Benjamin F. Miller, Psy.D., Chief Strategy Officer, Well Being Trust
Former Associate Professor, Department of Family Medicine, University of Colorado School of Medicine, Founding Director, Eugene S. Farley, Jr., Health Policy Center
The problems that exist in health care are so pervasive that new programmatic solutions are not going to solve them. Simply put, programs matter, but we need more thoughtful connection of these programs into a true system of care that can take into account the various pieces of health that health care has fragmented. Consider the problem our nation is facing with addiction – specifically, the opioid crisis. If all we did was to create a new program to decrease the amount of opioids on the street (supply side) we have done little to address the underlying issues driving our disease of despair, which are predominately social in nature (demand side). To this end, the last thing we need are more disconnected programs in this country without first creating a true system where people do not fall through the cracks.
This presentation will highlight some of the problems, elevate solutions, and most importantly help underscore the importance of making thoughtful systemic decisions for how we begin to address health. Using examples from business, health care, and on the ground experience, a framework will be proposed to help evaluate how we approach complex solutions to complex problems.
Attendees will be able to describe some of the problems around fragmentation in health care, specifically the impact this has on mortality;
Attendees will leave able to explain some of the solutions to addressing mental health and substance use in the larger context of health and community; and,
Attendees will be able to list the elements associated with a National Resilience Strategy and specific actions we could take together
WHEN: Wednesday, June 27th from 12 noon to 2 p.m.
WHERE: COPIC offices, 7351 Lowry Blvd., Denver, CO 80230
REGISTER: RSVP for this month’s event by clicking the appropriate button below.
Our Evening with Glenn Steele, MD, PhD Talking about Value-Based Healthcare: What It Looks Like, What it is, How to Achieve it.
Dr. Steele shared with the group how Geisinger developed its “Warranty” or “Money Back Guarantee”, and it’s effectiveness through Proven Care, systematic implementation of surgical procedures from one provider to another. He also spoke about xG Health Solutions that Geisinger developed to help other health systems develop more effective healthcare strategies.
With Dr. Steele’s role as Vice Chair of Health Transformation Alliance (HTA), Glenn talked about the efforts the 46 of the country’s largest employers working together to take population health management innovations out to markets where Geisinger has not expanded its provider component.
Sponsors, Key Bank (Melissa Whitmer) and Eide Bailly (Bruce Kirkpatrick) join Dr. and Mrs Steele (and Chris) for a photo of the speaker during the reception hour prior to the meeting.
We thank both Melissa and Bruce and their employers for their support of the Denver Medical Study Group this year. They are greatly appreciated!
Glenn and Chris listening intently to one of our attendees who is asking question about the HTA program and its similiarity to the recently publcised announcement of JP Morgan, Amazon and Berkshire Hathaway announcement of their intent to form their own health insurance plan for their employees.
Bobbie Kite and Dave Baker, DMSG Advisory Board members welcoming guests in the Children’s Hospital lobby.
Jennifer Brin and Dea Robinson, DMSG Advisory Board members, registering guests before they join the rest of our group in the reception lobby for hot appetizers and drinks.
Below: DMSG guests intently listening to Dr. Steele’s presentation about how HTA is going to expand its clinics in other parts of the country during 2018. They currently have clinics open in six different cities in the eastern part of the U.S. Their plan is to expand into six more cities in central and southwest U. S. in 2018.
Below: DMSG guests visiting about Dr. Steele’s presentation after the meeting. Dr. Marjie Harbrecht on the left is a long time supporter of the DMSG and has spoken to the group at previous meetings.
The meeting was a success and our guests left with a greater understanding of what can be done to provide effective value-based healthcare in Colorado.
The Bridge Across the healthcare delivery chasm, from where we are, to where we want to be
The Bridge Across the healthcare delivery chasm, from where we are, to where we want to be.
About The Authors
Denis A. Cortese, MD, joined Arizona State University (ASU) in 2010 as Foundation Professor, Director of ASU’s Healthcare Delivery and Policy Program, and President of the non-profit Healthcare Transformation Institute based in Phoenix, AZ. He is an Emeritus President and CEO of the Mayo Clinic, and former head of the Mayo Health Policy Center.
Professional activities as a staff member of Mayo Clinic were in the field of pulmonary medicine including interventional bronchoscopy, critical care, with special interests in early and advanced stage lung cancer, liver and lung transplantation. Activities in education included the medical school and director of the pulmonary-fellowship training program. Research was focused on NIH funded endoscopic laser photodynamic therapy for early stage lung cancer and on NdYAG-laser phototherapy of advanced stage airway obstructing cancer.
In addition to his current ASU academic position, Dr. Cortese currently serves on the board of trustees of Dartmouth-Hitchcock, and the boards of directors for Cerner Corporation, Essence Global Holding Corporation, and Pinnacle West.
Dr. Cortese is a member of the Institute of Medicine of the National Academy of Sciences, where he served as the original chair of the Roundtable on Value and Science-Driven Health Care; a National Associate of the National Research Council; an honorary member of the Royal College of Physicians (London) and the Academia Nacional de Medicina (Mexico).
He formerly served in the following positions: member of the health advisory board of RAND; member, and served as the chair of the board, of the Health Care Leadership Council in Washington, DC.; member of the Harvard/Kennedy Health Policy Group; member of the Division on Engineering and Physical Science (DEPS) of the National Academy of Engineering.
Dr. Cortese received his undergraduate degree from Franklin and Marshall, an MD from Temple University, and completed residency training in Internal Medicine and Pulmonary Diseases at the Mayo Clinic. He is a recipient of an Ellis Island Award (2007) and the National Healthcare Leadership Award (2009).
Robert K. Smoldt, MBA is Chief Administrative Officer Emeritus of the Mayo Clinic and currently serves as Associate Director of Arizona State University’s Healthcare Delivery and Policy Program. He served as a member of the Mayo Clinic Board of Trustees and Mayo Clinic Executive Committee from 1990 through 2007, and is presently pursuing U.S. health reform in close partnership with Dr. Denis A. Cortese. Mr Smoldt served two terms on the Board of Catholic Health Initiatives and continues as a member of its Finance Committee.
Mr. Smoldt earned a BS from Iowa State University and an MBA from the University of Southern California. He has given numerous presentations and is a recognized speaker on the healthcare environment. Mr. Smoldt has provided leadership at Mayo Clinic facilities in Rochester and Scottsdale. He has completed two terms as secretary of the Mayo Clinic Rochester Board of Governors and served on the Mayo Clinic Scottsdale Board of Governors as a senior advisor from 1998 to 2000.
He has been involved in healthcare administration for over 30 years — both with the U.S. Air Force and the Mayo Clinic. Mr. Smoldt joined Mayo in 1972, and he has worked in a variety of administrative positions in both medical and surgical departments. Prior to his CAO role, he served as chair of the Department of Planning and Public Affairs.
Mr. Smoldt has also been active in Medical Group Management Association, along with other members who manage and lead medical facilities across the nation — and work together to improve the knowledge, skills and the effectiveness of medical group practices. He has chaired the organization’s research and marketing committees and has acted as moderator of its international conference in London, UK. Most recently, he was a member of the Medical Group Management Association National Awards Committee, which honors those who make significant leadership contributions to healthcare administration, delivery or education in medical group practice and presents the following awards: Harry J. Harwick Award for Lifetime Achievement Award, Physician Executive Award, Fred Graham Award and Medical Practice Executive of the Year Award.
The views expressed on this website are our own and do not reflect the views of our current or former employers.
St. Luke’s Virtual Care Center Will Extend Reach, Expand Services
From left to right: Krista Stadler, senior director of telehealth services for St. Luke’s Health System, Lisa Knox, St. Luke’s project manager and Diane Wilson, St. Luke’s interior designer, on a recent tour of the 35,000 square foot virtual care center.
By Chereen Langrill, News and Community
April 3, 2018
St. Luke’s Virtual Care Center is one of the most exciting developments for patients served by St. Luke’s since I have been here. We have piloted components of the center including teleICU, remote patient monitoring, teleurology and telenephrology, but now the pieces are all coming together as a virtual hospital. This will translate into better outcomes at a lower total cost of care.
Here to tell you more about this exciting development is St. Luke’s Communications Coordinator Chereen Langrill.
– David C. Pate, M.D., J.D.
When St. Luke’s began offering telehealth services several years ago, the focus was an electronic intensive care unit that decreased the number of days people spent in the intensive care unit and improved overall patient outcomes. It was an important first step in a journey to improve patient care by harnessing technology, and that journey continues today.
St. Luke’s is now building a virtual care center that will serve as a hub for a suite of telehealth programs, consolidating the services in one building to allow the team to collaborate and coordinate care.
Construction on the 35,000-square-foot center began in January, and soon teams will begin training in the space. Expected to be complete this summer, the virtual care center represents St. Luke’s ongoing commitment to giving patients access to quality care without barriers.
Those barriers can be geographic when people living in rural areas have limited or no access to specialists. People with physical barriers can be too sick to travel to a provider visit. Other patients face barriers related to transportation because they can’t drive or don’t have access to transportation.
In addition to removing barriers, virtual care also helps St. Luke’s more effectively reach specific patient populations, such as people with chronic illnesses.
“Merging technology and care delivery is the way we have to operate in order to be successful in population health,” said Krista Stadler, senior director of telehealth services for St. Luke’s Health System. “Hiring an army of 20,000 people to deliver quality care services is not realistic.
“With the growing Idaho population and consumer demand for convenient care, we have to explore how we can use technology to achieve our goals and meet the needs of our patients.”
A high-tech hub in Boise will feature a centralized medical team that includes physicians, nurses, allied health professionals and IT professionals. When fully operational, 350 team members will work to ensure the center provides continuous care. This means services are available at night, on weekends and even holidays. Telehealth services are available for patients at clinics, hospitals and homes throughout Idaho and Eastern Oregon.
There will be more than 60 virtual care stations with the ability to operate continually using two-way audio and video. A generator and back-up power will support the virtual care center and a St. Luke’s Disaster Response Center.
“If you peel back the curtains of the virtual care center, it will look like a lot of desks and people, but it is much more than that because of the level of care and services we can provide and the number of patients we can serve,” Stadler said.
Among the services that will be supported:
Inpatient telehealth (intensive care unit and neurology)
Telehealth in the home (remote patient management)
Clinic telehealth consultation for services such as urology, nephrology, sleep medicine autism and pediatric surgery
Regardless of the care setting, telehealth is a way to enhance the service already given through patients’ primary physicians. Support offered through telehealth technology allows the provider to consult with a specialized team, extending the impact of evidence-based care.
“This space will allow us to grow our services and capacity throughout the organization to ensure patients have access to the right care at the right time, regardless of geographic location,” Stadler said. “We believe there is an opportunity to improve a patient’s access to care and ensure that care is patient-centered.
“The virtual care center will serve as the epicenter of discovery and innovation as we act on this belief.”
WARRANTIES, PROVEN CARE AND VALUE-BASED REIMBURSEMENT ALL IN ONE EVENING!
Glenn Steele, Jr., MD, PhD
On April 4th at Children’s Hospital Conference Center, we’re going to meet and hear from the physician who originated the “Warranty” concept in healthcare and took it to the “next level” as told in the article below from The New York Times on May 17, 2007. “The group, Geisinger Health System, had overhauled its approach to surgery. And taking a cue from the makers of television sets, washing machines and consumer products, Geisinger essentially guarantees its workmanship, charging a flat fee that includes 90 days of follow-up treatment.”
This is a “can’t miss” and “cutting edge” opportunity all in one to hear Glenn Steele, Jr., MD, PhD, Chairman, xG Health Solutions, Vice Chair, Health Transformation Alliance and Past President & CEO, Geisinger Health System, 2001-2015 to share with us what has happened since February 2006, when Geisinger began its experiment focusing on elective heart bypass surgery,
Register here for this educational and networking experience as it may be some time before a speaker of this national recognition visits Denver again:
“A Learning Forum for Leading-Edge Knowledge in Healthcare Innovation and Reform”
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Thinking Globally, Executing Locally: St. Luke’s Plans the Patient-Centered ‘Medical Neighborhood’
Thinking Globally, Executing Locally: St. Luke’s Plans the Patient-Centered ‘Medical Neighborhood’
Care coordination is a significant part of the team-based care approach at St. Luke’s Clinic – Payette Family Medicine and St. Luke’s Clinic – McCall Internal Medicine. Team huddles – like the one shown here – are often held to discuss patient care plans.
By Chereen Langrill, News and Community
March 6, 2018
Besides the malaligned incentives created by fee for service, one of the biggest downsides of that reimbursement methodology is that it produces fragmented care. With fee for service, providers are paid for defined visits, procedures or hospital stays but not work that might occur between visits. That is why, when I was in practice, I treated patients at appointments that were months apart, even though their disease or condition continued between visits.
The nature of fee for service also is that we typically only have time to address one problem at a time during a visit – again, an outcome of the incentives created under fee for service. Pay for value really changes the incentives and best promotes doing whatever it takes to improve outcomes and lower the total cost of care, including meeting patients’ health care needs in between visits to keep their diseases and conditions under control to avoid costly complications and avoidable emergency room visits. This has led to our patient-centered medical home model of care. Here with a report is St. Luke’s Communications Coordinator Chereen Langrill.
– David C. Pate, M.D., J.D.
A team-based care approach introduced in McCall and some other rural St. Luke’s locations is serving as a springboard to launch similar efforts at other St. Luke’s clinics.
Sometimes referred to as a patient-centered medical home, the approach emphasizes care customized for each patient. This comprehensive, coordinated care incorporates various providers based on patients’ needs, such as prevention, acute or chronic disease or behavioral health. A team of health professionals housed in one location can help patients avoid unnecessary emergency room visits and reduce the cost of their care.
Instead of a single-visit, single-provider approach, it is more of a big-picture focus. The team can triage, assess and help navigate for each patient’s best outcome.
“Team-based care is an important strategy as we shift from a volume-based model to one that is value-based,” said Lucy Dennis, vice president of operations for St. Luke’s physician services. “It improves patient outcomes and drives up patients’ perceptions of the value of their care. And it has the added benefit of supporting our physicians by preventing burnout and reducing stress.”
Team-based care makes sense for a community like McCall, where the population is approximately 3,000 and there are limited medical services available. In McCall, St. Luke’s has two clinics recognized as patient-centered medical homes. In 2014, practice manager Don McKenzie led the effort to adapt the patient-centered care model at St. Luke’s Clinic – Payette Lakes Family Medicine and St. Luke’s Clinic – Internal Medicine: McCall.
Before that shift, patients would sometimes visit the emergency department for treatment that could have been handled in a clinic setting because access was possible without a wait. The cost for an emergency department visit is significantly higher than a clinic visit, however, and doesn’t necessarily foster a long-term relationship between a physician and patient.
“A lot of our drivers were because we live in a rural community that doesn’t have all the services that are available in the Treasure Valley,” McKenzie said.
When people need care that isn’t available in McCall, it can become a roadblock. It can mean the delay of a critical diagnosis or lead to complications from a chronic illness.
“Some just say they won’t deal with it,” McKenzie said. “The saddest thing in this field is if you could have screened something early and stamped it out.”
McKenzie likes to call the clinics a medical neighborhood; a community rich with resources. Some of those resources include patient access navigators, early detection services, education that promotes healthy living, care coordination and behavioral health specialists.
These resources work together as a team when a patient needs multiple types of care. For example, a teen who comes to a clinic for a school sports physical may display signs of depression. He or she can be referred to a behavioral health specialist in that same location. Having multiple resources in one location makes it more likely a patient will receive additional care. When patients have to go elsewhere for care, they are less likely to follow through with a referral, especially when that care is far from home, according to McKenzie.
“There is so much work that occurs outside of the actual patient visit,” he said. “All these people with co-morbidities and chronic conditions, it takes a team to achieve success for that patient.”
Dennis is leading an effort to transform the care model at all St. Luke’s clinics and to adopt the type of team-based model that has been successful at clinics like those in McCall.
“We started with these patient-centered medical homes in these rural areas where, by default, it is the only place where patients could go,” Dennis said. “Our charge now is to take the very best and scale that throughout the system. To think globally but execute locally.”
To achieve that goal, the focus needs to shift from a physician-centric model to one that is patient-centered. Magic Valley is in the process of making that shift at two locations: St. Luke’s Clinic – Physician Center: Twin Falls, College Road, and St. Luke’s Clinic – Physician Center: Twin Falls, Pole Line Road. Dr. Bartholomew Ripepi helped launch a patient-centered medical home at the University of Pittsburgh and has provided support at the two St. Luke’s Magic Valley clinics as the project and physician lead.
“The patient-centered medical home model delivers a means of coordinating care and acting upon individual patient needs that may not otherwise be identified in a single patient visit to achieve high-quality, whole patient care,” Dr. Ripepi said.
Dennis said a team is looking at how to leverage the approach at highly diverse clinics.
“This is about working like a family would, with great communication, a strong culture and a team environment where everyone is focused on the patient and doing what’s right for that person,” Dennis said. “This is what we are trying to promote and deliver across the system.”
It’s shocking to hear about a medical clinic, hospital, or doctor’s office willing to give a money-back guarantee, but our understanding is that it is being done. In fact there is one healthcare organization that started doing this several years ago, Geisinger Health Systems in Danville, PA. Dr. Glenn Steele, CEO Emeritus, began the concept as a “waranty” to patients for specific surgical procedures.
Other health system leaders have said “Don’t do the warranty concept.” However, “Proven Care” has proven to be the beginning of Geisinger’s most radical innovation. Followed by Proven Experience where patients can use a smartphone app to tell Geisinger about their experience. They can request a refund if they are unhappy with the care they received.
A program offering refunds to patients with no questions asked seems ripe for abuse. But that is not the case. Patients don’t really want money back. They want the System to recognize they did something wrong and make it right, according to the current CEO, Dr. David Feinberg.
The Denver Medical Study Group has invited Dr. Steele to come here and talk to the group about this on April 4, 2018 (Warranties, Value Based Care and Health Transformation Alliance). You can register by clicking on the link below:
Adoption of fully electronic transactions varies significantly according to Key Bank’s white paper “From Crawl to Walk to Run”. From Streamlining business processes with new tools abounding, there are five questions CEOs should ask about their current payment management strategies. You can also educate the healthcare consumer with five strategies for improving patient relations in the front office.
Look for best practices for communicating with patients about prices, billing and payments. Ultimately, you will be able to lower the cost of staff time formerly devoted to largely fruitless pursuit of mostly small balance accounts after the procedure is completed.
Learn more about how to do this from Key Bank in the link below:
In preparation for our Feb. 21st DMSG meeting with our keynote speaker, Jonathan Edelheit, CEO and Co-Founder of the Medical Tourism Association, we are looking for a Colorado hospital or a large medical group that is involved with medical tourism. If you know of someone who is doing this either internationally or domestically or would like to, we’d like to know.
This will be helpful in understanding how medical tourism, especially domestically, would work here in Colorado as it is around the country. May be a new source of revenue for your institution or practice.
One question that has been asked already by one hospital executive is “how do you define Medical Tourism?” Here’s the definition Jonathan responded with:
“Medical Tourism can be defined as multiple things, 1) international patients traveling inbound into the US, 2) Domestic medical tourism (aka Direct Contracting/Bundled Payments, RBP, which is the big trend with all the national employers (Walmart, Jetblue, Boeing, etc) sending their employees to Cleveland clinic, Johns Hopkins, Mercy in Missouri etc. For some hospitals or large medical groups who aren’t familiar with it, I think they perceive it as something different than it is. I look forward to talking to you more about it.”
Thanks in advance for your comments or suggestions!
If you are interested in attending our meeting on Feb. 21st, you can register by clicking on the link below.
“Value-Based Healthcare: What it Looks Like, What it is, How to Achieve”
Glenn D. Steele Jr., MD, PhD; Chairman, xG Health Solutions; Vice-Chair, Health Transformation Alliance; Past President and CEO, Geisinger Health System
Dr. Steele will share how Geisinger, a vertically integrated healthcare organization serving a population of well over 3 million people in Pennsylvania, New Jersey, Maine, Delaware, and West Virginia, has developed and implemented value reengineering for populations of patients in both hospital and ambulatory care settings. The reengineering of care between community practice and hospital-based specialty and sub-specialty will be detailed as well as the inception of the “warranty” and how it has recently evolved. Dr. Steele will also share scaling and generalizing efforts through xG Health Solutions and the Health Transformation Alliance, taking the acute care and population health management innovations out to non-Geisinger, non-employed physicians and into markets where Geisinger has not expanded its provider component.
WHEN: Wednesday, April 4th at 5:30 p.m. Heavy Hors’d’oeuvres from 5:30-6:30, Meeting from 6:30-8:00 p.m.
WHERE: Children’s Hospital Conference Center, 13123 East 16th Avenue, Aurora, CO
REGISTER: The cost for this event is $50. RSVP for this month’s event below.
Refunds are available provided you cancel at least five days prior to the event.