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Remembering Mike

December 21, 1954-
August 9, 2012

 

New Blog Post

Four Themes to Successfully Navigating the Supreme Court Decision

The decision by the U.S. Supreme Court to uphold the controversial Patient Protection and Affordable Care Act confirms the direction of healthcare reform that had already begun a few years ago.  Many payers and providers, responding to the slowly emerging regulatory architecture of the law, have embarked on large scale transformational initiatives which will fundamentally change their business models forever.

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New Article

Payers and Providers: The Pressure On Payers Is Relentless

No matter the outcome of the Affordable Care Act, the long-term picture for payers remains uncertain. Even if all the ACA provisions are enforced by the Supreme Court, there are still many issues to sort out. If some of the provisions are struck down, then other issues will be encountered. In an unpredictable business environment, Blue Cross Blue Shield Montana decided to give itself a physical and make process improvements to control what we could control.

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Control Costs, Improve Care with Holistic Healthcare Management

Source: Fierce HealthFinance  – November 22, 2011
Guest Post By: Ron Wince, President and CEO

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Large and small healthcare systems across the country are facing a tidal wave of management and cost pressures–a confluence of new regulations, oversight, quality requirements–that are about to get even more complex. The impending changes in reimbursement, regulations, and closer scrutiny of patient outcomes are just the tip of the iceberg.

CFOs, CEOs, and their entire leadership teams are increasingly coping with continually soaring costs (which have led to staff layoffs when hospitals find no other way to meet budgets), shortages of personnel and supplies, increased waiting time, and changing relationships between providers and payers. Given that hospital costs are already among the highest in the nation, it’s clear that the pressures to find ways to effectively manage and improve patient outcomes are only going to get worse.

Talk to the CEO/CFO of any hospital system and odds are he or she will be able to cite pockets of success. But ask about the overall impact on the patients and the bottom line, and most would admit falling short.

And that is the problem in a nutshell: Healthcare system improvement is being attacked in “the C-suite” in isolated pockets instead of looking at the whole. The CFO focuses on cost. The CMO looks at quality of care. The CIO is sure that IT will be the solution to most of the problems. The CEO is thinking about whether to join a new provider network or negotiate partnerships with other providers or payers. And radiology institutes streamlining that may throw a monkey wrench into cardiology’s processing patients. Department heads innately focus on ensuring that their people are working most effectively and efficiently – often at the expense of other treatment units. No wonder there is negative synergy created, when improvements in one area cause worse performance in another.

To navigate through the increasingly complex landscape of healthcare, healthcare managers, particularly those charged with watching the bottom line, need to start looking at things more holistically, so that improvements that impact cost and service can be synchronized horizontally–not just vertically.

Actually, the model for success may lie in the movement towards patient-centered care, where practitioners work together to coordinate all the treatment a patient receives–and to make sure that all the components are working together and not in conflict with each other. If you think of the “patient” as the healthcare system, the metaphor is a perfect fit.

Holistic patient-centered care applies in another way. The one thing that can align all the components of a healthcare system is making sure everyone is looking at the system from the patient’s perspective. Getting “macro” around how you deliver care to a patient and how the patient receives that care is not easy, but developing that perspective throughout your organization can help you decide where and how to deploy unified and coordinated improvement efforts.

Taking this holistic view of your organization, shaped by the patient’s perspective, today is an urgent component in developing a high-performance healthcare culture that can address the myriad of challenges ahead and significantly affect the successful management of costs.

The C-suite, as well as leadership at all levels, must think and act more holistically to synchronize performance improvement to achieve a tangible difference in patient and institutional success.

All contents © 2012 Fierce HealthFinance. All Rights Reserved.

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