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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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Embracing Holistic Management - Systems Are Too Complicated to Envision Piecemeal

Source: Payers & Providers – November 17, 2011
By: Ron Wince, President and CEO

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Perhaps no state in the country has done as much for holistic medicine as California. But it’s time to apply the concept of holistic—dealing with entire systems as a whole, not individual parts—to healthcare management as well as medicine.

California’s healthcare systems are facing the same tidal wave of pressures found in other states - a confluence of new regulations, oversight, cost and quality requirements—that is 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.

Healthcare systems are increasingly coping with continually soaring costs (which have led to staff layoffs when hospitals and no other way to meet budgets), shortages of personnel and supplies, increased waiting time and changing relationships between providers and payers. Given that California’s inpatient hospital costs are already among the highest in the nation, it’s clear that the pressures to control costs, manage effectively, and improve patient outcomes are only going to get more prevalent.

Talk to the CEO of any hospital system and odds are that he or she will be able to cite pockets of success in their organization. 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 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.

Department heads innately focus on ensuring that their people are working most effectively and efficiently… often at the expense of other treatment units. A radiology institute’s streamlined procedures may throw a monkey wrench into cardiology’s processing records and patients. No wonder there is often negative synergy created, where improvements in one area cause worse performance in another.

To navigate through the increasing complex landscape of healthcare, organizations need to start looking at themselves more holistically, so that improvements can be synchronized horizontally—not just vertically.

In some ways, this is similar to the trend towards patient-centered care, where practitioners work more closely 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 here as well. The one thing that can align all the components of a healthcare system is making sure that everyone is looking at the system from the patient’s perspective. Getting “macro” around how you give care to a patient and how the patient receives that care is not easy, but developing that perspective in 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, is the first component of developing a high-performance health care culture that can address the myriad of challenges ahead.

Leadership at all levels must think and act more holistically as well as ecumenically to synchronize performance improvement in order to make change effective and see a tangible difference in patient and institutional success.

All contents © 2012 Payers & Providers. All Rights Reserved.

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