MedAxiom conducted a symposium June 18-20 in Beaver Creek, Colo., that offered pointers to directors, physicians and other professionals for improving the quality and efficiency of their cardiovascular service lines. Here are some of the lessons shared.
Top factors for top performers
No one service line incorporates all the characteristics of what Suzette Jaskie, president and CEO of MedAxiom, identifies as key to running a successful program. But they can strive to do so.
She offered her top 12 in this order: A shared vision; leadership; a healthy culture; a one-care delivery standard; planning and executing across the continuum of care; data quality, transparency and analytic capability; a dyad leadership model with a physician leader and administrator; care team utilization and talent management; operations efficiency mastery and resources availability; alignment of strategy and compensation; the ability to manage costs and experiment with new payment models; and the patient experience as a strategic operations priority.
Be prepared for tumultuous times. “Service lines are organizationally disruptive,” she said. “The service line challenges every way that we work and are organized.”
Assess the healthcare market, don’t be rash
Today’s healthcare system is fragmented and full of misaligned incentives, but it can be transformed with discipline, patience and adherence to evidence-based medicine, said Chris Lloyd, CEO of the Memorial Hermann Physician Network (MHMD) in Houston. “You have to go slow to go fast,” he advised.
Lloyd discussed strategies used to integrate MHMD, a network of nearly 5,000 physicians, with the goals of the Memorial Hermann Health System. Decision making should be deliberate and informed by evidence, he said. The network collaborated with payers, for instance, to obtain data to assess costs and outcomes. That helped them identify shared cost savings that funded up to $16 million in incentive payments for physicians and hospitals.
By studying organizational dynamics, a network can identify what best complements its culture, provides a good fit, ensures quality outcomes and is financially beneficial. The process requires a broad, strategic plan that clarifies priorities, processes and expectations.
They devoted a year on analyses before initiating a patient-centered medical home. Based on their preparation, they found opportunities to perform data mining, which allowed them to evaluate claims data faster. “We got very quickly to transparent use of data,” he said. “What does that drive? Outcomes that allow us to go to market. We could have gone faster and missed the mark.”
CXO: The new kid on the block
Does your hospital have a chief experience officer? The growing emphasis on patient-centered care may make this position increasingly valuable in a hospital system.
The chief experience officer—or CXO—helps make patients partners with their physicians and hospitals in their healthcare journey, explained Kristine K. S. White, RN, MBA, co-founder of Aefina Partners and former system vice president of patient affairs at Spectrum Health in Grand Rapids, Mich. “This is not seen as fluff in warm and fuzzy times,” she said. “It is a strategic imperative.”
Physicians, hospitals and their systems should focus on what is important to the patient, she said. She stressed the need for reliable data, including survey data of patients and their families, and the use of benchmarks.
The chief experience officer role may not be practical for all organizations, she added, but “you have to have the function of the chief experience officer somewhere in your executive team.”
Telehealth and cardiology: A growth opportunity
Telehealth offers an affordable way to expand outreach and improve population health, according to cardiologist Marc Newell, MD, director of a 41-site telehealth program at the Minneapolis Heart Institute.
Telehealth creates a positive experience for patients, reduces costs and eases the burden of long commutes for doctors to satellite sites and for patients to the hospital. It also builds relationships with partners who can provide referrals. “It is a way to supplement and enhance your outreach services,” Newell said.
The telehealth program hinges on key technologies, particularly the use of EMRs to facilitate communication between healthcare sites and a portable cart and ultrasound device that costs $10,000 and $15,000.
Chris Bent, senior vice president of the clinical services lines at Allina Health, added that telehealth allows the healthcare system to expand its brand and market share. The program is designed to stretch beyond cardiology to other services as well. “We hope it is a one-stop shop,” she said. “We have the capacity. It is an opportunity from a growth perspective to serve underserved areas.”
How the best do better
Only 1.2 percent of cardiovascular surgery programs earned three stars in Consumer Reports and the Heart Hospital Baylor Plano and Baylor University Medical Center both made the three-star grade. But as Michael Mack, MD, medical director of cardiovascular surgery at Baylor Scott & White Health in Dallas and chairman of the research center, will tell you, the centers are not resting on their laurels.
“You have to have good surgeons and you have to have good infrastructure,” he said. “By the time you get to a certain level, you have to get very much down in the weeds to move the needle further.”
Leaders initiated a number of strategies that focused on the heart center but are being expanded to other to parts of the cardiovascular service line, which is a $1 billion business, according to Mack. They include:
Public reporting;
Semi-annual best care meetings that provide unblinded peer-review reporting;
Mandating a second opinion for patients who have a predicted risk of surgical mortality of greater than 5 percent;
Conducting a root-cause analysis for every cardiac death;
Using a baseball card concept for the heart center and individual surgeons with risk-adjusted scores and benchmarks for surgeries and more complex procedures.