integration and accountable care models which place greater emphasis on services and technologies that complement the EHR. Providers need effective application support services, enabling technologies such as telehealth, and a health system who is continually evaluating new innovations such as wearable technologies, mHealth, analytics, etc. that work with a myriad of EHR environments including donated EHR, web/portal/HIE, call centers, cloud based scheduling, fax and direct.

Developing a Business Plan that includes services and solutions for your affiliated providers doesn’t need to be overwhelming.

Suggested steps include:

Step 1 – Recognize that your provider solution and service offering may start with physician practices, but will grow to include other provider settings. This may take time. While most markets share several similarities, there are unique factors that will determine when the business conditions of your market will support expanding the business plan and associated strategies to include additional care settings
Step 2 – Develop a standardized services and solutions catalog that your customers need, is easily understood and can be delivered with a high degree of reliability. The services and solutions may be tiered or packaged to appeal to specific groups and level of integration, and specific variations may be designed-in to allow “localization” of based on unique requirements of specific entities, markets and specialties. Yet, the important point is that it is standardized, which by definition will produce a modest set of services and solutions. When a health system allows customizations, the services and solutions catalog expands and operating costs soar
Step 3 – Resign yourself to the fact that your organization can’t do it all. Sourcing selected services and solutions from the catalog to value added resellers, Internet Service Providers, hardware providers, etc. will be important. The goal is to create a variable model that reduces risk, creates economies, and ultimately provides exceptional service
Step 4 – Determine the business (i.e., operational, organizational, & financial) model that is right for your organization. There are a number of different models that can be used. What is right for your organization will depend on its operating strategy. Key questions include:
o Do you provide services through existing IT departments or management services organizations?
o How are the services provided to employed providers and owned entities?
o Is a separate services organization necessary to provide the services? Do you run the business as a profit center or cost center?
o Are multiple entities using the services and how do you share oversight and management?
Step 5 – Create the go-to-market plan. Communicating the value proposition and earning the trust of customers can be the most challenging component of any business plan. This is particularly true if previous attempt to align with affiliated providers have not been successful at your organization or neighboring health systems. Pre-emptively addressing concerns, demonstrating how services have been tailored to better meet needs, illustrating the executive support, and painting a long-term vision are all required for the program to thrive.

Maestro Strategies uses our collective experience gained assisting health systems with their provider programs as well as our work launching new companies, affiliations and agencies to help explore key strategies and associated operating implications to create a vision, build a business plan and design a road map for affiliated provider services and solutions. Please contact us a [email protected] to discuss the unique needs of your provider community and how the steps above could be tailored to create a Business Plan for Affiliated Provider Services and Solutions to benefit your health system.

Organization Design – Emerging Models for IT, Informatics, Analytics & Quality

“IT in healthcare is no longer a hero’s game” indicates one executive. CIO in healthcare stands for “Chief Infrastructure Officer” and in the future it must stand for “Information, Integration and Innovation” says a CIO who comes from outside the healthcare industry. Our “clinical informatics leaders must think more strategically” indicates a CEO. All quotes from recent interviews of executives from 60 leading health systems conducted by Maestro Strategies CEO Pam Arlotto. CEOs, CMOs, CIOs and CMIOs all indicate new leadership and organizational models are needed as the industry transitions from volume to value. As senior leadership teams tackle consolidation, clinical integration, population health management and a variety of new strategies. Traditional silo based organization structures will not drive value in tomorrow’s health and healthcare enterprise. Emerging themes include:

The ability to work across entities, geographies, points in the continuum, service lines, etc
Clinical integration is driving new organizations structures and operating models
Informatics is being formalized and is pivoting from a focus on technology adoption to information, people, process and change
Analytics skills and competencies while not new to healthcare, must evolve to meet the demands of today’s enterprise
Convergence of informatics, analytics and quality is needed to manage the health of populations

See a short video (~15 minute) Research Summary of the emerging organization design trends for IT, Informatics, Analytics and Quality. A more in-depth virtual or in person briefing is available for leadership teams.

ROI and Vendor Sales Strategies

Maestro Strategies has worked with numerous vendors over the years to measure and document return on investment (ROI) to support vendor and service company sales efforts. Our approach has focused on providing an objective, independent and analytical perspective on the value of the solution from the view of the healthcare customer – health system, clinician, financial executive, etc. Typically, we validate hypotheses developed in conjunction with the company, in a number of real-world customer settings and create a model that can be used to project quantitative and qualitative benefits for prospective customers. Much of our work has been focused on expanding the conversation to examine both financial return on investment as well as strategic and process value – tangible and intangible. As one would imagine, over the years we have seen products implemented that were not used by their customers, solutions implemented on top of broken processes, systems whose users resisted mandated components of the applications, and complex modules whose capabilities were only partially configured and deployed – along with products and services that drove significant value for their customers. However, in all cases, potential benefits of the solutions and ROI were not fully realized. The reasons were many – health systems implemented without redesigning processes, executive sponsors didn’t remove barriers, projects weren’t managed well, and oh yes, sometimes the products didn’t deliver promised results.

The transition from volume to value by the healthcare industry will change the rules for both solution companies and their customers. Features, functionality and demonstrations will no longer be enough to drive sales, industry consolidation will reduce the number of customers, and ultimately solutions companies that don’t produce value over the entire life cycle of their product or service (e.g. beyond sales to include implementation and support) will be replaced by those who drive value creation, realization and results. Many solutions companies are developing ROI and value realization measurement tools and methodologies. Maestro’s experience in working tells us that often solution companies and their healthcare provider clients have different goals for the relationship, different perspectives on the value question and different language in explaining benefits.

Different Definitions of Value

A Joint Value Management Plan that maps out agreed upon initiatives, value targets, milestones and accountabilities is essential to drive successful adoption, use and value creation/realization. Sometimes separate initiatives are occurring in parallel with the implementation and attribution becomes challenging. Maestro works with both the solutions provider and their client to define common definitions of value and ROI, validate actual realization, understand key levers and accountabilities that will ensure ongoing value.

White Paper — From the Playing Field to the Pressbox: The Strategic Role of the Chief Health Information Officer (CHIO)

Based on dozens of interviews with health systems across the US and additional research, this report looks at where CHIOs and their teams are headed amid tumultuous change in healthcare. Originally seen as the stewards of CPOE and Meaningful Use — and known as the Chief Medical Informatics Officer — the Chief Health Information Officer is now tasked with ambitious information technology initiatives spanning the health continuum, retail health and consumer engagement, and population health management. Historically, limited in its authority and with few resources for support, this emerging role is a key player who must collaborate with Chief Innovation Officers, Chief Transformation Officers, and CIOs to drive clinical integration, care coordination and value realization.

To download your copy of the white paper, click here: From the Playing Field to the Press Box.

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