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Real Issues : Real Solutions

JAN/FEB 2015

Covenant Health System Covenant Health Transforms Care Delivery with Daily Safety Ops Briefings

Dr. Craig Rhyne, Chief Medical Officer

HEALTHCARE EXECUTIVE EXCHANGE MAGAZINE | www.healthcareix.com

Real Issues : Real Solutions

CONTENTS

06 Covenant Health System

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IN-FOCUS STORIES 08 Center for Health Care Services 12 InteliChart 14 Yale New Haven Health System 17 Gates Vascular Institute 20 Jersey Community Hospital 23 John Randolph Medical Center 26 Virginia Garcia Memorial Health Center 30 Palm Beach Orthopaedic Institute 34 Legacy Pharmaceutical Packaging 36 Larksfield Place 38 Virginia Urology 40 West Park Hospital District 42 Alivio Medical Center 44 Jefferson Community Health Care Centers

JAN/FEB

2015

COVENANT HEALTH

Transforms Care Delivery with Daily Safety Ops Briefings Many white papers have been written on the subject of care delivery and reinventing it for an Affordable Care future. But it wasn’t a white paper that transformed Lubbock, Texas-based Covenant Health System’s care delivery. It was a white board and 30 minutes every day. These tools were the game-changers for the system, Dr. Craig Rhyne, chief medical officer, said. Time, a marker, an eraser, and a room were all that was needed to conduct a Daily Safety Operations Briefing with Covenant Health’s leadership and medical team, and in so doing, communication throughout the system became less siloed and deskbound and more collaborative and interactive.

HOW TO HOST A DAILY, NO-NONSENSE BRIEFING The first thing a Daily Safety Operations Briefing is not like, Rhyne said, is an executive management team briefing, nor is it a two-hour leadership conference. Rather, department heads, physicians, and medical staff simply walk into an empty room. There are no chairs. No one sits down. Everyone stands. As Rhyne explained, this is purposeful. The Daily Safety Operations Briefing isn’t meant to be comfortable. It’s urgent. Things have happened in the last 24 hours that need to be addressed. Immediately. There’s no time to sit down. There’s not even time to chat. “It’s kind of an interesting concept, but the standing conveys the urgency and the rapid-fire nature of the event,” Rhyne said. In fact, all conversation dies to a barely audible

family member who had brought a Taser into the building. This led to a fairly robust discussion, he recounted, about screening and responsiveness and the importance of keeping contraband off the campus. Third, concerns and complaints from the team are heard. Are there any conflicts that need to be mediated? Are there staff members who aren’t getting along? Was a physician rude to a nurse or vice versa? “That to me is one of the biggest benefits of these briefings from a medical staff leadership standpoint,” Rhyne said. “They’ve changed my ability to address issues. It gives me a chance to respond while the issue is still fresh in everybody’s mind.” In fact, speed is perhaps the greatest benefit of these briefings, he said. “It has been fairly dramatic in terms of our ability to identify the problems that are occurring in the institution and getting them resolved much

whisper once the lights flicker and the 30-minute

faster than they ever used to.”

countdowns begins, and during those 30 minutes,

USING THE BRIEFINGS TO PREPARE AND INFORM

Rhyne and his fellow leaders expect a collaborative brainstorm to ensue. At the center of the room is the whiteboard. The whiteboard is there to keep the briefing on-track and on-task. It’s also there as a reminder. Nothing is erased from that board until it is tackled and resolved. Three major buckets, as Rhyne calls them, are discussed at each meeting. First, there’s the patient experience. Are there any issues or complaints from the previous 24 hours that need to be explored? Is there any service recovery that needs to take place? Second, there are the safety concerns. Has a patient-safety issue been identified that needs to be resolved? Do any of the patients need different IV pumps or different safety needles? The morning of our conversation, Dr. Rhyne said the safety concern was centered on a patient’s

After the three buckets are addressed, a report is given on the census and what the expectations for the day are, especially with regards to post-op bed needs and discharges before 3 p.m. “We do a two-minute report-out on the census,” Rhyne said. “It’s our state of the union in terms of bed and bed management and that gets everybody on the same page so we know what our challenges for the day are.” “The daily census used to come in an email that nobody ever opened and read,” he added. Toward the end of every briefing, a five-minute report is given on a different topic each day in which one member of the group outlines the system’s initiatives within that topic. Rhyne said they’ll also take time to report out any major decisions from the Physician Quality Review Committee or the Medical Executive Committee.

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“If any of those decisions that got made in those two medical staff venues need to be transferred to all of the managing department heads, that gives me an opportunity to let them know about it hot off the press.”

CHANGING THE WAY COMMUNICATION USED TO BE HANDLED The idea for the daily briefings came from Covenant’s sister organization, St. Joseph Hospital of Orange (SJO) in Orange County, Calif. Both Covenant and SJO are part of St. Joseph Health. Rhyne said he and a team from Covenant had journeyed to SJO to observe and share best practices with its clinicians and staff. While there, the Covenant team witnessed a similar daily briefing in

Under the previous system, institutional memory

which five to seven members of the SJO staff met in

could be poor and accountability was neglected, he

a copier room off the administrative suite.

said.

“We thought it was such a unique concept that

Since problems are now being documented in

we would bring it home,” Rhyne said. “And when we

real time, the daily briefings demand that issues be

brought it home, we decided that by picking a larger

addressed immediately, usually within a 24-hour

venue, copying the standing-only concept, and get-

timeframe. For a patient or patient-family com-

ting all of the appropriate department heads in the

plaint about services or responsiveness, a member

same room every day just for 30 minutes, we could

of the team is tagged with the responsibility of

really make an impact.”

addressing it. This person knows they’ll be asked to

Before the daily briefings were implemented, Rhyne said Covenant did what practically every other healthcare system in the United States does. “If a problem bubbled up to the CNO or the

report back the next day. “We’re doing very quick service recovery based on this,” Rhyne said. “Everybody knows that if they got tasked with a service recovery item, they’re

CMO, then it would start a string of either phone

going to have to report that out the next day. It has

calls or emails. You would call or email somebody

changed our accountability tremendously.”

in the affected department for information, then

If an issue will take more than 24 to 48 hours

information would be gathered and sent back by

to address—such as an EMR issue that requires a

email.

software change of six months or more--it goes to

“There would be basically a one- to two-week

a write-on strip that is then entered into a longer-

Ping-Pong match of information exchanged, going

term resolution file.

back and forth on emails. The other thing we found

However, the matter is not removed from the

was, it was really easy to have what felt like a situ-

whiteboard until it is resolved, no matter how long

ation, not necessarily a crisis, but a situation that

it takes.

needed to be addressed, and it would sometimes

“This holds the entire leadership team accountable

get lost in the next situation that needed to be ad-

to making sure that we’re not missing things, that

dressed.”

Real Issues : Real Solutions

we’re not forgetting things,” Rhyne said. “We’re not

The increased frequency of these meetings enables

dropping issues just because they’re remote in our

each director to advise the leadership, both in per-

memory.”

son and through a written report, of what they’re

A SIMPLE CONCEPT WITH FAR-REACHING RESULTS The beauty of these briefings is in the simplicity of

doing. They are required to present a set of nonnegotiable goals, as well as a set of negotiable goals, for every quarter. “I’m actually starting to treat my medical direc-

the concept, Rhyne said. Little time has been spent

tors more like physician executives,” Rhyne said.

modifying them.

“I’m asking them to give me their goals for their

Thus, the outcomes have been incredible. Each

department and what they want to accomplish

department is required to give a quarterly report on

as a medical director. And I think the message

its metrics, how many units were saved, how many

is very clear that I want them to be responsible.

complications were avoided, and the expense that

We shouldn’t be paying medical directors just to

was saved as a result.

breathe, but to actually produce results and im-

Initiatives such as the blood conservation program, which was designed to more appropriately

provements in their area.” Although it is not possible to accomplish every

utilize blood and blood products, have been imple-

day, several of the medical directors have been

mented with greater speed and efficiency.

invited to attend the Daily Safety Operations Brief-

The briefings, Rhyne said, also help to keep everyone on track with budget initiatives. He highly recommends that each organization

ing to witness the administrative mechanics behind event resolution. Utilized in this manner, it is easy to see how the

consider some form of the Daily Safety Operations

Daily Safety Operations Briefing is simultaneously

Briefing.

solving problems and fostering better relations with

Begin by identifying your buckets, Rhyne advised, then determine what the most press-

the medical staff, Rhyne said. “It has been eye-opening for many of our physi-

ing priority for your institution is. At each briefing,

cians to see how many issues are on the table at

address them in order of importance and keep an

any one time and to understand how the adminis-

ongoing record of the issues that arise, preferably

trative staff is working diligently to resolve issues in

on something as visual as a whiteboard.

real time.”

And, he stated adamantly, don’t let anybody take any item off the board until it is resolved.

BY PETE FERNBAUGH

TREATING MEDICAL DIRECTORS AS PHYSICIAN LEADERS The daily briefings have led to other initiatives being implemented throughout the system that are designed to improve communication and raise accountability, Rhyne said. For example, Covenant used to meet with each of its medical directors annually to review their contracts. Now, Rhyne and his administrative team meet with them quarterly.

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CENTER FOR HEALTH CARE SERVICES

Center Unites Community and Providers for Innovative Mental Health Program Mental and behavioral health services have often been overlooked or disjointed within the countryâ&#x20AC;&#x2122;s healthcare system. Mental health touches almost every aspect of a personâ&#x20AC;&#x2122;s life, making collaboration among medical service providers and community resources essential to properly caring for these individuals.

Nelson L. Hopkins III, MD, President,

Real Issues : Real Solutions

02 | CENTER FOR HEALTHCARE SERVICES

TREATING THE NEEDIEST WITH COMPASSION AND DIGNITY Most chronically homeless people suffer from severe mental health issues, making it difficult for them to break out of the cycle of homelessness, and many self-medicate with alcohol or drugs. One center in Texas has made huge strides in caring for some of the most challenging cases through empathetic care and community partnerships. The Center for Health Care Services in San Antonio, Texas, has instituted a number of programs from police crisis intervention training to a physician roundtable to provide holistic care for individuals with mental health and substance abuse problems. The center’s innovative program began

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in 2002 and operates under the leadership of Leon Evans, CEO, who has nearly 40 years of experience in mental health. “There are various degrees of mental illness,

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but the very ill tend to have multiple problems and often end up resistant to treatment and uninsured,” Evans said. “They have destroyed relationships with family and friends, so there’s no one to remind them to take medications or help them get treatment. We want to help those people.” Evans leads the center’s programs with the patients in mind, treating even the most desperate cases with respect and dignity. The compassion and empathy he shows serves as the inspiration for the hugely successful programs the center employs, including the 24/7 Crisis Care Center, Crisis Intervention Training, The Restoration Center and the Bexar County Jail Diversion Program. Evans’ passion for people originated early in life when his father suffered mentally, emotionally and physically after serving in World War II. He experi-

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ment. His passion was further cemented during a

to see the value of the training, and the county

volunteer child psychiatry program he participated

police chief and sheriff have mandated the train-

in during college.

ing. As a complement to the training, the Center

PROVIDING OPTIONS TO OFFICERS AND THE PRISON SYSTEM

instituted a diversion program to provide officers a place besides jail or the emergency room to take someone having a behavioral health problem. The center created space near an urgent care center

In 2002, the Center began providing Crisis Interven-

and found the funding to keep the center open 24/7

tion Training for police officers to help them de-

so that officers could obtain medical clearance and

escalate situations involving persons undergoing a

psychiatric evaluations for individuals picked up on

mental health crisis. The traditional police training

the street.

of “command presence” and “command voice”

Evans estimates about 25,000 people are di-

tends to further agitate individuals in this state and

verted away from the county jail and the emergency

can lead to the person or the officer being harmed.

rooms, which also saves taxpayers money by reduc-

At first, the training wasn’t met with enthusiasm from officers. “People in mental health and law enforcement

ing magistrate costs. The Center also took on helping nonviolent offenders in the overcrowded Texas prison sys-

are overworked and underfunded,” Evans said.

tem, many who have severe mental illness. Evans

“We don’t have the same goals or speak the same

said the prison system developed a new division

language, but we needed to come together.”

for inmates with mental illness, who were put on

After the first day, however, the officers came

parole under the condition they see a psychiatrist,

Real Issues : Real Solutions

“WE ALL HAVE DIFFERENT RESOURCES. WHAT’S MADE OUR MODEL WORK IS THAT ALL PARTIES HAVE BEEN INVOLVED IN DEVELOPING SOLUTIONS AND TAKE PRIDE IN THE OUTCOMES.” take medication and clear regular alcohol and drug screenings. He estimates that when these people receive treatment 6% or less commit a felony within their parole period, significantly fewer than the general population which ranges between 40 and 60% statewide.

OFFERING TREATMENT TO THOSE DIVERTED FROM JAIL When an officer diverts an individual from jail or the emergency room, the person starts in the observation unit or detox/sobering unit. Once sober, they are given the opportunity to receive treatment. “We give them showers, feed them, and treating them with dignity and respect,” Evans said. “Individuals are then able to enter The Restoration Center.” The Restoration Center is an integrated clinic where people can receive psychiatric care, substance abuse services, general healthcare services and transitional housing. It is run by people in recovery so those who choose to enter can see what’s on the other side. Of people brought in by police, Evans estimates that about 20% choose to go through detox, an impressive percentage, considering most of these

PARTNERSHIPS AND COMMUNITY CONNECTION KEY TO SUCCESS Evans said working closely with law enforcement, hospitals, physicians and others in the community has been key to keeping the program successful. Although underfunded, the Center seeks out any available money through state and federal funding, grants, payers and any other sources and manages to keep the center adequately funded. To prove success and further encourage funding, Evans keeps detailed data on all programs and conducts a physician roundtable monthly to review results and keep all parties engaged. For others considering developing integrated mental health programs, Evans encourages them to evaluate all community resources and existing data to find a model that works. “Everyone needs to come up with their own model,” he said. “We all have different resources. What’s made our model work is that all parties have been involved in developing solutions and take pride in the outcomes.” BY PATRICIA CHANEY

people would not have been reached for treatment otherwise. The Center also provides two dorms as transitional housing for men and women, who can stay up to 120 days. The program began about 4 years ago, and more than 60% of people who complete the program are now living drug-free and working.

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INTELICHART

Improves EHR Platforms with User-Friendly Patient Portals For 10 years, InteliChart, which is headquartered in Fort Mill, S.C., was primarily a distributor of EHR platforms, hosting and supporting systems and developing complementary solutions, such as interfacing technologies, for a variety of healthcare IT companies. As the company grew, however, its leaders realized there was more potential for their technology than the subservient role it had been playing. Therefore, the company decided to move away from being a host and developer for other companies and focus instead on providing solutions in three areas: patient engagement through its Patient Portal; accountable care through its Integration Engine; and information exchanges through its HIE Suite.

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03 | INTELICHART

STI In the rapidly changing area of IT hardware, STI has been a secret weapon for companies all over the world.Â STI began working with InteliChart in 2008, and has become one of their key sources of IT hardware as they expand their operations and consolidate their hardware to achieve improved performance and greater efficiency from cutting edge technology.Â InteliChart was able to maximize their IT budget by avoiding new retail costs, and purchasing warrantied certified refurbished hardware from STI.

A PATIENT PORTAL THAT IS NOT VENDOR-SPECIFIC The InteliChart Patient Portal stands out within a crowded marketplace because it refuses to be vendor-specific. Vendor-specific patient portals dominate the market, but the vendors are often more focused on developing EHR technology than they are on improving practice-management solutions. The InteliChart Patient Portal differentiates itself in that it is focused on the user experience. Most patient portals are unique to their particular platform, which would be fine, except a large percentage of organizations use multiple platforms

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INTELICHART BELIEVES DATA ISN’T JUST ABOUT REPORTING AND STATISTICS. IT’S ALSO ABOUT AUTOMATION AND ANALYSIS. to service different specialties. This is confusing for

model. If organizations wish to be viable into the

the patient, and it means they have to access their

next decade, their focus needs to be on financial

information across many different iterations of the

sustainability as opposed to satisfying Meaningful

EHR.

Use requirements.

The InteliChart Patient Portal provides patients

To achieve this viability, hospitals will have to

with one portal through which they can access

manage and then use enormous volumes of data in

every platform an organization uses.

order to engage with other providers and with their

Healthcare IT vendors have taken note of InteliChart’s innovations, and the company has

patients.

Netsmart, Healthland, Aetna, Cerner, and Practice

MAKING LARGE VOLUMES OF DATA USEFUL

Velocity.

InteliChart believes data isn’t just about report-

partnered with such industry heavy-hitters as

Thanks to these valuable partnerships, the

ing and statistics. It’s also about automation and

InteliChart Patient Portal services approximately

analysis. Data leads organizations to answer such

4.2 million individual accounts. This technology is

questions as: What is this data showing? How can

constantly updated to satisfy the most recent fed-

this information be acted upon by all stakeholders

eral requirements, and InteliChart is vigilant about

involved, including physicians and patients?

maintaining certifications and filling solution gaps.

EDUCATING PORTAL CONSUMERS ON THE FUTURE Even though InteliChart’s technology is actively

Finding the purpose behind aggregated and stored data for the sake of information exchange is what ACOs are trying to accomplish, and it’s what the InteliChart HIE is designed to do. Breaking it down into percentages, less than

being embraced by the vendor community, the pro-

five percent of an organization’s patients incur the

vider community tends to be hesitant about step-

largest percentage of its costs. Put another way,

ping outside its technological comfort zone. Many

less than five percent of an organization’s patients

providers prefer to continue with the vendors they

constitutes its cost center.

are using, even if this means navigating multiple

The data a hospital is collecting on its patients

portals, than integrate a new component to their IT

can help the administrative team understand how

infrastructure.

that five percent can be contained and prevented

InteliChart’s leaders believe this is short-

from growing to seven or 10 percent. It can also

sightedness, especially given the changes that are

help an organization understand the 95 percent of

being made to the traditional healthcare payment

its patients that are outside the cost center, along with who they are and what their needs are.

Real Issues : Real Solutions

INTELICHART BELIEVES THIS FACTOR ALONE WILL BENEFIT AN ORGANIZATION AS IT SEEKS TO SATISFY InteliChart believes its HIE suite provides a valid transitional solution that guides both patients and hospitals through the murky waters of ACOs by assisting them in managing this information. InteliChart walks them through each step, creating one continuous solution that avoids the bells, whistles, and new installs of other systems. Having the infrastructure already in place eliminates the need for another piece of technology. InteliChart believes this factor alone will benefit an organization as it seeks to satisfy ACO requirements. For more information on InteliChart and its family of products, please visit the companyâ&#x20AC;&#x2122;s website at www.intelichart.com or contact them at 866.957.8890.

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YALE NEW HAVEN HEALTH SYSTEM

Establishes Corporate-Level Facilities Department While many health systems are expanding through acquisitions and partnerships, the need to consolidate or share services in order to remain efficient is only increasing in importance. Yale New Haven Health System, which is based in New Haven, Conn., continues to explore ways in which it can consolidate care, enhance access to services, and generate efficiency within the system. Its newly created corporate-level facilities department was established so the organization could develop a system-wide approach to expansion and real estate. Previously, hospitals within the health system not only operated independently, but also negotiated real-estate contracts independently. As Yale New Haven seeks ways to consolidate and reduce costs, bringing its entities together and developing a more professional approach has resulted in savings for the organization. Uniting its individual parts has also allowed Yale New Haven to put all leases into one database and enabled the system to standardize leases, contracts, and review processes. Furthermore, Yale New Haven has hired real-estate professionals and created a system director of real estate position.

INCREASING EFFICIENCY IN FACILITIES DESIGN AND CONSTRUCTION

efficiency within each of its building and renovation

The system has been following best practices for

hospital in St. Raphael, just a few blocks from the

design and construction for years, and its cam-

flagship hospital.

projects. Recently, Yale New Haven acquired a 533-bed

This hospital was in need of renovations before

puses feature several LEED-certified buildings with infrastructures rooted in evidence-based design.

the acquisition, and Yale New Haven has invested

The organization has also used Building Informa-

about $28 million in a renovation project, which

tion Modeling (BIM) on many projects, including the

involves refurbishing nurses stations and develop-

cancer center that was completed in 2010. Further-

ing a musculoskeletal institute on the campus with

more, Integrated Project Delivery has also been

two new operating rooms. However, the primary focus of the renovation

crucial to its facilities philosophy. Since the system now has a dedicated corporate-level team and expertise for real-estate trans-

is on upgrading the infrastructure to support new program offerings.

actions, Yale New Haven is focused on creating

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04 | YALE NEW HAVEN HEALTH SYSTEM

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With this addition, Yale New Haven Health System now includes four hospitals, the Northeast Medical Group, and more than 140 ambulatory facilities. The organization is also seriously considering ways in which it can consolidate the ambulatory facilities to create a more efficient network. One plan is to build a large ambulatory facility that would consolidate multispecialty clinics and provide care in one convenient location. With its corporate facilities division firmly in place, Yale New Haven Health System has an even greater opportunity to pioneer best practices, leverage scale, and provide support for its integrated, patient-centered vision of care.

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GATES VASCULAR INSTITUTE

Gates Vascular Institute is a Collision of Innovative Ideas In 2005, Kaleida Health, Western New York’s largest healthcare provider, was approached by the Jacobs family.

Nelson L. Hopkins III, MD, President,

Dr. Larry Jacobs, the pioneering vascular neurologist who discovered a cure for multiple sclerosis by harnessing the human protein interferon, had died from cancer on Nov. 2, 2001. His family wanted to memorialize his life in a manner that reflected the innovative and progressive mindset of his research. The Buffalo, N.Y., region is one of the areas in the United States to experience some of the highest incidents of vascular disease, and Kaleida, along with the Jacobs, began to explore the relevancy of a groundbreaking vascular center, or as Dr. Nelson L. Hopkins III, president of Gates Vascular Institute, described it, “a vascular center of the future.”

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05 | GATES VASCULAR INSTITUTE

While at a conference in Jackson Hole, Wyo., Hopkins and his team polled 20 of the most innovative cardiologists, vascular surgeons, neurosurgeons, and radiologists in the country about what this center should look like. They also collaborated with Los Angeles architect Mehrdad Yazdani on how the center they were envisioning should be designed.

WHAT IF WE COULD TRANSFORM THE TREATMENT OF THE MOST EXPENSIVE EPIDEMIC DISEASES?

“As we talked about things that should be important, one of them was bringing all the disciplines together,” Hopkins said. Yazdani pointed out to the team that they were talking about “collisions” or a space in which all specialties would co-exist, literally bumping into each other and exchanging information in a lively, collaborative environment. “We decided that’s exactly what we wanted be-

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cause medical care now in most institutions around

Turning what if into why not™

the world is fairly siloed according to individual specialties, and you just don’t see other disciplines very much day to day,” Hopkins said. “Everybody is busy doing their own thing, so you just don’t run

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into each other.” It was determined that the building would be sizeable with a one-acre floor plate and eight stories, the vascular center being located on the floors, and the independent Jacobs Institute in the

BRINGING INDUSTRY AND INVENTORS INTO THE FOLD

middle.

From the beginning, Hopkins and his team wanted

bottom four floors, the research center on the top

The Gates Vascular Institute officially opened

to create an institute that would be a reliable part-

its doors two years ago under the Kaleida Health

ner for industry and inventors. To achieve this goal,

banner in partnership with the University at Buffalo

the independent Jacobs Institute was designed to

Neurosurgery. By that time, Hopkins and his team

serve as an entry point into the hospital and univer-

had successfully employed a group of three inde-

sity environments for those innovators who wanted

pendent cardiothoracic surgeons within the Gates

to participate in the program.

Vascular Institute. This year, Consumer Reports named Gates as

“Sometimes it’s a little forbidding to just walk into a hospital or university and say, ‘I want to see

one of only 17 centers in the country where cardio-

what’s going on here,’” Hopkins said. “But they can

thoracic surgeons were ranked with three stars for

come to the Jacobs Institute, which is small, and

all three major cardiothoracic procedures: bypass,

where they have needs that overlap with the hospi-

bypass plus valve, and valve.

tal and the university, the JI can become the broker

Much of this was made possible, Hopkins said,

of those needs. It’s a wonderful alternate pathway

because of the building’s design and its collisions

into the hospital and the university for industry and

template.

entrepreneurs.”

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In preparation for this progressive environment, Gates developed high-quality training programs for its physicians so each one would be thoroughly equipped with the best knowledge on complex implantable medical devices. This training also includes industry professionals, nurses, and technicians who are able to view live cases, interact with operating physicians, and perform procedures on simulators and in vascular models, providing them with a greater sense of a particular procedure’s complexity.

EXPANDING RELATIONSHIPS AND RECRUITING PROVIDERS Hopkins said the Institute’s long-term plan is to recruit leaders from other provider communities— “superstars” in their respective specialties—to carry out its three-pronged mission of clinical care,

first human testing can be done in this one facility,

innovation, and research.

so that makes it completely unique from a technol-

“From a clinical standpoint, we want to create

ogy development standpoint.”

an environment here that is just geared towards

Hopkins invites other healthcare organizations to

excellence in everything that everybody does,” he

visit the Institute to learn about the program and

said. “And because we have such a high instance

to explore ways in which they can become involved

of vascular disease, we have an opportunity to

with Gates’ mission. For more information, please

embrace it in ways that others don’t, given this fantastic facility that we have.”

visit the Gates Vascular Institute website at http:// www.kaleidahealth.org/gvi/.

Gates is also working with start-up companies in both the United States and Canada to develop

BY PETE FERNBAUGH

products for faster implantation in the human body. Additionally, the Jacobs Institute and the Gates Research Center is forming deeper partnerships with the university’s business school and biomedical engineering group. “When somebody comes in with a new idea, everything is right there,” Hopkins said. “We can make prototypes, and we have testing facilities so you can work with our physicians. You can take an idea, thoroughly vet it, make a prototype, put it in a model, and simulate it. You can actually do anything you need to test that new idea you’re creating. “Here, absolutely everything from the nascent idea all the way through to proof of concept to even

Real Issues : Real Solutions

06 | JERSEY COMMUNITY HOSPITAL

JERSEY COMMUNITY HOSPITAL

The Key to JCH’s Financial Success: Communication When Jon Wade began his tenure as chief executive officer of Jersey Community Hospital in Jerseyville, Ill., on Aug. 5, 2013, he was tasked with one overarching priority: turn the organization around financially. The hospital board told him, in no uncertain terms, that they wanted to see a definitive margin from core operations.

Jon Wade, FACHE, Chief Executive Officer

At the end of October 2014, after one year as CEO, the board gave Wade his evaluation, and it was overwhelmingly positive. JCH has had a $2.5 million financial upswing in the last year, one that has been holding steady for the past eight months. Wade’s key to success, however, didn’t revolve around clever revenue initiatives or trendy thinktank strategies. Most of what Wade did was simple leadership, such as becoming involved with the hospital’s agenda and messaging; restructuring and overhauling departments; and closing and expanding services. However, what was core to each of these initiatives, he said, was something JCH lacked when he arrived: communication.

RESTORING URGENCY AND TRANSPARENCY As an outsider, Wade noticed immediately that there was an acute lack of urgency about JCH’s financial situation. “I could see it pretty quickly that we weren’t communicating as an organization thoroughly, consistently, and we were off-message quite a bit,” he said. For example, Wade would talk with the personnel in different departments and ask questions about metrics. Most of them didn’t know what their department’s metrics were.

He eventually discovered that the administrative culture of the hospital had been traditionally closed. Information was doled out on a need-toknow basis. However, he believed that information through communication empowered clinicians and their staffs to succeed. With the board’s blessing, he began to instigate communication, beginning with his leadership team. Before he arrived, the leadership team would meet weekly, Wade said, but these meetings were structured in a way that limited open feedback from the team. There was no agenda, and they weren’t really asked to participate in establishing strategy.

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“They were all on a flat-salary model and not that productive,” he said. “It was death by a thousand cuts for us. Now we’re hiring on more of a produc-

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years ago, the hospital had built a wellness center that truly reflected the progressive ideas of JCH leaders at the time. With over 1,000 members, it was a bright spot in JCH’s dire revenue cycle. Through an expanded wellness program for employees, Wade was able to realize an additional $800,000 in lowered health insurance costs from

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RECEIVING FEEDBACK FROM UNUSUAL SOURCES Wade and his team expected pushback, and they did receive it. Initially. But feedback from the least likely sources confirmed in his mind that JCH’s leadership team

Wade said he changed this approach, immediately revealing to them that the hospital would be unable to make payroll in eight months. While this news was troubling, what he said next shocked them. “What should we do about this?” Wade asked the team. “What would you suggest?” “It took a little while for them to adjust to me asking for their input,” he said. “Then, things started surfacing and bubbling up.” The first step he took was to hire a new controller and chief financial officer, both of whom were tasked with restructuring JCH’s financial practices. His next steps were even more controversial. He closed labor and delivery and abandoned JCH’s physician compensation model.

was making the right decisions. “I sent out a survey in the pay stubs to try to make it anonymous,” he said. “I had been here a couple of months at the time, and I got some feedback that to me was very enlightening. It was from housekeepers, couriers, people that you would not really expect to have strategic insights into our issues. “They knew everything I did. That’s when I was more emboldened.” Most people, regardless of their role in an organization, know what’s happening in their guts, Wade said. They know what needs to be fixed. After labor and delivery closed, Wade said the employees began to open up and tell him they knew it wasn’t wise to keep it open. The department simply wasn’t busy enough.

Real Issues : Real Solutions

This was the type of communication JCH needed, but had lacked just a few months prior.

REMAINING INDEPENDENT AND FINANCIALLY STABLE Now that JCH has found financial stability, Wade and his team are looking to distinguish themselves further as a primary-care organization. Currently, JCH is in the early stages of purchasing a group of 25 primary-care providers. This provider expansion will enable JCH to develop a new business model centered on primary care, Wade said. He wants this model to be different from the market standard, where decisions tend to focus on what’s best for the highest-paid specialist.

“I’VE ALWAYS FELT THAT IT WASN’T NECESSARY,” HE SAID. “I’VE SEEN THE GOOD AND BAD OF SYSTEMS.”

Wade envisions a model that is focused on the holistic needs of the patient, one that realizes patients will receive care from other, non-JCH providers. Instead of leading to a fragmented care team, however, JCH will help coordinate care on the patient’s behalf, working as an informed patient advocate. “It’s going to be exciting,” he said. “I’m looking forward to that. The primary-care docs are anxious to begin advocating for patients, and we want to build an infrastructure around them.” In talking with fellow healthcare leaders at small hospitals like JCH, Wade said two words frequently are woven throughout the conversations: selling and merging. “I’ve always felt that it wasn’t necessary,” he said. “I’ve seen the good and bad of systems.” As JCH has shown, the answer to a floundering independent hospital doesn’t have to be a buy-out or a bail-out. What the executives in the larger system are going to do, he said, is make the hard decisions that you think you’re incapable of making on your own. “So you just need the courage and the backing to do the things that need to be done,” Wade said. “It takes courage.” BY PETE FERNBAUGH

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JOHN RANDOLPH MEDICAL CENTER

Dedicated to Quality Care for Local Community Itâ&#x20AC;&#x2122;s no secret that community hospitals around the country are struggling, and many partner with larger organizations to remain financially viable and provide their communities with seamless access to care.

Suzanne Jackson, Chief Executive Officer

By ensuring that people in smaller communities can receive the services they need close to home while being able to easily transfer to a larger facility for advanced levels of care, the system approach has become crucial to the future of U.S. healthcare.

Real Issues : Real Solutions

07 | JOHN RANDOLPH MEDICAL CENTER

Just south of Richmond, Va., John Randolph Medical Center is a 147-bed community hospital, serving Hopewell, Colonial Heights, Petersburg, and surrounding areas. The hospital has been in the community since 1915, and today, it is part of the larger HCA Virginia health system. Suzanne Jackson, the hospital’s chief executive officer, is committed to preserving community health and leveraging the larger system to benefit patients in John Randolph’s service area. “People like to stay close to home, and they should be able to,” she said. “Larger systems are

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ENGAGING EMPLOYEES AND STAFF FOR A CULTURE OF COMPASSION Having a reputation for quality is essential to any community hospital. With deep connections among staff, nurses, and physicians, cultivating a culture of compassion and employee engagement has been a critical part of John Randolph’s recent initiatives.

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“Many people who work here were born in this hospital or have family members who receive care here,” Jackson said. “We have a team committed and are passionate about providing patient-centered care with empathy and compassion. We want

difference in patient care, and Jackson works to

all patients to feel as though they are part of our

recognize those contributions.

family.” After implementing major initiatives in quality

“Each role and each individual is important in the delivery of care,” she said. “When human

improvement, the hospital has received numerous

capital is what makes you who you are, any turn-

awards and recognition for its efforts. Jackson said

over can be painful and create an opportunity for

communication was a key element in any new en-

breaks in the system. But we are fortunate to have

deavor when she came to the hospital a little over a

a hospital whose culture embraces the value of

year ago.

every role.”

“Patient experience is affected by communication, ers and patients, or nurses and ancillary staff,” she

PROMOTING QUALITY AND PATIENT EXPERIENCE

said. “We needed to get staff and physicians to the

As is the trend across the United States, the com-

table and establish processes that promote com-

munity surrounding John Randolph has a growing

munication and transparency.”

demographic with more comorbidities and chronic

whether between physicians and nurses, caregiv-

Employee engagement has been a top priority as well. With a small staff, every person makes a

diseases, while the hospital has limited resources. “We have been focused on investing and un-

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derstanding John Randolph in the community,”

Inside the hospital, an upgraded magnetic reso-

Jackson said. “We are making sure we have the

nance imaging system has been installed, and

resources we need to take care of patients and are

nurses’ stations in some areas are being renovated.

providing the right services.”

John Randolph is also in the midst of implement-

The hospital has achieved hip and knee disease-specific accreditation from the Joint Commission and has achieved the highest scores on

ing an electronic health record and computerized physician order entry. Jackson plans to continue focusing on quality

core measures for inpatient and outpatient services

and strengthening employee engagement, physi-

for several consecutive years. The hospital was

cian engagement, and the hospital’s connection

also recognized as a Top Performer on Key Quality

with community partners. Major changes are hap-

Measures for 2013 by the Joint Commission.

pening at the hospital, bolstering its commitment to

These achievements are no small feat for a community hospital. With lower volumes, any mistake has a huge effect on scores. “We have to do it right every time,” Jackson

residents of the local community. “If we focus on quality, everything else comes with it,” she said. “We will continue to ensure we have the right services conveniently available to our

said. “We have to ensure stopgaps are in place. It is

community and work with our sister hospitals for

hardwired as part of our culture, and we foster an

smooth transitions of care.”

environment of collaboration across all caregivers and all departments, not just clinical teams.”

BY PATRICIA CHANEY

IMPROVING ACCESS THROUGH FACILITY RENOVATIONS In addition to quality efforts, the hospital is undergoing major renovations to improve access and the patient experience. For example, John Randolph is creating a wellness pavilion that will house inpatient and outpatient behavioral health services together in a therapeutic environment. A new outpatient entrance is underway, along with landscaping, call lights in the parking lot, and other security and beautification projects.

Real Issues : Real Solutions

08 | VIRGINIA GARCIA MEMORIAL HEALTH CENTER

VIRGINIA GARCIA MEMORIAL HEALTH CENTER

Unites Care Teams in Managing Population Health Historically, Federally Qualified Health Centers (FQHCs) have always had to provide cost-effective, high-quality care for patients who are most in need. Perhaps this is why many of these centers have been quietly ahead of much of the healthcare industry in focusing on population health and developing new models of care. Gil Muñoz, MPA, Chief Executive Officer

In Washington and Yamhill counties, located west of Portland, Ore., Virginia Garcia Memorial Health Center is a network of five primary-care clinics and pharmacies, five dental offices, and five school-based health centers. For the last seven years, Virginia Garcia has been exploring an integrated, multidisciplinary, wellness-focused model of care and is now a Patient-Centered Medical Home. Care teams and treatment plans incorporate primary care, pharmacy, nursing, social work, behavioral health, and other health-education services within a culturally sensitive environment.

“We saw that this model of care held great promise to approach the needs of our patient population and organize care in a way that made more sense to

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the Center’s patient population has been an equally high priority. The Center sees about 38,000 patients per year, 62 percent of whom are Hispanic and 89 percent of whom come from low-income households. One recent initiative has been the development of group visits. Muñoz said a cohort of families can

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go through a care series together and learn from each other, receive group well-child visits, and form a support group. This initiative has proven effective within the Hispanic population.

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WELLNESS FACILITY ADDRESSES CHRONIC CONDITIONS PROVIDING TEAM-BASED, CULTURALLY SENSITIVE CARE

During the past two years, Virginia Garcia has established its wellness facility, Cornelius Wellness Center, to support the organization’s integrated

The Center’s original mission was to provide care to

model of care and assist in managing chronic con-

seasonal and migrant workers, who now make up

ditions. The wellness facility supplements Virginia

approximately 21 percent of the Center’s patients.

Garcia’s emphasis on primary care through pro-

In 1975, Virginia Garcia, the daughter of a mi-

moting healthy lifestyle activities such as Zumba,

grant worker died from an infection that developed

Tai Chi, yoga, and other exercise programs. Corne-

in a cut on her foot. Because of language, econom-

lius Wellness Center also offers a teaching kitchen

ic, and cultural barriers, she was unable to receive

for classes on how to prepare foods on a budget.

appropriate care fast enough.

“The Center offers services that support people

The Center was named in her honor, and it is the memory of her story that drives its initiatives. “Our Center has developed a model of care that is patient-centered and uses a team approach to

in making behavioral and lifestyle changes that will promote their health and manage or avoid chronic conditions,” Muñoz said. Many of Virginia Garcia’s patients have diabetes,

incorporate wraparound services that support the

hypertension, obesity, and other chronic conditions,

needs of each individual patient,” Gil Muñoz, MPA,

along with mental health issues. The Cornelius

chief executive officer, said.

Wellness Center allows care teams to be co-locat-

Muñoz said the development of this approach

ed so that providers, nurses, medical assistants,

started in conjunction with five other health sys-

and behavioral-health specialists can coordinate

tems.

care for patients.

Real Issues : Real Solutions

Muñoz said the development of the wellness facility

was for each member and focus on those key clini-

has greatly improved the organization’s ability to

cal areas.”

meet the needs of its patients by further enhancing its comprehensive approach to care delivery.

GETTING RESULTS THROUGH PRIMARY CARE

For example, screening for depression was typically conducted by nurses. By making that a target and incorporating it into the team’s standard work, the Center saw a dramatic improvement in how the screening was happening.

Recently, Virginia Garcia has been working with

Having these clinical standards also enables

local hospital Providence St. Vincent to connect

tracking outcomes and results to be easier, thereby

people who were seen in the emergency depart-

motivating the team to continue improving the

ment or admitted to the hospital with a primary-

model.

care provider. The hospital provides referrals to the

“Merely treating health conditions in a 15- to

clinic and a specialized team, called a Community

20-minute office visit is no longer sufficient to

Coordinated Care Team, helps manage the high-

address most patients’ overall health and reduce

needs patients.

costs,” Muñoz said. “Developing teams, focusing on

Muñoz said the results have been dramatic for patients who are engaged in the program. Among those patients, emergency-department visits dropped by 76 percent, inpatient visits dropped

primary care, and understanding how to motivate patients is where we need to place our emphasis.” BY PATRICIA CHANEY

82 percent, and associated charges dropped by 74 percent. Patients in the program have multiple health conditions and often behavioral-health issues as well. The care team is comprised of a nurse practitioner, mental health therapist, and community health worker who closely manages the patients. “We had heard that focusing on so-called ‘hot spotters’ was important, and we have seen that it does work,” Muñoz said. “Before enrollment in the program, patients had more than $4 million in total charges that included emergency services, inpatient services, and ambulatory surgery. After enrollment, those charges drop to $1.5 million.” Working collaboratively across disciplines and bringing together providers in one location is a shift in traditional healthcare delivery and one that many organizations are starting to make. Muñoz said engaging providers and staff in developing standard work was the biggest key to success. “Just bringing together the teams isn’t enough,” he said. “We had to look at what the standard work

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PALM BEACH ORTHOPAEDIC INSTITUTE Improves Revenue Cycles through Front-End Management In our last article on Palm Beach Orthopaedic Institute (PBOI), which is located in Palm Beach Gardens, Fla., Brian Bizub, chief executive officer, discussed two groundbreaking initiatives: implementing a post-surgical DME program and opening commercial pharmacies in physician group practices.

Brian Bizub, Chief Executive Officer

PBOI is the top orthopedic institute in the southeast and is spread across four locations in Florida. Recently, a new medical complex was unveiled at 4215 Burns Road in Palm Beach Gardens. This complex will house an MRI facility, a D1 sports training athletic complex, the online portal NextMD, a rehabilitation center, and an on-site pharmacy.

09 | PALM BEACH ORTHOPAEDIC INSTITUTE

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The organization’s continued growth is largely the result of innovative, daring initiatives, such as the ones we discussed in our previous article, as well as Bizub’s process-oriented approach to improving PBOI’s revenue cycle through front-desk management.

LOOKING BEYOND ACCOUNTS RECEIVABLE

through their employer and used a credit card for health-related expenses. With rising insurance premiums and higher deductibles under the Affordable Care Act, it has be-

Smaller practices are often unable to verify patient

come more important for practices to know what the

benefits prior to the patients coming in for an ap-

deductible is so they can collect it from the patient

pointment, mainly because they lack the resources

on the front end.

to do so. Unfortunately, practices then end up only

This is especially true in orthopedics, Bizub said,

collecting the co-pay at the time of the appointment

which is an events-based practice. “We’re a subspe-

and chasing any co-insurance and deductibles after

cialty, so you may see the patient only once.”

the fact.

Subspecialty practices like PBOI end up expending a

Medicare used to have an annual deductible 10

great deal of time and resources pursuing patients

years ago, Bizub said. A practice would collect 20

who owe $20 for services received or for a deduct-

percent, which was balance billed to the patient.

ible that hasn’t been paid yet.

For HMO plans, it was simply a co-pay with no

“Unless you’re a process-driven person, you

deductible, and HSAs were like HRAs in that they

really need to look at the front end, because that’s

were credit card-based. Patients self-funded HSAs

where it starts,” Bizub said. “We’ve all been trained

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to manage our accounts receivable because that’s

PBOI has interfaced ezVerify with its NextGen EMR

money in the bank.”

to extract the pertinent orthopedics information

UNDERSTANDING THE PAYMENT TYPE BEFORE THE VISIT

from the documents. This information is automatically placed in the appointment book, and when Bizub’s team looks at the patient profile, they see

Recently, Bizub renegotiated his outsource-billing

only the relevant information needed for each pa-

contract since he’s collecting more allowables on

tient’s visit.

the front end, amounting to hundreds of thousands

The staff then calls those patients two days in

of dollars in revenue every month because volume

advance, so they are aware of their payment obliga-

on the front end reduces billing expenses on the

tions before they arrive at the office. Bizub said this

back end. Why should he pay the billing company a

not only weeds out those who are unable to pay, but

percentage? he asked.

it also saves patients from the embarrassment of

Instead, PBOI has partnered with ezVerify, an automated healthcare solutions company that conducts real-time verifications. Bizub and his team check their patient sched-

realizing they don’t have the money while standing in the waiting room. For those patients who need care but can’t afford it, the two days also gives his staff time to help

ules two days in advance. They enter the patients’

them find alternative avenues for payment. Bizub

names, their insurance plans, and ID numbers into

said they still take a patient’s situation into account

ezVerify, and the software sends the information out

and will balance bill on occasion.

to the individual insurance companies. An electronic

The 10-page document is kept in the system just

file containing a 10-page document for each patient

in case a patient ever requests print verification of

is then returned to them.

their information. According to Bizub, the conve-

Real Issues : Real Solutions

nience of this software cannot be overstated. Since

the patients understand that. Once the program

installing it, he has saved $100,000 by reducing his

is up and running, the problems seem to go away

full-time FTE staff from four to one.

because the patient’s expectations are changed. It’s

He also emphasized the educational component to this software for everyone involved--the patients, physicians, and staff—since each party is learning to appreciate the cost and value of healthcare. After

definitely a mindset change.” It’s also important to remember that physicians would rather avoid the financial end of healthcare. “This helps to relieve that pressure from them

all, not collecting on the front end can cost a prac-

when the patient comes in and asks about billing,”

tice three times the original amount for a service.

Bizub said. “I think that breaking down each thing

REMEMBERING CHANGE IS A PROCESS

that we do into a process and trying to make it as efficient as possible is important for the success of both hospitals and practices. The more we can

Bizub said he has increased front-end collections

do to help our patients understand their part of

over the past six years by 53 percent, and he has

healthcare and the physicians to understand what

saved tens of thousands of dollars in labor and re-

they need to do to make it a more efficient process,

sources. But it has taken time to attain these levels

I think the more successful healthcare will be. And

of savings.

we can help reduce healthcare costs through ef-

“It’s a process,” he said. “If your practice is not used to collecting on the front desk, there needs to be some education to the patients prior to imple-

ficiencies.” BY PETE FERNBAUGH

menting this service. So you want to make sure

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LEGACY PHARMACEUTICAL PACKAGING

Reduces Distribution Costs Legacy Pharmaceutical Packaging, which is headquartered in St. Louis, Miss., is not your typical contract packager, Dave Spence, chief executive officer, will tell you. The company has figured out a way to eliminate several steps from the pharmaceutical distribution model.

Dave Spence, Chief Executive Officer

Here’s how it works: The pharmaceutical manufacturer sends its products to Legacy in bulk, and the company’s high-speed lines package these pharmaceuticals into unit-of-use bottles or compliance packages. Legacy then ships these pharmaceuticals directly from the manufacturer to the retailers’ distributions centers. “We’re bringing it in large containers of bulk, so it brings down the product cost,” Spence said. “Instead of having the pharmacist count out 30 or 60 tablets over and over and over like it’s Groundhog Day, we’re prepackaging the high-volume maintenance drugs. It allows the pharmacy to be more efficient and allows the pharmacist to have more time with customer interaction. It also speeds up the process and narrows the window of mistakes.” Legacy’s business model is fairly original within the pharmaceutical industry, he added, especially with direct-to-retail products. Furthermore, Legacy primarily deals with larger retail customers and pharmaceutical companies who buy or sell for products that are in the four-dollar prescription program.

BRINGING BUSINESS AND POLITICAL EXPERIENCE TO LEGACY Spence has been lead investor in Legacy Pharmaceutical for four years. On Jan. 1, 2014, after spending a lifetime in the manufacturing business, he became CEO. However, his first business venture was at the age of 26 when he bought a plastic-bottle company that supplied both nutritional and pharmaceutical companies. “I wouldn’t say I was an expert, but I had a working knowledge of this industry,” he said. Spence eventually sold his company to a private equity firm, remaining as CEO until 2010, when he resigned to run for governor of Missouri. “I didn’t win or I wouldn’t be doing this,” he said with a laugh. “That was an interesting experience. It makes the packaging business look pretty rational.”

Real Issues : Real Solutions

10 | LEGACY PHARMACEUTICAL PACKAGING

pation of hydrocodone, a Schedule III drug that was converted to a Schedule II, the company installed a vault. It also added cages for Schedules III through V drugs. Furthermore, the company added checkweighers, vision systems, and diagnostic machines. It improved tooling for thermal formers, and Legacy also constructed a state-of-the art training facility Following the election, he became more involved with Legacy and began identifying ways for the company to grow and improve its operations. Once he became CEO, Spence said it took him a while to master the plethora of pharmaceutical acronyms, but the company began to grow at a rapid rate, from $9 million in his first year to $18 million then $38 million in his second and third years, respectively. This year, Legacy will bring in $42 million, and the company’s growth rate has prompted Spence to make a risky decision. “We’ve kind of tapped the brakes a little bit on growth to catch up with it,” he said. “I think we took on a ton of growth. We moved into another building, and we finally finished consolidating into this building. We had a lot on our plate, and we’ve just had to get the infrastructure in place to catch up with our growth.”

BECOMING BEST IN CLASS With GDUFA fees receiving increased scrutiny and serialization on the horizon, many companies are teetering on the brink of failure, Spence said. Legacy wants to embrace these changes and become best in class. “In this industry, there’s a lot of paralysis through analysis,” he said. “We don’t want to be this aircraft carrier that can’t make decisions. You have to obviously make judicious, well-thought-out decisions, but that doesn’t mean they have to take years. And that’s what I’ve found out about this industry. People are very cautious, and rightfully so, but I think that there could be some more entrepreneurial thinking.”

on its campus.

EXPLORING THE INTERNATIONAL MARKET From personal experience, Spence said the lawmakers who are passing regulations on the pharmaceutical industry have never actually worked in it. This factor of inexperience makes it difficult for companies like Legacy to do business, he added, and it leaves competitors overseas with an edge. “What we’re doing is adding more and more complexity to doing business in the United States, which to me is counterintuitive,” Spence said. “We should be making business easier to do in the United States.” Spence would like the freedom to expand into the overseas market, where emerging countries are clamoring for FDA-approved pharmaceuticals, especially since many middle- and upper-class citizens lack confidence in local pharmaceuticals and are looking for products that are authentic and not counterfeit. “Every time I learn more about the business, I see more potential,” he said. “We’re trying to think outside the box more. We know there are regulations and there are protocols. I think people find us refreshing in the fact that we’re enthusiastic. We’re honest. “We don’t want to take on business that isn’t good for us, or we would be set up for failure. We can make decisions. We’re two-feet-on-the-ground, very commonsense people, and I think people find that engaging and refreshing.” BY PETE FERNBAUGH

Legacy’s model affords it efficiency in decisionmaking on capital expenditures. Recently, in antici-

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LARKSFIELD PLACE

Transitions to Automated Medication Dispensing As hospitals and other healthcare facilities rapidly change to meet new demands and implement technology, post-acute care and skilled nursing facilities have lagged, often because of legal and policy issues.

Reg Hislop, President and Chief Executive Officer

Larksfield Place, a not-for-profit Continuing Care Retirement Community, has implemented a major initiative to transform medication delivery.

President and Chief Executive Officer Reg Hislop

day supplies of medications, which are distributed

came to Larksfield after heading a healthcare

to them by the nursing staff.

capital development group and previously serving

Larksfield partnered with Wesley Medical

as CEO of a large post-acute care system. Hislop

Center on the project, but had to spend about a year

said Larksfield’s culture has enabled him to form

working with the state legislature to get approval to

closer relationships with the employees and resi-

initiate the program. It is still considered a demon-

dents, and it has provided him with the opportunity

stration project, but the results so far are looking

to innovate.

positive and may sway the legislature to change the

“Small companies are wonderful for innovation,” he said. “I know my customers and what matters to them.”

laws. “We have shared data with the state on two different occasions, and legislators have been

Larksfield Place is an independent facility in

impressed by how we have lived up to our claims of

South Central Kansas with a staff of about 300 and

efficiency, safety, clinical improvements, and reduc-

more than 400 residents. The campus has 22 free-

tion in delays,” Hislop said. “Our initial goals have

standing villas, 170 independent-living apartments,

been more than substantiated.”

40 assisted-living apartments, 32 memory-support rooms, and 90 licensed nursing-care beds.

IMPLEMENTING AUTOMATED MEDICATION DELIVERY Over a year ago, Larksfield Place began an initiative to transition to automated medication dispensing using Pyxis. Although hospitals have been using automated

IMPROVING EFFICIENCY THROUGH INTERCONNECTIVITY The primary advantages of an automated system are its ability to rapidly change pharmacologic care and reduce waste. “If a physician changed medication four times within a few days, patients aren’t getting four 30-day supplies,” Hislop said. “The only drug taken and

systems for more than a decade, in a long-term

charged is the one that was dispensed. We make

care facility, state and federal regulations support

sure the right medications are given at the right

medication administration that is similar to how

time at the proper dose and lowest cost.”

it would be for an individual living at home. This means patients individually receive and pay for 30-

The pharmacy component is interconnected electronically with both Larksfield’s system and

Real Issues : Real Solutions

11 | LARKSFIELD PLACE

the Wesley system. This connectivity then allows Larksfield to link its laboratory with radiology. “This means doctors can monitor their patients anywhere, write new orders, view lab results, change medications, and view radiology results all through the same access point or portal,” Hislop said. “Ultimately, we will use this same connection to provide our residents and families with access to their healthcare data, such as their prescriptions, their labs, their X-rays, and so on.” Larksfield is also working with Wesley to establish a laboratory partnership.

IMPACTING OUTCOMES AND COST REDUCTIONS Hislop said Larksfield has already seen cost reductions through the program, and automated dispensing helps improve medication safety as well. No specific medications are allocated to the

“Our pharmacists provide clinical integration,” His-

patients, which eliminates redundancy, and medi-

lop said. “We are lucky to have these sharp young

cations are dispensed one at a time to individuals.

individuals. There are only about 4,000 geriatric-

Nurses search by category of drug rather than

certified pharmacists in the country, and we have

name, making it extremely difficult to give the

two.”

wrong medication to the wrong patient.

The program is showing great success so far,

In addition, Larksfield, in partnership with

but it has been difficult to get all of the pieces in

Wesley Medical Center, has two geriatric-certified

place between attaining legislative approval and

pharmacists on site.

changing the culture that has been embedded in the organization for more than 20 years. Marrying technologies has also been a challenge. Because Pyxis is a hospital-based system, it doesn’t integrate into any software systems for post-acute care, so Larksfield is working on managing the IT aspects. Furthermore, the organization plans to continue expanding its IT infrastructure to include e-prescribing and personal health records for patients in the coming years. Hislop said healthcare must continue changing at all levels, and organizations need to come together to provide patient-centered care. “The world has changed, and the call is for all of us to be more efficient, more patient-focused, and more specific in our outcomes,” he said. “We can’t do that in the silos healthcare has typically been in. We have to partner to solve bigger problems, which is what we have been working on here with Wesley Medical Center.” BY PATRICIA CHANEY

HCE EXCHANGE MAGAZINE

VIRGINIA UROLOGY

Reduces ER Usage with 24-Hour Hotline Headquartered in the Greater Richmond region, Virginia Urology has eight locations and two surgery centers spread throughout its service area. It also holds a joint venture with a local hospital system for radiation oncology.

Brigette A. Booth, M.H.A., Chief Executive Officer,

Originally established 75 years ago, a merger in 1995 left the company poised for organic growth through physician recruitment. Currently, Virginia Urology employs 44 providers with 30 being urologists. The other represented specialties--six radiation oncologists, two radiologists, one pathologist, four anesthesiologists, two physical therapists, one gynecologist physician, and one urogynecologist—all provide support for the urologists. In total, Virginia Urology has 320 employees. By taking a collaborative approach with its physicians, Brigette A. Booth, M.H.A., chief executive officer, said the company encourages innovative ideas. In fact, these ideas often plant the seeds for some of Virginia Urology’s most successful initiatives, one being the 24-Hour Kidney Stone Hotline.

KEEPING PATIENTS OUT OF THE ER WITH A PHONE CALL The 24-Hour Kidney Stone Hotline was established in 2007. “The need arose out of an increased number of calls we received from the emergency-room physicians seeking follow-up care for their kidney-stone patients,” Booth said. “The Hotline served as an efficient conduit to close the transition of care from the emergency room to our office. The Hotline not only created a more efficient workflow for both sets of providers, but also minimized the costs of care for the patients.” If a patient is suffering from kidney stones, they simply have to call the 24/7 Kidney Stone Hotline, where a patient representative will take their information. If they’re a new patient, the patient rep will initiate the process for entering them into the Virginia Urology system. For existing patients, the rep has access to the organization’s EMR. They will look at the patient’s history, view the physician’s last plan of care, then

inquire with the on-call physician for a recommendation on whether or not the patient should go to the ER. For a majority of the cases, the on-call physician will instead choose to book an appointment for first thing the next morning. Additionally, a CT or imaging study will be scheduled and the patient will arrive NPO. In fact, most patients will receive everything they need on the same day, whether it’s lithotripsy or a ureteroscopy. They are usually able to return to work within the next one to two days, Booth said. This process is in sharp contrast to the ER, where it can take a couple of days to work the patient into the schedule for tests or surgery. “We’re able to reduce costs for not only the patients, but also the healthcare system, and we’re able to provide better care and access,” Booth said. “That’s something that has been extremely beneficial to the practice.” She added that referring physicians and ERs love the Hotline, because it can be called at any time.

Real Issues : Real Solutions

12 | VIRGINIA UROLOGY

Stericycle T. 910.330.9570 fschachter@stericycle.com

EARNING SUCCESS THROUGH MARKETING AND REFERRALS When it was first established, Virginia Urology was aggressive in marketing the Hotline, investing a great deal of money in a variety of media. Since then, the number of office visits generated from the Hotline, not including downstream revenue from the surgical procedures or imaging the organization provides, has given it a rapid return on investment. Keeping the Hotline in-house has also benefited this growth, Booth said, and patients have embraced the convenience of it and love the fact that they no longer have to wait for the physician to return their call as they would with an answering service. Furthermore, area hospitals have promoted it, and Virginia Urology’s director of marketing meets frequently with ER departments around the Richmond area, providing resources and literature on the Hotline. Billboards and buses have even carried advertising for it. But referrals from ERs and urgent-care facilities have contributed the most to the Hotline’s success, Booth said. The effectiveness of this Hotline is given more weight in light of a recent NIH study that found kidney stones are among the top five costliest ER admissions. As further proof of its necessity, Virginia Urology’s 24-Hour Kidney Stone Hotline has saved the system an estimated $3 million during its

not man the lines. It was innate to their nature to try to diagnose and treat the patient, which is explicitly not the Hotline’s purpose. “We thought at first it would have been good to have a clinical person in that role to answer all that patient’s questions,” she said. “But after further thought and review, it turned out that it had the potential to create more issues, so we had to take a step back and remove the clinical person from our plan and add a clerical person, which actually worked out a lot better because they’re familiar with our scheduling system and they know how to go ahead and generate the prior authorizations.” The level of empathy and compassion needed by those manning the Hotline, not to mention their willingness to be awakened and contacted at all hours of the day, has garnered the patient representatives prestige within the organization. In the early stages of the initiative, Virginia Urology selected its top performers to function as these patient reps. The same employees have been handling the Hotline since its inception. As the company looks to the future, Booth said the team is exploring ways in which the Hotline model can be applied to other urological conditions. She advises her colleagues to always be willing to explore fringe ideas or ideas that aren’t exactly trendy, but will improve their customer service. “With the way healthcare is changing, it’s additional ways we can enhance customer service and

short lifespan.

enhance the patient’s experience, and I think this

REALIZING THE IMPORTANCE OF THE PATIENT REPRESENTATIVE

doing so you have to have the right people on the

In setting up the Hotline, Booth said the first challenge was realizing a clinical staff member could

certainly does it,” Booth said. “But I would think in bus to be able to handle it and that will either make it or break it.” BY PETE FERNBAUGH

HCE EXCHANGE MAGAZINE

WEST PARK HOSPITAL DISTRICT Nearing Completion of Facility Master Plan Doug McMillan, chief executive officer of West Park Hospital District in Cody, Wyo., a critical-access hospital located on the East Gate of Yellowstone National Park, is a rare breed among modern healthcare executives. He has held his title of CEO at WPH for more than 17 years. This longevity has afforded him the benefit and perspective of hindsight. It has also helped him lead the organization through a long-term facility master-planning process that began in 2005.

Doug McMillan, Chief Executive Officer

At the time, McMillan had been at WPH for eight years, but the organization had never drawn up a formal facility master plan. “As we were putting together our strategic plan, we decided that we really needed to put together a facility master plan that was in alignment with our three-year strategic plan,” McMillan said. Nine years later, WPH is about to implement the third and final phase of that plan. All three phases combined have totaled approximately $70 million. “When you think of the textbook presentation of how a facility master-planning process should be developed and look, we’ve actually demonstrated it,” he said.

MEETING THE DEMANDS OF THE FUTURE

CONSTRUCTING A NEW MEDICAL OFFICE BUILDING

Prior to the facility master plan, the hospital had

The first phase of the project was constructing a

been updating its facilities under state grants, but

new medical office building. The old medical office

its building was still 40 years old. Furthermore, the

building was literally built on stilts and had far

hospital wasn’t prepared for the future, and McMil-

surpassed its golden anniversary. Beyond that, its

lan said one of the first questions he and his team

appearance was an eyesore, McMillan said.

asked was, “What will the hospital need to be in the

“It was the first thing that people saw in Cody,

next 20 to 30 years, especially when more growth is

which is a tourist community, and in the summer-

being projected?”

time we have over three million people who either

WPH has been managed by Quorum Health

go into or exit Yellowstone National Park.”

Resources (QHR) since 1987. By bringing in the

The new 60,000 square-foot medical office

American Health Facilities Department (AHFD),

building was about a mile from the campus proper.

a subsidiary of QHR, the facility master plan was

Initially, the community was against the first phase,

drawn up in collaboration with board members,

McMillan said, especially when a large portion of

managers, physicians, and administration. AHFD

the building was initially unoccupied.

spent a great deal of time gathering data from each

Nine years after the fact, those concerns have been

department, and in 2006, the board of directors ap-

answered. The building has accommodated the

proved the facility master plan.

organization’s projected growth, and now 50,000

Like most facility master plans, McMillan said it wasn’t something the hospital could devour in one

square feet is in use by existing and newly recruited physicians.

bite. Therefore, it was divided into the three phases.

Real Issues : Real Solutions

13 | WEST PARK HOSPITAL DISTRICT

Layton Construction Co., Inc. T. 801.563.3722 www.laytonconstruction.com

MODERNIZING INFRASTRUCTURE AND RELOCATING SERVICES The second phase, called the Modernization Project, was a $30-million renovation and expansion project that was built on the site of the old medical office building. The Modernization Project consisted of a new 11,000 square-foot emergency department with an ambulance bay connected to the ED. The second phase also included a new imaging department, laboratory, patient financial services department,

wife Fran Baker, MD, so we are excited about the new Baker Community Education Center, which will provide the nicest conference and education facilities in Northwest Wyoming.” The centerpiece of the third phase is the relocation of Cedar Mountain Center to the third floor of the hospital, the floor where the medical & surgical beds are currently located. The original facility for Cedar Mountain Center, which is an inpatient chemical dependency center, is located across the street from the hospital. Once it is relocated, the old Cedar Mountain site will be used for expanded

gift shop, and a new front entrance that features a

parking.

large mall connecting the newly constructed addi-

STRESSING THE IMPORTANCE OF ALIGNMENT

tion to the rest of the hospital. The new addition was designed with the Disney model in mind: on-stage and off-stage halls that provide a hallway in the front of the facility for all outpatients, visitors, and staff and a back hallway connecting all patient areas in the facility for transportation of inpatients, surgical patients, and ED patients who are admitted to the medical & surgical or coronary-care units. Other facets of the Modernization Project included relocating the LTCC front entrance and remodeling the front entrance and resident patios. The third phase in the project is a series of relocations and repurposing of locations. This includes moving all medical & surgical beds to the addition from the second phase and relocating the dietary department to the lower level of the new addition. WPH originally intended to expand its conference center adjacent to the kitchen and cafeteria during the third phase, but cut this project because of cost, McMillan said. “Fortunately, our Foundation has been offered

“When we look back at how it was developed and how we’ve just taken small bites over nine years with the first phase, second phase, and now third phase, it’s just pretty phenomenal,” McMillan said. Because WPH is a hospital district, which classifies it as a governmental entity, its board leadership changes every four years. However, even this turnover has not impeded forward progress on the master plan, since each board member has adopted the vision immediately. “I can’t stress the importance of aligning an organization’s facility master planning with their strategic planning process,” McMillan said. “Most organizations, large and small, want to attain growth, but without creating a template for the growth you want to achieve and without the overlay of what your existing hospital looks like and what it needs to look like, it’s easy to say, but hard to accomplish.” BY PETE FERNBAUGH

a very nice gift to expand our conference center from Lenox Baker, MD, hospital trustee, and his HCE EXCHANGE MAGAZINE

ALIVIO MEDICAL CENTER Finds Success with Peers for Progress Esther Corpuz arrived at Alivio Medical Center in Chicago, Ill., as chief executive officer nine months ago after spending the majority of her career working for Tenet Healthcare, the second largest investor-owned healthcare system in the country.

Esther Corpuz, Chief Executive Officer

For Corpuz, transferring to Alivio was a homecoming. Having been raised in Chicago, she was familiar with the large percentage of underinsured and undocumented residents in the city, especially within the Pilsen community, which is home to one of the largest and oldest Mexican communities in Chicago. Alivio had been struggling financially, and Corpuz wanted to make sure its presence in Pilsen would continue. “I felt that I could really make an impact and help them get back on track where they need to be, especially with my experience coming from the healthcare investor side,” she said.

AN INTEGRAL PRESENCE IN THE REGION Alivio was founded by grassroots activist Carmen Velásquez in 1989. Velásquez had no experience in

Because of its growth, Corpuz realized this model had become unsustainable, and the organization needed financially stability in order to remain open.

healthcare within the Pilsen community where 40

SALVAGING THE REVENUE CYCLE AND KEEPING PROVIDERS

percent of the residents were uninsured, 20 percent

From the start, Corpuz identified areas for immedi-

lacked coverage beyond hospitalization, and of

ate improvement. First, the revenue cycle was an

those who were insured, two percent had individual

ongoing struggle, especially since the organiza-

coverage only.

tion wasn’t collecting all of its revenue on the front

healthcare and was actually trained as an educator. But she wanted to combat the inadequate

During its first year of operation, Alivio saw

end. Various factors were hampering the process,

5,000 patients and maintained an operating budget

including coding, credentialing, and provider and

of $1.4 million. There was no indication then,

personnel issues.

Corpuz said, that Alivio would grow to its present strength. In 2014, nine low-income, marginalized communities depend on Alivio as their safety-net

“My providers work very, very hard, and they’re seeing patients who have a lot of complex issues,” she said. Corpuz decided to outsource billing to Priority

provider. Alivio’s annual operating budget is more

Management Group (PMG), a company that handles

than $12 million, and its providers see over 20,000

FQHC billing exclusively. PMG’s expertise showed

Spanish-speaking, Mexican immigrants each year.

immediate results.

The business model upon which the Center had been founded was focused on care before finances.

The second area Corpuz had to address was provider recruitment and retention.

Real Issues : Real Solutions

14 | ALIVIO MEDICAL CENTER “We had a catastrophic crisis,” she said. “We lost about eight providers last fall and that really impacted our visit volumes.” Fortunately for Alivio, Corpuz had handled provider alignment during her time at Tenet. The first step she took was to understand why the providers had left the organization. She discovered Alivio’s financial instability was one of the reasons for their departure, and the providers were attempting to express their dissatis-

MAC Source Communications www.macsourceinc.com

faction and perception that the billing issue wasn’t being given enough attention by the leadership. She then explored how the organization could recover from this loss through recruiting new phy-

diabetic population, which is the gold standard for

sicians and retaining those who had not left.

diabetes management.

On July 30, Corpuz held Alivio’s first annual pro-

Corpuz said Alivio was a late adapter of EMRs,

vider business meeting. She labeled her discussion

but Peers for Progress motivated the organization

the State of our State Address, and she used it to

to fully invest in the technology. To date, Alivio has

brief the providers on the new billing company and

gone live in all of its six locations.

present them with the 2015 Budget and with her strategy for organizational recovery. “Not knowing and not having a plan made them

However, the program initially failed to secure buy-in from the providers. They were reluctant to refer their patients to the health workers, and they

nervous,” she said. “We’re trying to address the

didn’t understand how health workers with limited

immediate concern about billing and really trying

training could have a positive impact on their dia-

to share with them and be more transparent about

betic patients.

our issues, including them in the plan to get us out of where we’re at.”

PEERS FOR PROGRESS BOLSTERS DIABETES CARE Two years before Corpuz arrived, Alivio joined the Peers for Progress global healthcare initiative,

Thankfully, their concerns have been answered, Corpuz said. Under the leadership of program director Yudy Galvan, Peers patients are showing greater progress in weight loss, diet control, and physical activity than those patients who are not in the Peers program. The team mentality promoted by Peers for

which is working to improve healthcare in under-

Progress reflects her ultimate goals as Alivio’s

served communities. Alivio was awarded a $1.8 mil-

leader, Corpuz said.

lion grant, called My Health Comes First, through

“I’m not Alivio by myself. It’s my responsibil-

the Peers program, courtesy of biopharmaceutical

ity to make sure that the team is all growing in the

company Bristol-Myers Squibb.

same direction and that we have a shared vision for

“We were selected because Peers for Progress

the future. And that’s always a challenge. We have

wanted to do an urban program that would inte-

to strategically plan to work and then work the

grate community health workers into primary care

plan. It can’t sit on a shelf.

to improve the health status of Type II diabetics,”

“I think you have to be incredibly focused on

Corpuz said.

where you want to go in order to get there and you

Although community health workers had always

have to remember it’s a marathon, not a sprint.

been part of the Alivio team, they were mostly vol-

You’re not going to be able to get everything done

unteers who provided the community with educa-

overnight or you’ll burn yourself out.”

tional support groups. Under Peers, these workers were hired into the organization and tasked with

BY PETE FERNBAUGH

the goal of lowering A1C-level indicators among the

HCE EXCHANGE MAGAZINE

JEFFERSON COMMUNITY HEALTH CARE CENTERS

Wants to be the Friendliest Hospital in N.C. Even as healthcare reform provides more people with health coverage, many patients still face barriers in accessing care. For this reason, community health centers provide a vital service to indigent and homeless populations.

Dr. Shondra Williams, Chief Executive Officer

Jefferson Community Health Care Centers (JCHCC) is a system of four clinics in Jefferson Parish, La., that are all certified Patient-Centered Medical Homes, providing care close to home to populations in need.

DEDICATED STAFF FROM THE TOP DOWN

While in that position, she learned to navigate poli-

Finding the right staff and physicians to provide

state and what drives outcomes, all of which she

care is one of the biggest challenges faced by

applies to promoting the highest quality and com-

community health centers. The patient populations

passionate care at JCHCC clinics.

these clinics serve can be complex. Providers are

cies and understand the scope of healthcare in the

“Our mission is to provide high-quality care to

confronted with multiple health conditions, along

the uninsured, underinsured, and most vulnerable

with psychosocial issues that make it harder for the

populations in and around Jefferson Parish,” Wil-

patients to adhere to treatment plans.

liams said. “Our providers have a reputation of trust

It takes individuals dedicated to the holistic healing of people in need to work at one of JCHCC’s clinics.

in our communities that is so vital for helping our patients.”

ficer of JCHCC. Most of her career has been spent

PROVIDING A ONE-STOP SHOP FOR THOSE IN NEED

caring for indigent populations. She trained as a

Because many patients in the community struggle

nurse, receiving a master’s and PhD in nursing,

to find transportation to multiple appointments,

which gives her insight into providing care at the

face limits in accessing technology, and deal with

bedside.

other social factors, JCHCC strives to provide one-

Shondra Williams, PhD, is chief executive of-

“As a nurse, I understand the holistic care that’s needed,” she said. “Nurses know how to reach and

stop shopping for healthcare needs. The clinics offer primary care, preventive

engage patients, as well as reaching providers in

health, disease management, and specialty ser-

a way they can understand. As CEO, I also hold the

vices, including pediatrics, dentistry, podiatry, and

responsibility of galvanizing internal and external

behavioral health. In addition, patients can find en-

stakeholders in our mission. Population health is

abling services such as billing Medicaid, assisting

more important now than ever.”

with enrolling in marketplace plans, and connecting

Before coming to JCHCC, Williams was program director for the Department of Health and Hospitals, overseeing 63 clinics across Louisiana.

to social services outside of the clinics. “Our goal is to increase access to care as much as we can for a community of more than 435,000

Real Issues : Real Solutions

15 | JEFFERSON COMMUNITY HEALTH CARE CENTERS

Eagan Insurance Agency, LLC Toll Free: 888.882.9600 duvernayj@eaganins.com

residents,” Williams said. “We develop external

Going the extra mile for its patients is integral to

partnerships to optimize what we do, while control-

JCHCC’s vision, Williams stressed.

ling costs and sharing services.”

However, coordinating care, not only across the

With policy changes, Williams believes that being

JCHCC network, but also across multiple health-

able to provide multiple services under one roof is

care providers, creates difficulties in controlling

vital for vulnerable populations.

costs. JCHCC is a member of the Bayou Health

“Policy constraints in our state have increased

Plan, a statewide initiative to coordinate healthcare

the level of public/private partnerships, but have

by avoiding duplication, reducing costs, and improv-

left a gap in services available to indigent popu-

ing quality.

lations,” she said. “We have to analyze how our

While JCHCC is a data-driven organization with

clients access specialty services under one roof and

detailed tracking of outcomes, Meaningful-Use

review the social determinants that create barriers

compliance, and evidence-based decision making,

to accessing care. The most essential one is trans-

Williams said it is still challenging to keep up with

portation, and all that is improved when you have a

policy changes related to being compliant with the

comprehensive healthcare delivery system.”

Bayou Health Plan.

CONTROLLING COSTS AND PROMOTING PATIENT RESPONSIBILITY

“So many changes occur frequently, and we have to adapt as necessary to continue being reimbursed for the services we provide,” she said.

industry require everyone to control costs and limit

KEEPING COMMUNITY AT THE CORE OF ITS MISSION

spending, but it is also encouraging patients to take

JCHCC continues to gain assistance through public

more responsibility for their health.

programs and partnerships.

Reform and other factors within the healthcare

Williams said reform and availability of health

Recently, JCHCC was awarded a grant, one of

insurance is reshaping the behavior of the patients

30 given in Louisiana, by the Health Resources and

they see. She said JCHCC has reached out to more

Service Administration to expand primary care and

than 1,000 individuals to help them enroll in mar-

dental services to low-income families. JCHCC

ketplace plans, and many of them have received

also partners with the medical schools at Louisiana

subsidies in the first year, some taking their premi-

State University and Tulane to train young physi-

ums down to less than $1 a month.

cians in a community-based setting.

“There’s a need for patients to be responsible

“What we do is challenging, but we always

for their healthcare now,” she said. “They need to

ensure patients get quality treatment regardless

have an email address and access to some resourc-

of ability to pay,” Williams said. “Community is the

es to assist in decision making. Those are things my

very essence of what we do, and we are dedicated

team had to help them develop.”

to coordinating the care and meeting the medical

To promote that responsibility, JCHCC has also launched a patient portal to help patients understand what’s happening with their healthcare.

and psychosocial needs of our patients.” BY PATRICIA CHANEY

HCE EXCHANGE MAGAZINE

JAN/FEB

2015

HCE Exchange Magazine EDITORIAL Editor: In-Focus Pete Fernbaugh Contributing Writers Teresa Pecoraro Jacqueline Rupp David Winterstein Meghan White Patricia Chaney Kathy Knaub-Hardy Editorial Associates Levent Nebi Deepa Bhatia Lori Ryan Anami Mittal ART DEPARTMENT Art Director Kiki Ikura Associate Art Director Devdutt PRODUCTION DEPARTMENT Production Director Russell Ford Production Associate Ivan Bogdanovich SALES DEPARTMENT Sales Associates Rahul Bhende

HCE EXCHANGE

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Real Issues : Real Solutions

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