Industry Outlook | Winter 2014 Edition by Premier, Inc.

STRATEGIC LEADERSHIP FOR FINANCIAL AND CLINICAL HEALTHCARE EXECUTIVES • SPECIAL EDITION • WINTER 2014

Reinventing the Care Experience

The New Healthcare Marketplace

The 5-Star Patient Experience

About the cover The Economic Outlook team is excited to bring you the first edition of the Industry Outlook. As the name, “At Your Service,” implies, this edition highlights the growing emphasis on consumer choice and service culture in the healthcare industry. Healthcare stakeholders –including providers, payers, suppliers and a wide range of others – are rapidly innovating to provide less costly, higher-quality, patient-centered care. By showcasing the industry’s efforts to increase patient engagement, we hope to offer insight on enhancing patient experience, the next frontier in performance.

About the publication Stemming from thought leadership we

A key aspect of the long-term strategy for

have provided semiannually in the Eco-

the Outlook series is collaboration among

nomic Outlook since spring 2011, the

internal and external subject matter ex-

Outlook series has been expanded to a

perts to build consensus across diverse

quarterly publication that now includes

points of view. The publication harnesses

the Industry Outlook and the Quality Out-

the expertise of our network of health-

look, first published summer 2013. Unlike

care leaders to illuminate best practices

the other publications in the series, the

and strategies that can drive performance

Industry Outlook highlights one specific

improvement. Our goal is providing our

macro-level trend impacting healthcare

members and other healthcare organiza-

and examines that trend across the supply

tions with valuable, timely information

chain. This first edition, which illustrates

and business intelligence derived from the

the growing emphasis on service culture

industry’s most progressive participants.

and patient experience in healthcare, offers strategic insight about the trend’s dual aspects – how it has been shaped by current healthcare reform and how the trend itself affects how healthcare might look in the future.

We welcome your comments and questions. For additional information, please email economicoutlook@premierinc.com. premierinc.com/economicoutlook outlookmarketplace.hostedbywebstore.com

LETTER 01

EXECUTIVE LETTER

Healthy service, healthy outcomes Mike Alkire, Chief operating officer, Premier, Inc.

FEATURES | ENHANCING PATIENT EXPERIENCE THE CARE EXPERIENCE

05 REINVENTING THE CARE EXPERIENCE

12 THE NEW HEALTHCARE MARKETPLACE: A PATIENT-CENTRIC MODEL

09 FACE TIME WITH MAUREEN BISOGNANO

17 AT YOUR SERVICE: STRENGTHENING PATIENT ENGAGEMENT

PERSPECTIVES 23

OUTLOOK LEADERSHIP

TRENDS

The Five-star Patient Experience: How Henry Ford Health System is Redefining Hospital Service

MANAGING DIRECTOR Kayla Sutton

28 High-touch Pharmacy Care 32 Success Stories

EDITORIAL STAFF

E XECUTIVE SPONSORS Mike Alkire, chief operating officer Durral Gilbert, president, supply chain services Amy Denny, vice president, strategy, supply chain services A special thanks to Andrea Blom, Tina Harlan, Vic Simianu, Jeff Willink, and Laura Yandell for their contributions to this edition of the Industry Outlook.

DESIGN AND PRODUCTION Chris Cardelli, director, creative services Sung Ginader, senior graphics designer, creative services Dave Dixon, associate graphics designer, creative services Bryan Verrone, project manager, creative services EDITORIAL SUPPORT Amanda Forster, vice president, public relations Alven Weil, director, public relations Bryan Alsop, senior manager, corporate communications

EX E C U TI V E LE TTER

Healthy service, healthy outcomes

The hospital’s outreach doesn’t end there. It extends into the community via a weekly farmers market that promotes healthy foods and showcases local produce. There is also a demonstration kitchen that offers classes in nutrition and healthy cooking and is often home to local school field trips. It’s an approach that addresses a problem many providers are facing right now. How do we connect with our communities and patient populations so that we aren’t seen solely as a place for the sick? The Henry Ford West Bloomfield executives understand that we must engage people while they’re healthy and involve them in the culture of our health systems.

MEMBERS OF THE PREMIER ALLIANCE,

The idea appears to be working. Since opening its doors in 2009, Henry Ford West Bloomfield’s 30-day readmission rates and length of stay are among the lowest in the country. At the same time, patient satisfaction scores have remained above the 90th percentile.

ealth systems have long distinguished themselves based on the top priorities for all

Care for the whole person

providers: clinical quality and safety. Now,

Conversations about healthcare reform frequently target

many of these providers are also focusing

care models that take ownership of the patient lifecycle,

on other aspects that create satisfied, engaged patients.

including bundled payments, patient-centered medical homes, and accountable care organizations (ACOs), to name a few.

In constructing Henry Ford West Bloomfield Hospital

These programs encourage a more holistic view and help

– Henry Ford Health System’s first new hospital since

control costs while ensuring that the right care is provided

1915 – executives wanted to create something radically

by the right people, in the right place, at the right time.

different from the traditional hospital environment. That difference is apparent from the moment patients arrive.

It’s only logical to emphasize a holistic view of the patient

They are greeted by a concierge who helps them find their

in others ways as well. When surveyed for our fall 2013

pre-assigned room where they can order room service

Economic Outlook, 71 percent of C-suite executives said

and even preset music and television preferences.

that they are dedicating resources to lifestyle and wellness coaching for improved population health management. Of the

And the differences don’t stop there. The emphasis on health

top nine areas of resource dedication, five focus on changing

and wellness extends throughout the hospital, from Henry,

the way that patients experience care (for example, home

the therapy dog, to the food at Henry’s Café, much of which

health, telemedicine, and transitional or end-of-life care).

is stocked directly from West Bloomfield’s own greenhouse, to healing arts programs and yoga classes. The facility freely

An industry that has long been seen as lagging behind

borrows innovative concepts and best practices from other

others in terms of customer service is changing to

sectors. In fact, the system’s current vice president of hospitality

feature innovative consumer choices and a holistic

and service culture came directly from the Ritz-Carlton Hotel

definition of the patient and person experience.

Company as did West Bloomfield’s first president and CEO. OUTLOOK

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EX E C U TI V E LE TTER

Healthy service, healthy outcomes

Adding choice

Closing

Providers aren’t the only ones moving beyond traditional

Healthcare is undergoing radical changes, and many of us

healthcare business practices. Through additional

are trying to determine what we’re going to look like in this

consumer choices, such as healthcare exchanges,

new atmosphere. To meet the needs of our communities,

other commercial products, and patient education

we’re moving care beyond the hospital walls and changing

programs, payers are acknowledging the importance

how we deliver care within them. In a time where much of

of patient engagement and marketplace realities.

our success hinges on whether we can get patients actively engaged with their own health, it’s vitally important we focus

The Hawaii Medical Service Association (HMSA) recently

our efforts on what people actually want and need from us.

opened retail centers that offer people a place to meet directly with representatives to ask about products. Representatives

At Premier, we believe the future demands safe, affordable,

also provide policy information and help people sign up for the

high-quality care. As we continue to provide that, we’ll also

state exchange. HMSA is also investing in various tools aimed

be exploring the nearly limitless opportunities available

at keeping patients more engaged with their care, including

to positively transform the healthcare experience.

a virtual care, Skype-like program that enables patients to reach a physician 24 hours a day and provide alerts for patients who are eligible for screenings or immunizations.

– MIKE ALKIRE Chief operating officer

/ Premier, Inc.

“We’re shifting our focus away from just paying claims,” Hilton Raethel IV, HMSA’s executive vice president and chief health officer, recently told HealthLeaders magazine. “Now we’re focusing much more on keeping people healthy, out of hospitals, getting the appropriate screenings. We’re emphasizing reduction of disease.” Suppliers that have long competed on cost and outcomes are also exploring new ways to do business that enhances consumer choice and patient experience. Noise, a major contributor to poor patient satisfaction, has been a big focus for suppliers from construction and facilities products all the way to MRI machines. GE Healthcare, for instance, recently introduced the Silent Scan, a magnetic resonance scanner that takes noise from jackhammer-like levels to nearly ambient sound. We’re also seeing a growing number of suppliers that exist primarily in the experience space. Bear Facts Entertainment, a company that creates multi-sensory environments for healthcare facilities, can completely transform the way a hospital looks and feels. It can make your radiology rooms look like the beach, the CT scanner a sandcastle.

It can make your radiology rooms look like the beach, the CT scanner a sandcastle.

FEATURES Reinventing the Care Experience, 5 Face Time with Maureen Bisognano, 9 The New Healthcare Marketplace: A Patient-Centric Model, 12 At Your Service: Strengthening Patient Engagement, 17

THE CARE EXPERIENCE

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Kayla Sutton

Managing director / economic outlook Premier, Inc.

Sutton is a healthcare supply chain strategist who researches, writes and speaks about trends in the healthcare system. As the managing director of economic outlook, Sutton

or some time now, industry

holistic care to keep patients from

leaders have wanted to

using more costly services that could

supplement existing

be avoided through patient-centered

quality and clinical data

disease management and similar

by learning how patients perceive the

wellness programs. Value-based

healthcare experience. Evaluating

payment and other payment reform

the care experience has largely

models provide additional incentives

semiannual flagship publication, Economic

focused on patients’ satisfaction

for clinicians to more effectively

Outlook. She also holds responsibilities

with the services they receive.

manage the entire care continuum.

leads strategy and execution of Premier’s quarterly thought leadership publications: Industry Outlook, Quality Outlook and its

Today, in line with healthcare’s

within the supply chain strategy team.

Increasingly, value-based payments

concentration on coordinating care

will depend not only on provider

manager for the Center for Healthcare

across the continuum, assessing

performance and efficiency but also

Supply Chain Research, the non-profit arm

patient satisfaction means forming

on patient experience scores, which

of the Healthcare Distribution Management

a more holistic view of a patient’s

are typically judged by HCAHPS.

full interactions with the healthcare

Fiscal year 2013 payments were

system. This includes anything

split 70/30 between clinical process

that affects the patient experience,

and patient experience, while fiscal

from enhanced patient-caregiver

year 2014 reduced clinical process

communications to affordability

to 45 percent of payment, with 25

and accessibility of care.

percent based on outcomes. We expect

Previously, Ms. Sutton served as research

Association, where she authored several benchmarking studies on the specialty pharmaceutical industry, track and trace, and other supply chain issues. Prior to her work in supply chain research, Sutton coordinated clinical research programs in cancer, stroke and communicable disease care at Georgetown University Medical Center and Wake Forest University School of Medicine.

Several features of healthcare reform encourage more comprehensive,

that will continue to evolve over the next few years (see figure 1).

Beyond asking patients to rate hospital care, the industry is also asking them to evaluate their satisfaction with:

Physician and nurse communications

Facility cleanliness

Quietness of rooms

Ease of understanding discharge plans

Level of follow-up after discharge

OUTLOOK

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Greater coordination among providers

Fig.1

Value-based payments move toward outcomes and efficiency

FY 2014

FY 2013

30%

25%

FY 2015

30%

70%

20%

30%

45%

FY 2016

30%

25%

25% 10%

20%

40%

Active Performance Period

Clinical process

Patient experience

Outcomes

Source: Premier, Inc.

Providers are using telehealth or remotebased services to boost convenience and encourage patient engagement.

Efficiency

clinics – is undergoing a major transition.

systems and others are trying to address

helps ensure delivery of the most

We’re seeing a change in aesthetics

convenience and affordability issues

appropriate care in the most appropriate

(building supplies shifting to low-noise

through innovative concepts and

settings, while avoiding more costly, less

and green products, for instance), as

programs, such as patient-centered

patient-centric alternatives (i.e., the

discussed in this edition’s “The New

medical homes that aim to reduce

emergency department). This approach

Healthcare Marketplace” and “The

confusion about treatment plans and

requires that providers shift their

Five-Star Patient Experience.” We’re also

improve coordination among patients,

emphasis from acute care to outpatient

noticing changes in the actual location

specialists and primary care physicians.

facilities or alternative care sites, whether

of care, with the expansion of medical

There are currently more than 1,400

based in the home or in the community.

services into non-traditional settings

health clinics located inside retail

and the proliferation of telemedicine

pharmacies. This number is double

and mobile health applications.

that of six years ago3 and is expected to

Just as new care delivery models encourage holistic patient-provider

double again between 2012 and 2015.4

relationships, evaluating the success of these models requires a more complete

Innovation in care settings

Data from the three largest operators

analysis of the patient experience. To

Access and affordability can influence

of retail clinics – MinuteClinic,

optimize the overall care experience, we

whether or not people receive

TakeCare and LittleClinic – showed

must improve affordability; reduce or

recommended care and adhere

that the influx of retail clinics has

eliminate complexity; and pay attention

to treatment (see figure 2).

met an existing need. There were 5.97

to choice, convenience and flexibility for patients and their families.

For some who will be obtaining insurance coverage for the first time in 2014, many from low- and middle-

million visits to retail clinics in 2009, up from 1.48 million visits in 2007.5 Retail clinics can serve lower-acuity

Care where you live

income families, convenience and

patients in convenient locations.

What we’ve always thought of as

affordability will be a determining

(Approximately one-third of the

traditional care settings – hospitals or

factor in where they seek care. Health

urban U.S. population lives within a

FE ATU R E S

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Fig.2

Where cost interferes with care Percentage of people surveyed who say they couldn’t see a doctor in the past 12 months due to cost

17.1% of Californians don’t see a doctor because of expense. 7.5% of Hawaiians reported difficulty seeing a doctor due to cost. The state suffers from one of the worst doctor shortages. People who didn’t see a doctor because of expense also live in the states with the lowest number of primary care physicians per resident, according to the Association of American Medical Colleges: Mississippi (160), Texas (176), Alabama (178), and Oklahoma (179). North Dakota residents report the least amount of trouble seeing a doctor; 6.5% have difficulty. In Mississippi, 1 in 5 people haven’t been to a doctor because of money. 6.5%–10.8%

11.1%–13.1%

13.3%–13.7%

16.8%–20.9%

Source: Bloomberg Businessweek, "Is Concierge Medicine the Future of Health Care?"

The region where people reported more healthcare affordability is also where there is a less acute doctor shortage: the Northeast.

10-minute drive from a retail clinic.6)

exchange consumers to speak with

providers for telehealth services just as

Insurers, previously skeptical about

representatives about insurance options.

they reimburse in-person care. These

covering care administered in a retail

mandates also prohibited insurers from

setting, now view it as a way for patients

Proliferation of telemedicine/

to manage regular vaccinations, check-

mobile health

ups and other non-acute issues.

Patient and family engagement has become

a wide range of services, including

a prime indicator of satisfaction with

patient monitoring and compliance,

also begun leveraging the scale and

care and adherence to treatment plans

remote diagnosis, public wellness, health

accessibility of retail pharmacies while

(see figure 3). Establishing alternative

surveillance and information on disease

simultaneously increasing access

communication channels between patients

prevention.8 In September 2011, 17 percent

to healthcare services through the

and their care providers may be useful

of cellphone owners used their phones

acquisition or expansion of primary care

to increase connectivity, depending on

to look for health or medical information

groups, urgent care facilities and other

individual patient needs and preferences.

online; by September 2012, that figure

ACOs and health systems have

denying coverage for telehealth services.7 Mobile healthcare applications offer

community-based centers. One example

Providers are using telehealth

reached 30 percent.9 Estimates suggest

of this is Heartland Health’s Mosaic Life

or remote-based services to boost

that by the end of 2017, the total mobile

Care program, which has opened several

convenience and encourage patient

health market will have grown by 61

locations where patients can easily and

engagement. Someone in a rural area, for

percent to approximately $26 billion.10

conveniently meet with life coaches

instance, may have a difficult time going in

to discuss diet, nutrition, exercise and

for regular appointments if the physician

have great potential to improve patient

even non-health-related concerns.

is far away. Telemedicine programs and

access and engagement. New incentives

mobile health applications are growing

for providers to lower readmission

their community presence. HMSA, a

in popularity for this very reason. As of

rates and more properly manage

health plan in Hawaii, has launched

summer 2013, 19 states mandated that

patient care rely on patients being fully

retail centers that allow state

private insurers reimburse healthcare

engaged in their own healthcare.

Payers are also expected to increase

Telehealth and mobile health services

OUTLOOK

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Fig.3

Activated patients have better outcomes The more activated you are in your own healthcare, the better healthcare you get More activated patient

Less activated patient

Readmitted to the hospital within 30 days of discharge Experienced a medical error Have poor care coordination between healthcare providers Suffer a health consequence because of poor communication among providers Lose confidence in the healthcare system 60%

50%

40%

30%

20%

10%

20%

30%

40%

50%

60%

Source: mHealth Summit 2012, "Innovating the Way: mHealth, Military and Veterans Care."

Concierge medicine

offering similar services as accountable

Concierge medicine is the concept

care organizations. They are paid a set

of paying providers for additional

amount per month to keep patients

services, such as rapid return calls

healthy. It’s one more example of

or supplementary counseling. In an

expanded options for patients and

era when providers are paid less and

potential healthcare consumers. Patient

have more demands on their time,

engagement is a necessary piece of the

concierge medicine is a way patients

accountable care, population health

can receive higher-touch care as long as

puzzle. Giving patients greater choice

they are willing to pay more. There are

in the care they receive can increase

varying concierge service levels within

their own health accountability.

medical practices. Some providers

Improving the patient (or “person”)

have hybrid models that accept all

experience not only makes for a single

patients, with only 3-8 percent opting

positive interaction, it can also increase

in for additional services. Others

engagement, reduce costs and improve

accept concierge patients only.

outcomes. The growth in community-

Medical practices offering concierge

located facilities, proliferation of

services can also differ in the payment

telemedicine and mobile health

options they accept. A recent article in

applications, and the introduction of

Bloomberg Businessweek highlights a

customizable or concierge services are

concierge medical practice that does not

some of the more dramatic changes

take insurance but charges a monthly

aimed at engaging patients and their

fee for regular access to physicians.

families. Innovation regarding location,

Although many say concierge

setting or services offered can also

services are just another way for

have a huge impact on the way people

wealthier patients to get better care,

receive and perceive their care.

some concierge practices are actually

REFERENCES 1. Devin Leonard, “Is Concierge Medicine the Future of Health Care?” Bloomberg Businessweek, November 29, 2012, http://www.businessweek.com/articles/2012-11-29/isconcierge-medicine-the-future-of-health-care. 2. Andis Robeznieks, “Retail Clinics at Tipping Point,” Modern Healthcare, May 4, 2013, http://www.modernhealthcare. com/article/20130504/MAGAZINE/305049991/. 3. Ibid. 4. “U.S. Retail Health Clinics Expected to Double by 2015, According to Accenture,” Accenture, June 12, 2013, http:// newsroom.accenture.com/news/us-retail-health-clinicsexpected-to-double-by-2015-according-to-accenture.htm. 5. “Projections: 2,868 Retail Clinics in 2015,” July 17, 2013, American Hospital Association Resource Center, http:// aharesourcecenter.wordpress.com/2013/07/17/ projecions-2868-retail-clinics-in-2015/. 6. Ibid. 7. Eric Wicklund, editor, “More States Take to Telehealth Expansion,” Healthcare IT News, July 17, 2013, http://www. healthcareitnews.com/news/more-states-take-telehealthexpansion. 8. “Rising Popularity of Mobile Health Apps,” Visual.ly [infographic], January 12, 2013, http://visual.ly/rising popularity-mobile-health-apps. 9. Ibid. 10. Peter McLaughlin and Melissa Crespo, “The Proliferation of Mobile Devices and Apps for Health Care: Promise and Risks,” Bloomberg BNA, May 20, 2013, http://www.mofo. com/files/Uploads/Images/130520-BNA-Proliferation-ofMobile-Devices-and-Apps-for-Health-Care.pdf. 11. Linda Harder, “Alternative Care Delivery Models,” Maryland Physician, June 28, 2012, http://www.mdphysicianmag.com/2012/06/28/alternative-care-delivery-models/. 12. Devin Leonard, “Is Concierge Medicine the Future of Health Care?” Bloomberg Businessweek, November 29, 2012, http://www.businessweek.com/articles/2012-11-29/isconcierge-medicine-the-future-of-health-care.

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FACE TIME WITH

Maureen Bisognano, president and chief executive officer, Institute for Healthcare Improvement (IHI), previously served as IHI’s executive vice president and chief operating officer for 15 years. She is a prominent authority on improving healthcare systems, whose expertise has been recognized by her elected

Maureen Bisognano I

president and chief executive officer, Institute for Healthcare Improvement

Lately, more health systems and stakeholders have been engaging in programs to enhance patient experience or build a service culture within their organizations. Can you explain why patient experience is becoming an area of greater emphasis within the healthcare industry? I think there are a few contributing factors to this big shift in the past couple of years. There’s been a dramatic transition from a “caring for” culture to one of “caring with.” I was at a recent Health Affairs meeting and the theme was “patient

membership to the Institute of Medicine and by

engagement is the next blockbuster drug.” I think everyone’s coming to realize

her appointment to The Commonwealth Fund’s

that’s the case.

Commission on a High Performance Health

Medication adherence is only averaging approximately 50 percent across the

System, among other distinctions. She is also

board. Providers don’t typically know which patients are adherent until the

an instructor of medicine at Harvard Medical

patients show up with escalated illness. For whatever reason, patients aren’t taking

School, a research associate in the Brigham

their medications, and this is a big issue. It’s clear we need to be better at engaging

and Women’s Hospital Division of Social

our patients in their own care plans.

Medicine and Health Inequalities, and serves on the boards of the Commonwealth Fund, ThedaCare Center for Healthcare Value, and Mayo Clinic Health System-Eau Claire. Prior to joining IHI, she served as chief executive officer of the Massachusetts Respiratory Hospital and senior vice president of The Juran Institute.

It’s a critical way for us to think about new design in healthcare. We see that outcomes improve when patients are involved in co-designing and co-producing care. I think two things are really changing the dialogue here. Patient engagement is demonstrating superior clinical outcomes, and millennials are much more used to doing things for themselves than previous generations. Millennials have grown up managing many aspects of their lives in the palms of their hands, so the idea that a provider would just tell them what to do is very foreign to them. OUTLOOK

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What do you see as health systems’ top

What are some ways that patient and family

areas for improving patient experience?

experience can be improved within health systems

Leaders need to understand the entire patient journey.

and care facilities? How can the experience be

From the time physicians tell patients about upcoming

enhanced in the broader healthcare marketplace?

hospitalizations to the time patients return home,

It’s important that we cure and care for patients in a different

leaders need to better understand patient handovers

way. Curing is how we apply technology to diagnose and treat.

and care transitions. The problem is that our system is

A patient with a chronic disease will often see a physician twice

so fragmented that no one owns the patient journey.

a year for just 15 minutes at a time. In reality, patients with

Culture is also important. We have many generations

chronic disease have 5,000 waking hours each in which they

in the healthcare system now. “What’s the matter?”

manage their disease themselves. We have a choice between

used to be the first question asked, and providers

optimizing the 5,000 hours or optimizing the 15 minutes.

responded specifically to that question. “What matters to you?” might be a better question to

The other big curing piece is that physicians don’t know all the answers. Keeping up with the latest evidence is impossible.

ask. Since that is indicative of a service culture, rather than

Co-producing care is going to create much better outcomes.

a specific treatment, it can change the course of a patient’s

If I were a hospital CEO again, I would be wondering how to

journey. As leaders, we need to see the whole patient

use technology to optimize care in those 5,000 hours. Then

picture and change the way we think about our work.

I would work on redesigning care across the continuum. On the caring side, I think the whole experience needs empathy. Today’s healthcare leaders have a responsibility to teach their employees empathy.

“ What’s the matter?” used to be the first question asked...

IHI’s 2011 article, “Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care,” used Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data to distinguish those hospitals that patients would recommend. Do you think greater attention will be given to HCAHPS

“ What matters to you?”

results going forward? As a result of the Affordable

might be a better

they sit with patients and actually talk about their experiences.

question to ask.

Care Act (ACA), do you anticipate reporting to include measures outside of the inpatient setting? HCAHPS scores are a step toward the in-depth knowledge we need about service culture. It’s a red flag if you have to tell an executive that there’s an issue. That’s why I always ask the executives certain questions when I visit hospitals. I ask, “Do you know how good you are?” For service quality, I’d expect them to thoroughly understand their HCAHPS scores. I would also expect them to know about complaints and if their staff have what they need to do their jobs. I expect that Then I ask if they know where variation exists in their systems. There are typically pockets of excellence and pockets of mediocrity in every health system. It’s really important for leaders to know where the gaps are so that they can close them.

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Today’s healthcare leaders have a

responsibility to teach

their employees empathy.

It’s also important for hospital leaders to understand

One of the key factors is reducing the complexity of the

how they compare with others. If you don’t know your

service we provide to our patients. It’s very difficult to

organization’s benchmarks, you can become satisfied about

be a patient in our healthcare system. It’s a much more

scores and protocols in a way that isn’t helpful to growth.

complex system to navigate as a consumer. It could

Finally, I’ll ask if the executives know how they are trending over time. Are their HCAHPS scores getting

easily be reinvented, but we have to demand it. Through IHI’s Conversation Project, Ellen Goodman,

better? Many leaders think their HCAHPS scores are

a Pulitzer prize-winning journalist, is going directly to

good when they may be flat. Health system executives may

the public and telling every family to have a conversation

not even realize they could be falling behind hospitals

at home about end-of-life care. She’s advising them

that are seeing improved scores year after year.

to have that conversation now and not to wait until

Something I think we need is a total experience score, a way

the time comes. At IHI, we’re going to hospitals and

to assess the whole bundle of care. We need to get feedback

explaining how to work with patients who express end-

on where we fail, where physicians recommend different

of-life wishes. End-of-life care is just one factor, but

treatments, and where patients had to repeat themselves.

engaging patients and their families in this way will

We haven’t yet looked at the entire journey or care continuum.

get them used to being part of the conversation.

An interesting example is a patient in a nursing home who

We need to pay closer attention to patients and their

needs palliative or end-of-life care. If this patient uses an

families and help them fully understand clinical processes

oxygen tank in the nursing home, and then is transferred

and their treatment plans. When you engage patients

home, the payer will actually change the equipment that is

in their treatment decisions, they feel very empowered.

covered. Patients would have to change their oxygen tanks

That empowerment encourages self-management.

because they’re in a different bracket of coverage. I think that’s a failure in managing patient experience across the continuum.

Lastly, I think another aspect of patient engagement is in understanding the other assets within a community. Executives stepping outside the walls of their clinics

Patient engagement is a large factor in overall

and engaging with local community groups to encourage

experience. How do we get patients more engaged in

engagement with the health system is a new experience for

their care? What other challenges exist in creating a

hospitals. However, the more partners patients feel they have

more consumer-focused service culture in healthcare?

in their care, the more likely they will be to stay engaged. OUTLOOK

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nlike other industries, healthcare has

responded accordingly, adopting best practices and

historically drawn a distinct line between

methodologies from sectors such as retail and technology.

service and care providers and their consumers

A study conducted by The Beryl Institute showed patient

(patients). While it’s critically important that

experience as the top priority in 2013 for 70 percent of

patients adhere to treatment regimens and follow physicians’ recommendations,

responding healthcare leaders.2 When patients are educated about

navigating the healthcare system can be a

their options, healthcare becomes

complicated and intimidating experience

a true consumer marketplace.

for many. It’s often difficult for consumers

Providers, payers, suppliers and other

to fully understand their options and the

stakeholders look for innovative ways

range of services or products available

to offer high-quality, low-cost care

to them. People often know more about

that enhances the patient experience.

the phone or car they’re buying than the surgery they’re receiving. The Affordable Care Act (ACA) was designed to remove some of the barriers that currently exist in the system by

Provider initiatives To accommodate market expectations, a number of providers have created positions within their organizations, such

improving access to care and simplifying

as chief experience officers, dedicated to

disease and treatment management. Both

improving the patient experience. One

accountable care organizations and the ACA

study says 22 percent of facilities had

promote increased provider coordination and

such positions in 2013, up from 13 percent in

patient engagement through primary care

2011. 3 The study also noted that 45 percent of

physicians and new care delivery models. In

hospitals have established a formal definition

addition, healthcare reform laws are beginning to have an impact, with more than 30 states passing legislation regulating transparency practices.

The market has

for patient experience, an increase from 18 percent two years ago. And 81 percent have a formal structure for addressing patient experience, a 12 percent increase since 2011.4

FE ATU R E S

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Meanwhile, 86 percent of providers are using government-mandated

full risk for their patient populations,

using Premier’s QUEST® (Quality,

in effect functioning as payers.

Efficiency, Safety and Transparency)

surveys, such as HCAHPS scores,

program as the framework. Thus

to measure progress in patient

Payer initiatives

far, HMSA’s program has seen a 12.5

experience. Other common metrics

While some providers are acting as

percent drop in readmissions and

are patient satisfaction surveys

payers, certain payers have launched

a 43 percent decrease in hospital-

(80 percent) and post-discharge

initiatives to connect with providers.

acquired infections statewide.

calls (70 percent). Providers are

In 2011, the Hawaii Medical Service

also increasingly aware of their Net

Association (HMSA) began a four-year

president and chief health officer

Promoter Score, which measures how

program, Advanced Hospital Care, in

of HMSA, highlighted a few of the

patients rate the overall experience.6

which it partnered with its network

program’s strategies. “One of the main

of contracted hospitals and Premier.

things we’re doing is working to get

processes and improve patient care

The program aims to increase safety,

individuals much more engaged in their

coordination. Many providers are

reduce readmissions, cut costs and

healthcare than we have historically.

implementing integrated practice units

improve the patient experience.

We’ve opened a few retail centers,

New care delivery models streamline

(IPUs), teams that are organized around a patient to eliminate silos of specialized

HMSA now ties 15 percent of all reimbursements to facility performance,

Hilton Raethel IV, executive vice

and we have a new website that allows our exchange members to purchase

treatment. IPUs treat diseases and all related conditions, complications and related circumstances. For example, an IPU treating a diabetic patient would also treat any resulting kidney and eye disorders. IPUs work to engage patients and

The changing face of patient experience:

their families in treatment plans. Research has shown that clinics using IPUs have patients who miss fewer days of work and need less

22%

To accommodate market expectations, of providers have created a position dedicated to improving the patient experience.3

physical therapy. These facilities also reported increased revenue, since their improved efficiencies allowed them to see more patients.7

86 %

of providers are using government-mandated surveys to measure patient experience.5

With value-based payment models, providers are under constant pressure to assume more risk, as their financial rewards are linked to their

The Hawaii Medical Service Association ties reimbursements to facility performance.

15 %

of all

performance in cost, quality and outcomes. Some providers assume OUTLOOK

QTR 1.14

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insurance directly through us. We are

Pediatrics case study:

reaching out much more to individual

An MRI adventure

consumers than we have in the past,

Norton Kosair Children’s Hospital (Louisville,

patients to be active consumers.”

KY) and Winter Park Memorial Hospital

Other payers are using the new

because we can’t expect to see real outcome improvements without getting

(Winter Park, FL) are giving some of their

state and federal insurance exchanges

younger patients an unusual adventure – the

as well as creative marketing

chance to use a themed MRI machine.

strategies to connect with consumers.

These facilities allow children to select a

UnitedHealthcare, for example, has

cartoon character who will help guide them

established retail stores in shopping

through the process. When the child chooses

malls where consumers can compare

a character, all surroundings change to match.

and buy insurance products. Aetna

The new technology makes the visit a little less

has formed a partnership with Costco

scary for the child. When the children have a

to sell individual health insurance

good experience, their parents do, too.

plans in some of its stores.9 Payers have also begun introducing products that give consumers more choices. These include health savings

When the children have a good experience, their parents do, too.

accounts (HSAs) and plans with lower premiums and higher deductibles that encourage patients to be more selective with the services they use. Enrollees in HSAs went from 4.5 million in January 2007 to 15.5 million in June 2013.10 “We really believe in patient choice in terms of both providers and products,” says HMSA’s Raethel. “We want patients to get involved in their care. They need information to make good or better healthcare decisions. We’re shifting our focus away from just paying claims to keeping people healthy, out of hospitals, and getting the appropriate screenings.” Payers are also working with providers to create notification systems

FE ATU R E S

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that alert physicians to which patients are eligible for mammography or

dressing rooms look like cabanas. Equipment design is changing

a more relaxing environment and improve patients’ family experiences.

other screenings. And they’re piloting

as well, as suppliers work to

programs and products that help

accommodate bariatric patients or

an important role. Designers are

patients connect with their physicians.

those with claustrophobia. Other

working to reduce hospital noise,

strategies include reducing radiation

even going so far as to use silent

that allows patients to speak with a

doses while maintaining image

casters on movable equipment.

physician via computer 24 hours a

quality, thus creating a higher-

day. “In behavioral health, we have

value experience for the patient.

Raethel says HMSA has an application

a model where a provider will do an

Environmental impact also plays

And of course, cleanliness and safety remain vitally important. One recent innovation is replacing paper-based

initial evaluation in person, especially

Construction

drywall with glass matte-faced drywall,

for patients outside of the Big Island,

More than ever before, construction

which has been found to decrease mold.

then weekly follow-up consults are

suppliers are changing their focus

done using online technology.”

from function to form by asking

Supplier innovations Suppliers are also contributing to the

As the healthcare industry moves to

themselves which designs deliver

a performance-based reimbursement

a better consumer experience.

model, providers, payers and

Some facilities have implemented a

suppliers are finding new partnership

new patient-centered marketplace,

number of smaller nursing stations on

opportunities. It’s in the best interest

creating technologies that foster

the floor to permit more rapid patient

of all involved to create higher-value

an enhanced patient experience.

access. At the same time, planners

healthcare, and many partners have

Two key areas where significant

are realizing that additional spaces to

discovered that patient-centered care

advancements have been made are

wait, sleep or watch television create

is the best mechanism for delivery.

in radiology and construction. Radiology Few hospital experiences are more frightening than a visit to the radiology department, particularly since the loud noise from an MRI machine is unsettling to many patients. Suppliers are searching for innovative solutions to reduce patient stress and improve the overall experience. At Celebration Hospital (Kissimmee, FL), for instance, the radiology department resembles a beach. The CT scanner is shaped like a sand castle, and the

REFERENCES 1. TripleTree, Empowering Individuals To Be Better Healthcare Consumers: An Assessment of How Consumerism and Innovation in Healthcare Are Redefining How Consumers Engage with the Healthcare System, Industry Perspective (Minneapolis, MN, 2013). http://www.triple-tree.com/files/3313/6094/0083/Empowering_Individuals_To_Be_Better_Healthcare_Consumers.pdf. 2. Jason A. Wolf, The State of Patient Experience in American Hospitals 2013: Positive Trends and Opportunities for the Future, Report on The Beryl Institute Benchmarking Study (Dallas/Fort Worth: The Beryl Institute, 2013), http://www.theberylinstitute. org/?page=PXBENCHMARKING. 3. Wolf, The State of Patient Experience, 2013. 4. Ibid. 5. Ibid. 6. TripleTree, Empowering Individuals To Be Better Healthcare Consumers, Industry Perspective. 2013. 7. Michael E. Porter and Thomas H. Lee, “The Strategy That Will Fix Health Care,” Harvard Business Review (October 2013). http:// hbr.org/2013/10/the-strategy-that-will-fix-health-care/ 8. TripleTree, Empowering Individuals To Be Better Healthcare Consumers, Industry Perspective. 2013. 9. Ibid. 10. AHIP, Health Savings Account Enrollment Reaches 13.5 Million, (May 30, 2012). http://www.ahip.org/News/Press-Room/2012/ Health-Savings-Account-Enrollment-Reaches-13-5-Million.aspx.

OUTLOOK

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Susan DeVore Chief executive officer / Premier, Inc.

With approximately 30 years of experience, DeVore is an industry-leading thinker who has been named to Modern Healthcare’s 100 Most Influential People in Healthcare and Top 25 Women in Healthcare lists. She serves on the board of directors for American Diversified Reinsurance Ltd., National Center for Healthcare Leadership, Coalition to Protect America’s Health Care, and the Medicare Rights Center. She is an executive committee member of the Healthcare Leadership Council and Charlotte Chamber of Commerce. DeVore is also a member of the Institute of Medicine’s Roundtable on Value and Science Driven Health Care. Under DeVore’s leadership, Premier has built an industry-leading code of ethics, been named six times as one of the World’s Most Ethical Companies by Ethisphere, won the Malcolm Baldrige National Quality Award, been named to Information Week’s 500 top technology innovators in the nation four years running and won IBM’s CTO innovation award for advanced analytics in healthcare. DeVore obtained a bachelor’s degree from the University of North Carolina at Charlotte and a Master of

Management degree from McGill University.

or those of us who have

Many of the changes we’ve seen in

been in healthcare for

care delivery models, such as patient-

counterparts. Patients who are actively

some time, the recent

centered medical homes and accountable

engaged with their providers are more

surge in discussion

care organizations, emphasize the

likely to receive the appropriate care

about reinventing

need to engage patients and help them

at the appropriate time, avoiding

the patient experience has been hard

navigate the healthcare system based

complications, and follow preventive

to miss. Incentives built into the

on their needs. Patient engagement

recommendations.3 Similarly, providers

Affordable Care Act require that we

is considered a strategy to meet the

whose patients are actively engaged are

change how we provide services in a

Institute for Healthcare Improvement’s

better able to identify health issues in

variety of important ways, such as better

Triple Aim, a framework consisting

a timely manner before they become

coordination of care and improving

of three dimensions – improving the

emergencies. That means providers and

efficiency of care by reducing waste and

patient experience, improving the

other stakeholders need to innovate

unnecessary variation in care delivery.

health of populations, and reducing

the way they interact with their

At Premier, we’ve talked at length about

the per capita cost of healthcare. It

communities and patient populations.

how we and our members are working

is also a prominent goal of the EHR

together to transform healthcare, and

Incentive Program, Meaningful Use.

improving the patient experience has been an important area of focus.

lower costs than their less engaged

Strengthening patient engagement is a 2

Observers widely believe that engaged patients have better outcomes and incur

necessary part of our journey to improve outcomes and reduce costs within the healthcare system. That’s why Premier’s OUTLOOK

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Fig.1

A Multidimensional Framework for Patient and Family Engagement in Health and Healthcare

QUEST® program, one of the most comprehensive hospital collaboratives in the nation with approximately 330 participating health systems – saving

CONTINUUM OF ENGAGEMENT Levels of engagement

Consultation

Involvement

DIRECT CARE

Patients receive information about a diagnosis

Patients are asked about their preferences in treatment plan

Treatment decisions are made based on patients’ preferences, medical evidence, and clinical judgment

ORGANIZATIONAL DESIGN AND GOVERNANCE

Organization surveys patients about their care experiences

Hospital involves patients as advisers or advisory council members

Patients co-lead hospital safety and quality improvement committees

Public agency conducts focus groups with patients to ask opinions about a healthcare issue

Patients’ recommendations about research priorities are used by public agency to make funding decisions

Patients have equal representation on agency committee that makes decisions about how to allocate resources to health programs

over $10.1 billion and avoiding 112,000 hospital deaths since its inception in 2008 – now includes a new domain of focus for participating health systems: patient and family engagement.

It takes two

> Partnership and shared leadership

Patient engagement isn’t a one-sided endeavor. Rather, patient engagement can be enhanced and encouraged by both patients and providers, as well

POLICY MAKING

recently published an article on patient

healthcare community. Health Affairs

< >

as policymakers and the rest of the

engagement that outlined a continuum of engagement framework (see figure 1). This framework emphasizes that many factors contribute to patient and family healthcare, including

FACTORS INFLUENCING ENGAGEMENT PATIENT

Beliefs about patient role, health literacy, education

ORGANIZATION

Policies and practices, culture

SOCIETY

Social norms, regulations, policy

Source: Health Affairs, Health Policy Brief, “Patient Engagement. People actively involved in their health and health care tend to have better outcomes – and, some evidence suggests, lower costs.”

the practices of their providers and culture of their health system, and

and foremost, though, we need to

new knee or hip), and patients often

extending up through the regulations

involve and educate those who do not

do not have enough understanding of

and policies impacting healthcare and

engage with the healthcare system

the actual options or procedures to

health-related areas. For instance,

at all, or only in an emergency, and

comfortably weigh in about what is

changes to transportation or housing

bring them to a place where they

best for them. When buying a car or

policy can affect access to providers,

comfortably interact with providers.

choosing a college, people can access

thus impacting care. The framework

consumer-friendly reviews of the

also shows the progression from the

Engaged patients, healthy people

items in question to help them decide;

fairly typical consultative relationship

The healthcare industry differs in a

in healthcare, many rely on their

patients have with their physicians

multitude of ways from other industries

providers to make the choice for them.

to partnership and shared leadership

that emphasize consumer choice

at the other end of the spectrum.

and service. The services rendered in

willingness or inclination of patients

healthcare are not typically tangible

to manage their health and care. This

(though they can be, such as with a

includes their ability to understand the

Ideally, we want to move all patients to a shared leadership position. First

Patient activation refers to the

FE ATU R E S

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New care delivery models, such as patient-centered medical homes and

encouraging people to have

Gross, chief medical officer, Riverside

ACOs, are built on the

end-of-life conversations at

Health System (Newport News, VA).

home over dinner. Although 70 percent of people say

Care coordination and outreach

they prefer to die at home,

Increasing patient engagement isn’t

according to the Centers

just about the patient’s willingness to

for Disease Control and

be involved in healthcare decision-

and increasing the

Prevention, the same

making. It requires physicians and other

percent die in a hospital,

providers to be actively engaged with

“stickiness” between

nursing home or long-

their patients as well. Partly, it means

a patient population

term care facility.6 The gap

optimizing the educational opportunities

between a patient’s wishes

about illnesses and treatment options

and its providers.

and what actually happens

during the physician/patient visit. The

can create incredible

increase in telemedicine and mobile

difficulties for patients and

health applications also helps to

their families, to say nothing

enhance connectivity between patients

major role in how

of the financial burdens

and caregivers by reducing access and

placed on these families

communication barriers. Physician

these new models are

and the costs borne by the

time, however, remains limited.

concept of improving care coordination

Technology plays a

able to succeed.

healthcare system at large. Having the conversation

New care delivery models, such as patient-centered medical homes

can ensure that family

and ACOs, are built on the concept

members are aware of

of improving care coordination and

a patient’s desires for

increasing the “stickiness” between a

options presented to them and navigate

end-of-life care, which will help them

patient population and its providers.

the healthcare system. Research at

better engage with providers when the

Technology plays a major role in how

Fairview Health Services (Minneapolis,

time comes. The Conversation Project

these new models are able to succeed.

MN) showed that patient activation

encourages the discussion among family

scores were directly related to the

members, while also preparing them

centered medical home practices offer

cost of caring for the patient. Those

to be more confident with providers.

layers of engagement for patients.

patients who were the most activated –

Ultimately, engaged patients are more

Riverside Health System’s patient-

“We provide patients the information

the most actively involved and skilled

likely to be satisfied with their overall

and tools to get the most out of their

in understanding their options – had

care experience. “Patient engagement

patient visits,” says Dr. Gross.

costs 8 to 21 percent lower than those

leads to better patient experience,

patients who were the least activated.5

because patients who are involved in

which provides a number of newly

IHI’s Conversation Project seeks

their care and invested in the outcome

developed features including lab

to improve the connectivity between

feel more empowered to ask questions

and diagnostic results monitoring,

patients, their families and providers by

of their caregivers,” says Dr. Barry

access to education and engagement

“It starts with our Patient Portal,

OUTLOOK

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FE ATU R E S

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“ If a physician can see only 50 percent of a patient’s clinical encounters, how can that physician make the very best treatment decisions?”

materials around chronic disease

CEO of Virginia’s statewide health

navigate the healthcare system through

management, and reminders of

information exchange and inHEALTH,

enhanced care coordination. Providers,

annual prevention exams.”

a population health-enablement

suppliers and other stakeholders are

Riverside Health System has also

partner. “Phytel leverages the

improving the patient experience from

implemented interdisciplinary plan-

investment providers have already

other angles by bolstering consumer

of-care rounds across its sites, as

made in their electronic medical

choice and by providing more patient-

well as face-to-face or telemedicine

records and integrates well with the

centered care delivery options.

patient handoff transitions between

HIE functionality. If a physician can

acute and skilled facilities to reduce

see only 50 percent of a patient’s

piece in many aspects of healthcare

miscues and drops. These efforts have

clinical encounters, how can that

reform. Without activated, involved

resulted in statistically significant

physician make the very best treatment

patients, it will be difficult or nearly

improvements in its patient

decisions? Engaged providers,

impossible to reduce chronic disease,

satisfaction scores across the board.

complete clinical information and

improve outcomes and reduce costs

systems support enable providers to

associated with the U.S. healthcare

of transforming the care experience

better coordinate care, identify gaps

system. Engaged patients are usually

at Riverside Health System. The

and enhance overall outcomes.”

happier, healthier patients. As we work

Partnerships are an important part

Patient engagement is an important

health system connected years ago

Data collection from electronic

on the ambulatory side with Phytel,

medical records, health information

that we take every opportunity to

a technology company and partner

exchanges and technology from

innovate and to question the way

in Premier’s population health

partners like Phytel makes the patient

we’ve always done things – both

platform, and two years ago extended

connection process more seamless, says

as providers and as patients.

the partnership into after-care calls

Matthews. Nevertheless, he emphasizes

for emergency room patients.

that information gathered from new

“Through Phytel, we reach our

technologies should dovetail with

patients who have been discharged

provider workflow. “It’s great to know

home and ask them a few simple

that 1,000 diabetic patients haven’t

items, including if they have questions

seen a physician in six months, but

about their discharge instructions or

you need standardized and efficient

any new medications. If the patient

processes that allow the physician to

requests a call back, a member of our

properly manage these patients in

team provides further clarification and

an actionable provider workflow.”

navigation,” notes Renee Rountree, vice president, patient experience,

Closing

Riverside Health System.

New care delivery models and revised

Technology is key to building connectivity, states Michael Matthews,

to transform healthcare, it’s important

incentives encourage providers to better engage their patients and help them

REFERENCES 1. IHI, “The IHI Triple Aim,” Retrieved from http://www.ihi. org/offerings/Initiatives/TripleAIM/Pages/default.aspx 2. HRSA, “Introduction to Meaningful Use.” Retrieved from http://www.hrsa.gov/healthit/toolbox/ HealthITAdoptiontoolbox/MeaningfulUse/ intro2meaningfuluseandpatientandfamily.html 3. Health Affairs. Health Policy Brief: Patient Engagement. People actively involved in their health and health care tend to have better outcomes – and, some evidence suggests, lower costs. (February 2013) Retrieved from http://www. healthaffairs.org/healthpolicybriefs/brief.php?brief_id=86 4. Ibid. 5. Ibid. 6. IHI. “The Conversation Project.” Retrieved from http:// theconversationproject.org/starter-kit/get-ready/

PERSPECTIVES The Five-star Patient Experience: How Henry Ford Health System is Redefining Hospital Service, 23

P E R S P E C TI V E S

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P E RS P E C T I V E S

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How Henry Ford Health System is redefining hospital service

oday’s healthcare consumers have unprecedented choices, thanks to the increased accessibility of

provider performance information.

This enhanced transparency enables patients to make more informed decisions while simultaneously compelling providers to improve the overall consumer experience. As a result, many healthcare systems are expanding their focus from clinical care only to the broader aspects of patient care. In creating a brand new hospital,

very mature market, we needed to create

the world, gave him a particular edge in

great distinction. That distinction was

understanding the customer experience.

Detroit’s Henry Ford Health System

already there in our clinical products,

“Patients are becoming consumers

took advantage of an opportunity to

but it needed to be there in our service

of healthcare goods and services,”

work from a blank slate. Henry Ford

and in our whole experience blueprint.”

Gierlinger notes. “In the past, quality

West Bloomfield Hospital, which

Sven Gierlinger, vice president

was always limited to clinical aspects,

opened in 2009, was inspired by the

of hospitality and service culture

but now the service component is

concept of a luxury hotel, complete with

for Henry Ford Health System, was

becoming equally important. This

valet parking and concierge service.

originally hired to help design the

facility was designed to be like a

“Service has always been a part of the

service excellence element of the

resort that you would find in northern

DNA of Henry Ford Health System,”

West Bloomfield Hospital. His past

Michigan, and we really strived for

says Robert Riney, its president and

experience as an executive for the

a strong Michigan connection. We

chief operating officer. “We knew that

Ritz-Carlton Hotel Company, one of the

wanted to set the stage and create

in building a brand new hospital in a

most highly regarded hotel chains in

the friendly first impression that you OUTLOOK

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would find at a hotel. You’re greeted

know from an evidence-based

at the door and welcomed by valet

standpoint that our services really

we were designing the hospital was to

parkers. All of this decreases anxiety.”

help in educating consumers around

figure out how we could truly make

ownership of their care and improving

this a community center,” Riney says.

their overall experience,” Riney says.

“One of the greatest ways to create

Furthermore, the emphasis isn’t

a service environment is for people

Since its opening, the hospital has experienced patient satisfaction (HCAHPS) scores in the 90th-plus

“The first thing that we did when

percentile. However, the focus on

simply on the patient. It’s on the entire

to see us as more than a hospital. We

patient experience has accomplished

patient-family experience. Geirlinger

wanted them to see us as a destination

much more. The hospital’s average

says that the hospital’s layout and design

place, with an atmosphere that is

length of stay and readmission rates

“is intended to provide unique spaces for

calm, stress-free and healing.”

are among the lowest in the country.

patients and their families to relax. Our

MaryClaire Dangel-Palmer, chief

patient rooms are private and were built

operating officer at Henry Ford West

hospitals does? It lowers length of stay;

to minimize noise. There are various

Bloomfield, takes it a step further.

it lowers readmissions; and it allows you

quiet spaces, family sleeping rooms, and

“We are a community center of

to better educate patients and families

areas for families to play cards or talk

wellness, and we want the community

on post-discharge procedures,” Riney

while they wait to visit their loved ones.”

that actually helped build this place

“Do you know what reducing stress in

explains. “Many of the value-added

In addition to patient-centric services,

to remain part of this place.”

services we provide are cost-efficient,

the hospital emphasizes community

because they build patient engagement

involvement. Henry Ford West Bloomfield

hospital’s mission and the community’s

and create a relationship among patients,

offers many community engagement

needs is West Bloomfield’s emphasis

their families and our facility.”

programs, including school field trips,

on healthy food. An on-site greenhouse

The West Bloomfield hospital

An important aspect of both the

senior citizen health classes, cooking and

provides much of the produce available

uses industry best practices to track

nutritional instruction for all ages, and

at the in-house Henry’s café. And

patient satisfaction, going straight to

parenting guidance. The facility also serves

weekly farmers markets, hosted on

the consumer for input and feedback

as an event space for fashion shows, special

“Main Street,” are open to the public.

on the services provided. “We now

concerts, and, on occasion, even weddings.

“In the 1980s and ‘90s it was very

P E RS P E C T I V E S

T P F

â&#x20AC;&#x153; We are a community center of wellness, and we want the community that actually helped build this place to remain part of this place.â&#x20AC;?

OUTLOOK

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popular to have fast food restaurants

participants share patient stories,

work on creating an even better patient

in your hospitals, but in creating a

keeping the patient-centered philosophy

experience for the future. “We picture

healthy environment, that doesn’t

at the forefront. “You keep it right

senior support services,” says Riney.

make much sense,” says Dangel-

in front of people all the time, and

“We picture a rehabilitation center.

Palmer. “We have healthy food here,

you make it something that they live

We picture perhaps a boutique hotel.

and we’ve learned how to serve it

every day. It’s not an exception. It’s

We envision a lot of things that would

in a cost-effective manner.”

the rule,” explains Dangel-Palmer.

all be created and centered around a

In addition to community outreach,

Gierlinger notes that Henry Ford

destination for health and healing.”

Henry Ford executives paid particular

Health System has leveraged what it’s

attention to their hiring practices. In

learned from West Bloomfield Hospital

prides itself in its unique patient

a new hospital, with no existing staff,

to expand its patient-centric culture,

experience, it has not lost sight of the

executives had an opportunity to find

including the emphasis on healthy

importance of the quality of care. “At the

healthcare professionals specifically

eating, to its other sites. “We want

end of the day,” Riney says, “people want

concerned with patient service.

the whole system to focus on healthy

all those wraparound services, which

foods that are fresh and presented in

are certainly part of the healing process.

about educating our candidates as it

a room-service type of environment.”

But they first and foremost want a

was about interviewing them,” says

The hospital’s talent-selection

safe hospital with great clinicians. We

Dangel-Palmer. “We brought our staff

process is also taking hold system-

try to balance that in our messages,

on in January and opened in March, so

wide. “We put an enormous amount

ensuring that this is clinically the place

during that 2 ½ month period, there

of emphasis on selecting employees

they want to be. These wraparound

was a lot of training and an emphasis on

who are service-driven and focused

services aren’t just nice things to have;

the core values we wanted established.”

on the patient experience,” he says.

they are a core part of how you create

“The interview process was as much

Patient experience is something

Though Henry Ford West Bloomfield

the hospital continues to focus on

has experienced tremendous success

daily. At the start of all team meetings,

since opening, its executives continue to

While Henry Ford West Bloomfield

a healthy and healing environment.”

TRENDS High-touch Pharmacy Care, 28 Success Story: ArjoHuntleigh, 32 Success Story: Boston Scientific, 34

TR E N D S

T P F

.. sugar. f o ful n o o p st a s

HIGH-TOUCH

PHARMACY CARE

atient engagement is a major

other care providers, including

encompass computerized prescriber

component in providing

pharmacies and clinical pharmacists,

order entry, bar coding at the point

accountable, high-quality

is essential for patients with complex

of care, and bedside scanning, all of

care. Without some level

health or life issues.”

which help in streamlining pharmacy

of patient commitment to a treatment

processes, reducing medication errors,

regimen or wellness program, it is

Technology reigns

and, by default, decreasing length of stay

nearly impossible to manage a patient

Advances in pharmacy technology –

and improving patient satisfaction.

across the care continuum. That’s why it

as well as connectivity among health

is vitally important that each caregiver

systems, pharmacies and patients

Chronic complexities

stay engaged with their patients to help

– attempt to reduce the nearly $200

Medication reconciliation and refill

them navigate the healthcare system.

billion in medication cost-avoidance

reminders, in addition to pharmacy

Pharmacies are no exception, especially

opportunities. These include:

and provider-specific technologies

when they are managing patients

• $105 billion attributed to

that reduce medication errors or side

with chronic, complex, or potentially confusing treatment regimes. “Health systems are now expected to manage all aspects of patient care

medication non-adherence,

effects, contribute to lower medication

• $39 billion in delayed medicine use,

costs by eliminating or decreasing care

• $20 billion in medication errors, and

complications. Since chronic conditions

• $1.3 billion in mismanaged

account for more than 75 percent of U.S.

under new accountable care, value-

polypharmacy.1

healthcare costs,2 and there will be a

based models,” says Phil Johnson, MS,

Recent pharmacy developments

predicted 42 percent increase in chronic

RPh, director, pharmacy contracting,

run the gamut of new technologies

conditions by 2023,3 high-touch pharmacy

Premier, Inc. “Collaboration with

within the health system setting. They

and clinical management services are

TRE N D S

T P F

Furthermore, specialty pharmaceuticals

Several studies have also shown that

and the patients who take them require

between 63 and 89 percent of patients

that pharmacies manage complex

prefer an oral therapy.8, 9

administration and compliance issues. “Specialty pharmacies are really the

While oral formulations deliver unprecedented benefits in terms of

crux of reducing cost and improving

both treatment and convenience,

outcomes in medication use for chronic

optimal patient outcomes depend on

disease patients,” notes Johnson. “High-

strict adherence to prescribed regimes.

touch pharmacy programs also have the

Non-adherence to oral chemotherapy

benefit of improving patient engagement

remains a big challenge, with several

and satisfaction.”

reports documenting adherence levels as low as 20 percent.10, 11 Reasons for

critically important in meeting the needs of this growing population. Chronic disease patients, such as those receiving treatment for cancer, diabetes, rheumatoid arthritis, hepatitis C and other blood disorders, have a higher risk of falling out of care plans due to the complexity of their treatment regimens and the long-term cost of their medications.

Driving oncology adherence

non-adherence range from complicated

While cancer chemotherapy has

regimens to unreported, and, hence,

traditionally been given intravenously,

untreated side effects.12

the number of available oral

Certain oral oncologics have been

chemotherapeutic agents has more than

identified as having the greatest risk of

doubled in the past 15 years.4 What’s

discontinuation due to the side effects

more, approximately 30 to 35 percent of

or treatment complexity. Some patients

antineoplastics are in an oral formulation.

on these formulations are taking part

Within the last decade, the number of

in Commcare’s OncologyASSIST®,

available oral oncologics has more than

which provides more in-depth clinical

doubled.

5, 6

These oral formulations offer

patients many advantages, including convenience, potential reduction in side effects, and enhanced quality of life.7

pharmacist involvement than standard patient management. To be selected for OncologyASSIST, a patient must be: • New to therapy and starting one of the

Chronic conditions account for more than 75 percent of U.S. healthcare costs,2 and there will be a predicted 42 percent increase in chronic conditions by 2023.3

following oral oncologics (Gleevec®, Sutent®, Tarceva®, Temodar®, Xeloda® or Zytiga®); • On existing therapy and experiencing side effects or exhibiting noncompliance based on an adherence score of less than 90 percent; or • New to any oral oncologic with a desire to be enrolled in the oncology monitoring program. OUTLOOK

QTR 1.14

TR E N D S

T P F

... h

elps the m edi cin e

go d

ow n.

Savings derived from higher adherence among a cohort of 2,549 patients amounts to a total of nearly $207 million from June 2012-October 2013. Total net savings with high adherence (n=2,549)

Average annual cost

Patient costs at national average MPR $264,689,943 Patient costs at Commcare average MPR $57,703,674 Net total medical savings $206,986,269

TRE N D S

T P F

Managing side effects through pharmacist intervention and patient education can improve tolerability and preserve quality of life, leading to increased medication adherence.

The OncologyASSIST model is based

On average, oncology patients with

enrolled patients (n=87) at an MPR of

on various published pharmacist-

high MPR scores (MPR > 90 percent)

98.1 percent, with the overall oncology

managed oral chemotherapy monitoring

are spending $17,500-$25,000 in total

population (n=2,549) at an MPR of

medical therapy costs, while less-

90.3 percent. The difference in MPR

through pharmacist intervention and

compliant patients (MPR <70 percent)

between the Commcare oncology

patient education can improve tolerability

are spending upwards of $100,000.

population and the national average

programs.

13, 14, 15

Managing side effects

and preserve quality of life, leading

The oncology monitoring program

results in approximately $57,423 in

to increased medication adherence.

flags any patient for immediate clinical

additional medical costs per patient.

In the program, clinical pharmacists

triage when the compliance score falls

maintain direct communication

below a threshold MPR of 90 percent.

among a cohort of 2,549 patients

with patients and their prescribers to

This methodology has kept Commcare’s

amounts to a total of nearly $207

monitor and manage side effects.

clinically managed and program-

million from June 2012-October 2013.

Savings derived from higher adherence

Total patient medical costs are negatively correlated with their respective medication possession ratio (MPR), a metric used to measure medication adherence. Studies show that non-adherent patients (MPR <70 percent) experience total medical costs of two to five times the magnitude of their compliant peers. Unfortunately, the national average of oncology medication MPR is below this 70 percent threshold – hovering around 63 percent across the nation.

Tier

Average annual cost metric16, 17

High MPR

$22,882

Medium MPR

$40,366

Low MPR

$104,961

REFERENCES IMS Institute for Healthcare Informatics, Avoidable Costs in U.S. Healthcare, June 2013. Centers for Disease Control and Prevention, Chronic Disease Prevention and Health Promotion, September 2013. Milken Institute, An Unhealthy America: The Economic Burden of Chronic Disease, October 2007. R. Mancini, L. M. Kaster, B. Vu, et al., “Implementation of a Pharmacist-Managed Interdisciplinary Oral Chemotherapy Program in Community Cancer Center,” J. Hematol. Oncol. Pharm. 1(2) (2011): 23-30. 5. Ibid. 6. R. DeCardenas, J. Helfrich, “Oral Therapies and Safety Issues for Oncology Practices.” Oncology Issues, March/April 2010: 40-42. 7. R. Mancini, L. M. Kaster , B. Vu, et al., “Implementation of a Pharmacist-Managed Interdisciplinary Oral Chemotherapy Program in Community Cancer Center,” J. Hematol. Oncol. Pharm. 1(2) (2011): 23-30. 8. Ibid. 9. L. Fallowfield, L. Atkins, S. Catt, et al., “Patients’ Preference for Administration of Endocrine Treatments by Injection or Tablets: Results from a Study with Breast Cancer,” Am. Oncol. 17 (2006): 205-210. 10. A. H. Partridge, J. Avorn, P. S. Wang, et al., “Adherence to Therapy with Oral Antineoplastic Agents.” Journal of the National Cancer Institute 94 (2002): 652-661, doi:10.1093/jnci/94.9.65 11. S. Moore, M. L. Bandt, B. G. Lubejko, American Society of Clinical Oncology Adherence Toolkit. Accessed March 20, 2012. http:// www.ons.org/ClinicalResources/OralTherapies/media/ons/docs/clinical/AdherenceToolkit/oraladherencetoolkit-print.pdf. 12. Ibid. 13. R. Mancini, L. M. Kaster, B. Vu, et al., “Implementation of a Pharmacist-Managed Interdisciplinary Oral Chemotherapy Program in Community Cancer Center,” J. Hematol. Oncol. Pharm. 1(2) ( 2011): 23-30. 14. N. Khandelwal, I. Duncan, T. Ahmed, et al., “Impact of Clinical Oral Chemotherapy Program on Wastage and Hospitalizations,” Am. J. Manag. Care 17 (5 Spec. No.) (2011):: e169-e173. 15. R. DeCardenas, J. Helfrich, “Oral Therapies and Safety Issues for Oncology Practices,” Oncology Issues March/April 2010: 40-42. 16. “Relationship Between Compliance with Imatinib Mesylate and Medical Costs for Patients with CML and GIST,” Meeting Abstract. J. Clin. Oncol. 25, no 18, suppl 6618 (June 2007). 17. “Costs and Utilization Associated with Imatinib Adherence in Patients with Chronic Myeloid Leukemia or Gastrointestinal Stromal Tumors,” JCOM. 16, No. 5. (May 2009). Retrieved from http://www.turner-white.com/pdf/jcom_may09_myeloid.pdf. 1. 2. 3. 4.

OUTLOOK

QTR 1.14

SUCCESS STORY

Sustainable reduction in patient handling injuries

TRE N D S

T P F

The Challenge UnityPoint Health - Methodist is a

Fig.1

Fewer patient handling worker injuries Methodist has reduced patient handling worker injuries by a sustained 97.1 percent.

Magnet hospital with 329 beds in Peoria,

Program implementation

Illinois. The Group has over 3,000 employees across 52 locations with

525 board-certified physicians and 327

40 Number of injuries

volunteers. In 2011, there were 58,201 annual emergency department visits. Several years ago, UnityPoint Health was concerned about the number of

30 20

staff injuries they were seeing. Medical

center employees were accustomed to

lifting patients manually, which led to

2005

2006

2007 (Prior)

patient handling issues and injuries. Staff injuries were not only an issue of worker’s safety, but also resulted in lost employee time and increasing costs.

Fig.2

2007 (After)

2008

2009

2010

2011

2012

2011

2012

Lower workers’ compensation costs Methodist has reduced workers’ compensation costs by a sustained 99.7 percent. Program implementation

Through ArjoHuntleigh’s 3-year injury

250,000

prevention program, UnityPoint

200,000

Cost (in dollars)

The Solution

300,000

Health was given the means to create a sustainable change solution to safeguard care quality and employee welfare while also decreasing costs. Moreover,

150,000 100,000 50,000

ArjoHuntleigh guaranteed the hospital

would achieve at least a 60 percent

2005

2006

reduction in employee patient handling incidents by implementing the program.

Proper aids to enable safe patient

2007 (Prior)

2007 (After)

2008

2009

2010

One key success factor to creating

handling were delivered, installed

a sustainable change has been the

comprehensive assessment of UnityPoint

and UnityPoint Health staff were

participation of leadership staff.

Health facilities in 2006. Hospital-

provided training. These included

Initially 75 departmental and caregiver

wide implementation commenced in

passive and active lifts, bariatric

employees were trained in the initiative;

2007. The program encompassed:

solutions and repositioning tools.

in five years, more than 600 staff

ArjoHuntleigh staff performed a

members have received patient handling

• Clinical oversight; • Process mapping and process resolution;

The Outcome

• Education and staff development; and

Methodist has reduced patient handling

• Ongoing support for 36 months at

injuries to workers by a sustained 97.1

all facilities.

training via ArjoHuntleigh’s program.

Since implemention, UnityPoint Health -

percent and has reduced workers’ compensation costs by 99.7 percent.

THIS ARTICLE IS A PAID ADVERTISEMENT. This article was not written by Premier and is not an endorsement by Premier.

OUTLOOK

QTR 1.14

SUCCESS STORY

Subcutaneous ICD provides protection from sudden cardiac arrest without touching the heart

TRE N D S

T P F

fter beating breast cancer last year, 76-yearold Nancy Killion was looking forward to getting

back on the tennis court. However, half-way through her chemotherapy treatments she suffered a stroke and major heart damage, resulting in a diagnosis of congestive heart failure and dilated cardiomyopathy.

“This is truly a paradigm shift in less-invasive, long-term treatment options for our patients.”

Because of her underlying heart condition, she was at high risk of having sudden cardiac arrest. Killion never dreamed she’d pick up

meant her heart was not monitored. But

shock pacing when needed – without

a tennis racket again. But thanks

this device will always be with her.”

direct contact with the heart.

to a new device, the subcutaneous

The subcutaneous ICD is similar

“For patients with a high risk of

implantable cardioverter defibrillator

to a traditional defibrillator in that

developing device infection or who

(S-ICD™), she’s feeling optimistic.

it delivers an electric shock to the

may have vascular access issues such

heart if it detects abnormal cardiac

as cancer patients with mediports in

try and have a normal life again,”

rhythm. But the new subcutaneous

their vasculature or dialysis patients

said Killion. “I don’t have much

ICD does so without the electrical

with access issues, this new device

energy these days but I’m hoping

leads placed directly into the heart.

is a life-saving option,” said Dr. Le.

“I knew I needed to do something to

that’s going to change.” For patients like Killion who are

“In many patients with an ICD, the

“This is truly a paradigm shift in less-

leads are the most common component

invasive, long-term treatment options

at risk for sudden cardiac death, a

that could fail,” Dr. Brian Le said, who

for our patients. This technology has

subcutaneous ICD is now an option

implanted the first device at Texas

been in development over the past 10

for treatment. The device, called a

Health Presbyterian Hospital Dallas.

years and has now become a reality.”

major technological advancement in

“Some of the complications from the

implantable defibrillators, is placed

leads include fracture, insulation

under the fat of the skin and does not

failure, and infection. When the leads

touch the heart — making more patients

need to be removed, the adherence of

candidates for implantable defibrillators

the leads inside the heart creates scar

and reducing the risk of complications.

tissue making extractions difficult.”

“She tried a wearable defibrillator

For important safety information on the S-ICD System please visit: http://www.bostonscientific. com/s-icd/important-safety-information.html?

The subcutaneous ICD is placed on

that fits like a vest around the chest,

the left side of the chest just below the

but that didn’t last long because it

arm pit under the skin. The device is

was uncomfortable and heavy for her

connected to a thin electrode that is

while she regained her strength,” said

implanted along the rib cage next to the

her husband, Charles Killion. “I was

breastbone. If a ventricular arrhythmia

always concerned for her when she’d

is detected, the subcutaneous ICD

have to take it off because I knew that

delivers a shock and can provide post-

THIS ARTICLE IS A PAID ADVERTISEMENT. This article was not written by Premier and is not an endorsement by Premier.

OUTLOOK

QTR 1.14

FOR FURTHER INFORMATION To learn more about this publication, please visit premierinc.com/economicoutlook, or email economicoutlook@premierinc.com.

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