Insigniam Quarterly 2014 Special Edition - Healthcare

S P E C I A L H E A LT H CA R E I S S U E 2 014
HEALTHCAREAN INNOVATION MANIFESTO
INSIGNIAM QUARTERLY’S
HEALTHCARE
OVERVIEW

“In the increasingly complex healthcare
marketplace of today, innovation is not
a nice-to-have; it is essential for simply
surviving. At the same time, potent
innovation can also be a source of
sustainable success, especially when the
creativity and contributions of the people
of an enterprise are unleashed and the
execution of new possibilities is reliable.”
— SCOTT W. BECKETT

LETTER
W
Welcome to this special edition of Insigniam Quarterly, which focuses on today’s
global healthcare industry. While transforming healthcare means different things
in different geographies, we have found that a vast majority of the issues are
actually the same. As individual and business consumers of healthcare,we often
do not see the background forces that are radically disrupting the resources
and money available for our care. Healthcare executives know them all too
well: shifting demographics, increased incidence of noncommunicable diseases,
greater emphasis on wellness and value-based reimbursements, higher patient
involvement and accountability,etc.Together,these issues have all the makings of
a wicked,seemingly impossible problem to solve.However,when broken down,
there is a path to success that offers unprecedented opportunity.
Although we don’t have all the answers,we do know that the path starts with
innovation.Through our experiences working with healthcare organizations,
we’ve identified what we believe are critical success factors we will all need in
our back pocket on our journey to reshape the future of healthcare.What is it
to be accountable for our health? What does it take for a healthcare system to
become indispensable? How can the entire patient experience be reinvented?
Is it possible to embed innovation into an organization as a core competency?
What about creating a mindset of well-being and expanding our horizons for
access and delivery of care? Do you aspire to be a transformational leader in
healthcare? Have we put the right technology in place? Is our healthcare culture
guided by responsibility and accountability?Are your physicians integrated with
a diversity of specializations?
While overwhelming in the aggregate,we hope to help answer some of these
questions in this special issue, leading us all to a clearer vision. Consider it a
healthcare manifesto,a playbook of sorts,outlining critical success factors to keep
on your radar as we counter — and overcome — real-world, disruptive forces
occurring around us.Know that the same forces that are turning our world upside
down today,are leading us toward a better future.This is a rare moment in time.
This is our moment to transform healthcare itself.
Game on.
Shideh Sedgh Bina
Founding Partner, Insigniam
SPECIAL HEALTHCARE ISSUE 2014 INSIGNIAM QUARTERLY 1
OUR TIME IS NOW

SPECIAL HEALTHCARE ISSUE 20142 INSIGNIAM QUARTERLY
12
INDISPENSABILITY
Make the patient an offer, and give them an
experience, they can’t refuse.
16
REINVENTING THE PATIENT EXPERIENCE
If solutions begin by focusing on the patient, let
patient-centric care be your guide.
20
GETTING MORE FOR LESS
Outdated revenue models will cripple your returns.
The path to efficiency — and profitability — may be
simpler than you think.
24
DIVERSIFIED, YET INTEGRATED
SPECIALIZATION
How a physician leadership network and a focus
on population health is putting the heart back into
healing.
FEATURES
DEFINING SUCCESS
The key to cracking
healthcare’s wicked
problems requires a
“different agenda”.
OVERVIEW
04
TABLEOFCONTENTS

EDITOR-IN-CHIEF Shideh Sedgh Bina
shidehbinaIQ@insigniam.com
EXECUTIVE EDITOR Nathan O. Rosenberg
nrosenberg@insigniam.com
CHIEF FINANCIAL OFFICER Ralph Gotto
DIRECTOR OF WORLDWIDE Karen Turner
CLIENT SERVICES kturner@insigniam.com
DIRECTOR OF SPECIAL PROJECTS Alexes Fath
PUBLISHER Gordon Price Locke
gordon.locke@dcustom.com
EDITORIAL DIRECTOR Amy Robinson
amy.robinson@dcustom.com
GUEST EDITOR Liz Willding
MANAGING EDITOR Jonathan Ball
jonathan.ball@dcustom.com
EDITORIAL CONTRIBUTOR Ira Katz
ikatz@insigniam.com
CREATIVE DIRECTOR Kyle Phelps
kyle.phelps@dcustom.com
ASSISTANT ART DIRECTOR Emily Slack
PRODUCTION MANAGER Pedro Armstrong
IMAGING SPECIALIST John Gay
DIRECTOR, ACCOUNT SERVICES Jas Robertson
ACCOUNT SERVICE MANAGER Joan Khalaf
EDITORIAL QUERIES
750 N. Saint Paul Street
Suite 2100
Dallas, Texas 75201
www.dcustom.com
214.523.0300
For advertising information, contact Jas Robertson at
214.937.9811 or jas.robertson@dcustom.com
Insigniam Quarterly is published by D Custom, 750 N. Saint Paul Street, Ste. 2100, Dallas, Texas
75201. Copyright 2014 by Insigniam. All rights reserved. Letters to the editors may be sent to
Insigniam Quarterly c/o D Custom, N. 750 Saint Paul Street, Ste. 2100, Dallas, Texas 75201. No part of
this publication may be reproduced in any form or by any means without prior written permission of the
publisher and Insigniam. Printed in the U.S.A. Magazine patents pending. For subscriptions, please visit
www.insigniamquarterly.com.
Q U A R T E R LY
SPECIAL HEALTHCARE ISSUE | 2014
“People don’t often seek care due to the deep fear of the
complexity of the cost, and because they don’t feel we are
listening to their needs. We need to understand their reasons.”
— DOUGLAS L.WOOD, M.D.
DIRECTOR OFTHE CENTER FOR INNOVATION, MAYO CLINIC
MINDSET OF WELL-BEING
Shifting the focus is all about engagement
NEW HORIZONS
A model for the future of healthcare: Women’s College
Hospital
HEALTHCARE LEADERS, OUR TIME IS NOW
“Innovation” is today’s critical objective
LEVERAGING NEW TECHNOLOGY
Take technology to a personal level
TRANSFORMATIONAL LEADERSHIP
For Cone Health, “unleashing the tiger” of transfomation
begins with empowerment
HOW WELL ARE YOU FULFILLING YOUR PROMISE?
Accountability is more than just lip service. It’s strategy.
IQ BOOST
Infographic: RX For Success
28
30
34
38
40
44
48
ADDITIONAL FEATURES
Woman of theYear Award
Congratulations to our editor-in-chief,
Shideh Sedgh Bina, on being named a
“Woman of the Year” by the Healthcare
Businesswomen’s Association.
For more on this award, visit
www.insigniamquarterly.com/HBAaward
Insigniam and its publisher, D Custom, distribute
this editorial magazine to share the opinions
and insights of companies and their leaders on
impactful global business issues. Insigniam
Quarterly’s inclusion of a company or individual
does not indicate that they are a client of Insigniam.
Remuneration is not provided for editorial
coverage. Individuals appearing in Insigniam
Quarterly have done so with direct consent, or
provided consent by a designated authorized agent
in addition to being disclosed on the magazine’s
audience and purpose.

4 INSIGNIAM QUARTERLY
DEFINING
SUCCESS
Cracking healthcare’s wicked problems
requires a “different agenda.”
BY LIZ WILLDING
SPECIAL HEALTHCARE ISSUE 2014

INSIGNIAM QUARTERLY 5
INSIGNIAM
HEALTHCARE
OVERVIEW

In every respect,today’s global healthcare challenges fit the
definition of a wicked problem,essentially a moving target that
is difficult,if not impossible,to solve (see the 10 characteristics
of wicked problems in the accompanying sidebar).
At Insigniam, we believe a number of disruptive forces
are in play today that indeed make healthcare a wicked nut
to crack. Most healthcare executives are well aware of the
challenges, which start with shifting demographics resulting
in a predicted tsunami of older, more diverse patients with
chronic noncommunicable diseases.(NCDs). To counter this,
the industry is logically shifting to population health, which
demands a focus on wellness and value versus the old volumes-
based model to treat illnesses.While there is no dispute that
technology — from electronic health records to a plethora
of digital health tools — is proving to be a big part of the
solution, implementation is arduous and costly, and the real
gains expected from integration are still on the horizon. Factor
in increasingly involved patients who want to know where
their money is going,and it is enough to make any healthcare
executive’sheadspin.Thenthere’sprojectedprovidershortages,
increased regulation,and shrinking access to capital to contend
with.
While all of this may seem daunting and truly wicked, we
suggest that focusing on a handful of critical success factors
canfacilitatereinventionandinnovationdespitetoday’schaotic
healthcare environment.The process begins by asking hard
yet provocative questions.“What are the key variables that
leaders should have on their radar as they attempt to reinvent
healthcare? What will it take, as an industry, to turn today’s
enormous healthcare‘cruise liner’in the direction of wellness?
How will technology help enable patients as they assume more
responsibility for their own care?” While there are no easy
answers, Insigniam Quarterly turned to a number of industry
experts for context and insight into critical success factors for
10 of the top issues facing the healthcare industry for 2014
and beyond.
GLOBAL TRENDS
In the landmark study “Global Burden of Disease, 2010,”
healthcare leaders viewed a snapshot of key demographic
changes that are fundamentally changing healthcare delivery.
The study documented that global life expectancy for males
and females had risen more than 10 years from 1970 to 2010,
reaching a global average of 67.6 and 73.3, respectively. Even
more revealing, more deaths occurred globally at 70 years of
age or older,with 22.9 percent,almost a quarter,occurring at
80 years or older.
In contrast, the study noted that deaths from
noncommunicablediseaseseclipsedthoseofinfectiousdiseases
duringthesametimeperiod,killingmorethan35millionpeople
When Horst Rittel and Melvin M.
Webber coined the concept of
wicked problems in 1973, they were
largely talking about policy issues
— however they might as well have
been referring to modern healthcare.
OVERVIEW

yearly — accounting for nearly two-thirds of the world’s
deaths.Why? According to theWorld Health Organization
(WHO),it’s a matter of priorities.In its“2008-2013Action
PlanfortheGlobalStrategyforthePreventionandControlof
Noncommunicable Diseases,” WHO reported that“NCD
preventionandcontrolprogramsremaindramaticallyunder-
fundedatthenationalandgloballevels,”andnotedthatNCD
prevention was “currently absent from the Millennium
Development Goals,” established by the United Nations
with a target date of 2015. If allowed to go unchecked, the
report estimates that NCDs will increase by 17 percent over
the next 10 years.
While “increased longevity represents success against
infectiousdiseases,”saysRoger
I. Glass, M.D., Ph.D., director
of the Fogarty International
Center at the National
Institutes of Health (NIH),
the pendulum has clearly
swung in the other direction.
“What are we going to do
with our aging populations
who are suffering from
diabetes, heart disease, cancer,
and other noncommunicable
conditions? It suggests a
completely different agenda.”
The irony is that the
vast majority of NCDs are
preventable and could be
reducedoreliminatedthrough
increased patient support. In
this sense, Dr. Glass says it is
time that preventive programs
aimed at addressing lifestyle
issues catch up with scientific
advances.AccordingtoWHO,
up to 80 percent of heart disease,stroke,andType 2 diabetes,
and more than a third of cancers, could be prevented by
eliminating shared risk factors, which include tobacco use,
unhealthydiet,physicalinactivity,andharmfuluseofalcohol.
“The issues are the same worldwide,” says Elizabeth H.
Bradley, Ph.D., who is faculty director of theYale Global
Health Leadership Institute.“The big question is whether
reimbursements based on services related to treating illness
versus funding preventive programs will keep up with the
demographic and epidemiological shifts resulting from
an aging population and the epidemic of obesity,” which
contributes to NCDs.
In the U.S. alone, she notes that one-third of the
population is obese, with the cost of care per patient
estimatedatapproximately$5,000moreperyearthannonobese
patients.“This is very taxing to medical systems and executives
who are looking at the long run and struggling to deal with it.”
TURNING THE SHIP
While reinventing healthcare is indeed a wicked problem,
a number of demonstrated critical factors can provide
healthcare executives with a path toward an elevated
likelihood of success.
“The process starts and ends
with having the patient’s best
interests in mind,” says Dr.
Bradley. “You have to frame
your products and services so
customers really want to come
to you. It boils down to putting
the customer first.” This means
looking at problems through the
patient’s eyes,becoming a partner
in their care.It is everything from
reducing wait times and billing
errors to supporting them with
wellness programs to achieve
lifestyle changes.
Adds Douglas L. Wood,
M.D., director of the Center for
Innovation at the Mayo Clinic,
it is important to approach
any problem in the context of
“transforming the way people
experiencehealthandhealthcare.”
He notes that “understanding
why people do what they do,” is the starting point.“First,
people don’t often seek care due to the deep fear of the
complexity of the cost, and because they don’t feel we are
listeningtotheirneeds.Weneedtounderstandtheirreasons.”
Asorganizationsseektoinnovateandreinventthemselves,
they should also be cautious not to rely on a cookie-cutter
approach,saysNathanOwenRosenberg,Insigniamfounding
partner.“It is a big mistake to copy what other enterprises
have done to innovate.The success we see in designing new
methodsforvalueandaccessforpatientsaresuccessfulbecause
they have been invented — not merely copied. Sustained
“IT IS A BIG MISTAKE
TO COPY WHAT OTHER
ENTERPRISES HAVE
DONE TO INNOVATE.
THE SUCCESS WE
SEE IN DESIGNING
NEW METHODS FOR
VALUE AND ACCESS
FOR PATIENTS
ARE SUCCESSFUL
BECAUSE THEY HAVE
BEEN INVENTED —
NOT MERELY COPIED.”
OVERVIEW

innovation requires a leadership mandate for innovation,
proprietary innovation processes, and an infrastructure that
plays to the strengths and ambitions of your enterprise.And,
ofcourse,unlesschangesaresupportedbytheexisitingculture
they are rarely sustained long term.”
Ensuring that the revenue cycle is running like a well-
oiled machine is another key variable, says Jennifer Zimmer,
Insigniam partner,noting that most are archaic and rooted in
the past pay-for-services model.“This makes it difficult and
frustratingforpatientsbecauseasignificanttouchpointintheir
experience is not user-friendly nor is it value-added for the
patient. Innovation is about building a revenue cycle where
each touch point enhances the patient experience and shows
added value.”
Regardless of the geography, tomorrow’s revenue cycle
must focus on value, especially to keep up with trends such
as personalized medicine,says Corinne Le Goff,president of
Roche SAS.“In oncology,” she explains,“different biologics
are often combined for treatment,but,‘how do you bill for it?’
We need to have a system that allows for reimbursement in a
more personalized way.”
All of this begs for new business processes that keep pace
with those occurring in science.“We believe it is by bringing
the best minds around the table that you find the solution,”
Le Goff adds,“which includes partnerships with academia.”
Alex Gorsky, CEO of Johnson & Johnson, agrees, but
cautions,inaMarch2013interviewwithCNBC,thattheway
forward will also“involve trade-offs,and participation from all
aspectsofsociety.Whenyouthinkabouttheagingpopulation,
when you think about the demographics … it is hard not to
talk about healthcare in the context of the economy and the
systemicissueof howwesomehowfindawaytoprovidehigh
quality,affordable healthcare in a sustainable way.
“It first starts with‘where do we think the unmet medical
needs are going to be?’”he explains.“If you look at the data,
it suggests cardiovascular disease,Type 2 diabetes, Alzheimer’s
— all are going to be cost drivers, particularly in an aging
population where there is a higher incidence rate and very
high costs are associated with them.” Part of the challenge,
Gorsky adds,“is being disciplined about where you do — and
don’t — invest.”
Because lifestyle-related conditions are front and center,
industry experts around the globe are in agreement that a big
part of the solution resides with primary care,integrated with
the specialties,to serve the needs of the whole population.In
thequesttoachievepopulationhealth,“it’sabouthospitalsand
physicians working together,”says Dr.Bradley,with physician
leaderstakingamajorleadershiprole. Shenotes,however,that
CRITICAL SUCCESS FACTORS
IN HEALTHCARE DRIVING
REINVENTION AND INNOVATION,
COMPILED BY INSIGNIAM FROM
INDUSTRY DATA, INCLUDE:
INDISPENSABILITY
REINVENT PATIENT
EXPERIENCE
NEW REVENUE CYCLE
DIVERSIFIED,
YET INTEGRATED
SPECIALIZATION
MINDSET OF WELL-
BEING
NEW HORIZONS
EMBEDDED
INNOVATION
LEVERAGING NEW
TECHNOLOGY
TRANSFORMATIONAL
LEADERSHIP
CULTURE OF
RESPONSIBILITY AND
ACCOUNTABILITY
1
2
3
4
5
6
7
8
9
10

“there is a lack of understanding on adaptive leadership in both
middle and upper management,” suggesting that medical and
professional leaders alike must sharpen their skills to effectively
react to the shifts that are occurring.This includes supporting
creativity and innovation within their organizations,as well as
developing the interpersonal skills needed to partner effectively
with physicians and care providers.
USING TECHNOLOGY TO ENGAGE PATIENTS
Innovative use of technology also is expected to “take care
to the people,” says Patricia Abbott, R.N., Ph.D., an associate
professor at the University of Michigan School of Nursing
Office of Global Outreach. Dr.Abbott spoke about the use
of wireless technology to engage vulnerable populations at an
“Innovations for Global Health” conference hosted by U-M.
ShereferencedherstudyininnercityBaltimorethatmonitored
heart patients at home using mobile health (mHealth) devices.
“The mHealth intervention used wireless technology with
Bluetooth scales and blood pressure cuffs. It also used video
telephony (similar to Skype) and touchscreen computing to
deliver tailored messages, quizzes, and reminders.Within the
computer was a patient-owned personal record, which was
incredibly valuable in creating partnerships and engaging
patients in their care.”
As information technology proliferates, she stresses the
importancefortheindustrytocreateaninteroperableandopen
digitalecosystem,saying,“Accessto,andsharingof,information
is a basic tenent for improving health, both in the U.S. and
abroad.”
Thisecosystemincludespayersandtheprivatesector,whoare
innovatingrapidlywithtoolstoassistpeopleinmonitoringtheir
ownhealth,ultimatelydrivinggreaterpersonalresponsibility.A
big part of driving compliance can be achieved by empathizing
with patients, helping them address life issues, and rewarding
theirsuccesses.“Thebehaviormodificationconceptsareglobal,”
says Joan Kennedy, Cigna vice president, customer health
engagement,noting that the industry is leaning toward virtual
interventions with incentives built in to reward success,which
canincludeeverythingfromreceivingagiftcardforcompleting
OVERVIEW
In their 1973 treatise“Dilemmas in a
GeneralTheory of Planning,”Rittel and
Webber noted that wicked problems
have 10 characteristics:
Wicked problems have no definitive
formulation. Formulating the problem and
the solution is essentially the same task.Each
attempt at creating a solution changes your
understanding of the problem.
Wicked problems have no stopping rule.
Since you can’t define the problem in any single
way, it’s difficult to tell when it’s resolved.The
problem-solving process ends when resources
are depleted, stakeholders lose interest, or
political realities change.
Solutions to wicked problems are not true-
or-false, but good-or-bad. Since there are
no unambiguous criteria for deciding if the
problem is resolved, getting all stakeholders to
agree that a resolution is “good enough” can
be a challenge, but getting to a “good enough”
resolution may be the best we can do.
There is no immediate or ultimate test of a
solution to a wicked problem. Since there is
no singular description of a wicked problem,
and since the very act of intervention has at
least the potential to change what we deem to
be “the problem,” there is no one way to test the
success of the proposed resolution.
Every implemented solution to a wicked
problem has consequences. Solutions
CRACKING A WICKED PROBLEM
1
2
3
4
5

a fitness goal, to lower insurance rates.“Our role is to provide
the tools and services and give credit when the member does
great things.”
In this sense,“It is very important that people are responsible
for the outcomes of their treatment,”says Le Goff.“We need to
hear their voice and understand their medical needs.They need
to be involved.If we can have a role in integrating the solution,
that is a role we can play.”
Dr.Glassagrees,notingthatthemostcost-effectivetreatments
are preventive and don’t involve traditional medical care.
“Twenty percent of the population still smokes.What can we
dotogetthemtostop?Howdowehelppeoplewithunderlying
addiction issues? Better treatment of hypertension could bring
down the incidence of stroke, including limiting salt.We have
to think about incentivizing health interventions as one step
forward.”
What does a future-perfect picture of success look like?“It’s
when we’ve adapted our lifestyles and we say we can’t afford
to be obese,”says Dr.Glass. “We’re tracking ourselves to avoid
risks and consequences,because we think we have a future.”
to such problems generate waves of
consequences, and it’s impossible to know, in
advance and completely, how these waves will
eventually play out.
Wicked problems don’t have a well-
described set of potential solutions. Various
stakeholders have differing views of acceptable
solutions.It’s a matter of judgment as to when
enough potential solutions have emerged and
which should be pursued.
Each wicked problem is essentially unique.
There are no “classes” of solutions that can
be applied, a priori, to a specific case.Part
of the art of dealing with wicked problems is
not assuming any given solution is correct,
especially early in the investigation.
Each wicked problem can be considered
a symptom of another problem. A wicked
problem is a set of interlocking issues and
constraints that change over time, embedded in
a dynamic social context. But, more importantly,
each proposed resolution of a particular
description of “a problem” should be expected to
generate its own set of unique problems.
The causes of a wicked problem can be
explained in numerous ways. There are
many stakeholders who will have various
and changing ideas about what might be a
problem, what might be causing it, and how to
resolve it.There is no way to sort these different
explanations into sets of “correct/incorrect.”
The planner (designer) has no right to be
wrong. Scientists are expected to formulate
hypotheses, which may or may not be
supportable by evidence.Designers don’t
have such a luxury — they’re expected to get
things right.People get hurt when planners
are “wrong.” Yet, there will always be some
condition under which planners will make errors.
6
7
8
9
10
“INNOVATION IS
ABOUT BUILDING A
REVENUE CYCLE WHERE
EACH TOUCH POINT
ENHANCES THE PATIENT
EXPERIENCE AND
SHOWS ADDED VALUE.”
- JENNIFER ZIMMER, INSIGNIAM PARTNER

01

INDISPENSABILITY
Make the patient an offer, and give them an experience,
they can’t refuse.
BY ROBERT ITO
CONSUMER INDUSTRIES HAVE LONG KNOWN
the secret to capturing and retaining customers:offer the best
products and services for the price.
Anyone who has ever owned a luxury
vehicle no longer wants to live without
exceptional service, especially when
somethinggoeswrong.Togainandkeep
loyalcustomers,healthcareleaderswould
do well to become equally indispensable
withpatients,payers,andthecommunity.
This means improving every aspect of
service, whether it’s in the primary
physician’s hospital,the specialist’s office,
or even the patient’s home.
“As a patient, healthcare can be very
daunting, so we’re finding ways to ease
their navigation, making sure that we
address what their expectations are,”
says William Dinsmoor, chief financial
officer of the Nebraska Medical Center,
a nationally ranked hospital in Omaha.
Technological innovation is key to that
mission; for example, the use of the
latest electronic medical record systems,
accessiblealongeverystepofthepatient’s
medical journey, translates to speedier,
moreefficientcare.Similarly,technology
that tracks every aspect of a patient’s
care, from registration to outpatient
billing — like the Epic Systems suite of
healthcare software — can help identify
andeliminatemedicalredundancies,thus
driving down patient costs.
Healthcare organizations also need
to stake their claims as the go-to centers
for healthcare information, now more
than ever before.“As we experience changes in healthcare
systems, medicine is moving beyond the hospital’s four walls
and out to community settings, from
community-basedorganizationstotele-
healthsettingstoretailhealthclinics,”says
Thomas Concannon, Ph.D., a policy
researcher at the RAND Corporation.
“Hospitals needs to be thinking about
taking the reins and trying to create and
sustain a place where stakeholders can
come together.”
Concannonbelievesthatbidirectional
communication is essential, even if
many medical centers — academic and
research institutions, for example —
haven’t done much of it in the past. In
that spirit, creating transparency is the
obvious place to start, beginning with
clarityonpricingstrategies,whichtoday,
quite literally, are all over the map.
For instance, on average, the U.S.
spends twice as much on healthcare per
capita than other industrialized nations;
the same bypass surgery a citizen of
Switzerland receives for $17,000 will set
Americans back about $150,000.These
huge discrepancies have resulted in a
growth of so-called “medical tourism,”
where patients travel to places like
Belgium or South Korea to receive
operations at a fraction of the price that
they’d pay at home.
In this global environment, how do
American healthcare systems make
themselves competitive with their
internationalcounterparts?Howdothey
BY THE NUMBERS
THE UNITED STATES HAS
SIX TIMES MORE MRI
MACHINES PER CAPITA THAN
AUSTRALIA AND THE UNITED
KINGDOM
6X
$150,000
$17,000
THE U.S. ALSO SPENDS AN AVERAGE OF
TWICE AS MUCH ON HEALTHCARE PER
CAPITA THAN OTHER INDUSTRIALIZED
NATIONS.
AVERAGE COST OF A BYPASS SURGERY
IN THE U.S. VERSUS SWITZERLAND
VS

prevent the people they serve from going to the other provider
down the block — let alone to the other provider overseas?
In other countries around the world, patients have ready
access to price lists for the procedures
offered at a hospital or clinic, a service
scarcelyimaginabletomostAmericans.
“There’s been a lot of recent attention
to hospital pricing strategies in the
U.S.,” says Concannon. “These are
not transparent strategies. It would be
nice to see improved transparency in
inpatient stay, to see all the costs that
gointomaterials,labor,andresidential
care.”
As more and more Americans learn
just how much less their overseas
counterparts have to pay for each
visit or procedure, there have been
increasing calls for change. A good
place to look is Canada, says Colin
Busby, senior policy analyst at the
C.D. Howe Institute, a Toronto-based think tank. There,
healthcare centers in some provinces are slowly moving from
afee-for-servicesystemtoamoreblendedpaymentmodel.In
that model, family doctors are paid on a per-patient basis and
encouraged to enroll a large number of patients — basically,
the Accountable Care Organization
(ACO) model many physicians are
aiming for here. “By paying them per
patient,theincentiveonaphysicianisto
only spend their time with their sickest
patients,” he says, “and to try to keep
everyone else healthy.”
In addition to lowering prices,
healthcare providers can also boost
their desirability by offering services
that their patients simply can’t receive
from their competition. “What we do
is provide a very high quality product,”
says Dinsmoor. “And we provide very
specialized services. We do things that
nobody else can.”
IntheU.S.,thedrivetowardmoreand
more advanced medical technologies is
another big reason for the country’s escalating healthcare
costs; for example, America has six times more magnetic
FINDING WAYS FOR DOCTORS TO SEE
PATIENTS LESS — ALBEIT BY KEEPING
THEM WELL — MIGHT BE THE BEST WAY
TO INCREASE PATIENT SATISFACTION.
HEALTHCARE
ORGANIZATIONS
ALSO NEED TO
STAKE THEIR
CLAIMS AS THE
GO-TO CENTERS
FOR HEALTHCARE
INFORMATION,
NOW MORE THAN
EVER BEFORE.

resonance imaging (MRI) machines per capita than Australia
and the United Kingdom.
But lest one think that Dinsmoor is just playing the medical
equipmentarmsrace—“ourprotontherapytreatmentprogram
isbetterthanyours”— that’sjustonepartofthepicture.Those
servicesDinsmooristalkingaboutaren’tjusthingedonhaving
the latest, greatest medical devices, although that’s certainly a
factor. The service component is part of a larger package of
customer relations.
Central to this is the understanding that physicians and
patients are all in this thing together. “Shared responsibility
is huge,” says Dr. Carlos Jaén, chair of the University of Texas
Health Science Center at San Antonio, Family & Community
Medicine. “We’re here to be partners. If you’re ready to do it,
I’m happy to help you. But it’s up to you, really. It’s your life.”
This idea of “shared responsibility” (both in terms of taking
careofone’sownhealthandpayingone’sfairshareforservices)
is one that’s built into the systems of countries like France,
Belgium, and Japan.
When patients decide to become more proactive about their
healthcare,education and wellness centers will play a key role in
thefuture.“Ithinkpatienteducationisextremelyimportant,”says
Dinsmoor, who cites the health management program Simply
Well as a step in the right direction.“It’s a tool that employers
canusetohelpscreenandidentifyopportunitiestoimprovetheir
employees’ health status,” he says.“If we want to bend the cost
curve in healthcare, we’ll need to shift resources from the back
end,from the complicated intervention,to more prevention.”
Ironically, finding ways for doctors to see patients less —
albeitbykeepingthemwell—mightbethebestwaytoincrease
patientsatisfaction.Nobodylikesbeingsick,afterall,nomatter
how efficient or professional the care at their hospital might
be. And while patient satisfaction might be a key component,
perhapsthemostimportantcomponentofmakingahealthcare
providerindispensabletoitspatientsandpayers,gettingpatients
to take responsibility for their own health, is often one of the
toughest things for doctors to do.
Although some regions of the world are further along than
others, forging stronger shared responsibility is a place where
the new U.S. model, driven by the Affordable Care Act, could
well stake a claim. “That’s the challenge with the ACA:
How are the individuals going to be engaged with this?” says
Dinsmoor. “What’s their responsibility? And that’s the piece
that’s been missing. The delivery system is getting organized
to do it, but how do you get the individual engaged? There are
some people that are very engaged with it, but there are lots
of people that are not. And underlying that is education, and
taking ownership of your own health status.”
01
CRITICAL
SUCCESS
FACTOR
Indispensability:A healthcare
system must make itself
indispensable with an offering that
healthcare community residents,
patients, and payers cannot (and
will not) avoid or go around.
CLOCKWISE FROM TOP LEFT: COLIN BUSBY, SENIOR
POLICY ANALYST, C.D. HOWE INSTITUTE; THOMAS
CONCANNON, PH.D., POLICY RESEARCHER, THE
RAND CORPORATION; DR. CARLOS JAÉN, CHAIR,
THE UNIVERSITY OF TEXAS HEALTH SCIENCE
CENTER, UT SAN ANTONIO; WILLIAM DINSMOOR,
CFO, THE NEBRASKA MEDICAL CENTER.
HEALTHCARE LEADERS

TAKING CUES FROMTHE HOSPITALITY INDUSTRY,
leading healthcare organizations around the globe have been
rethinking the experience they provide to patients.
The Beryl Institute, a global community of practice and
thought leaders,supports the notion that improving the patient
experience has financial implications that reach far beyond
reimbursementdollars,performancepay, andcompensationtied
to outcomes. In a recently published white paper,“The State
of Patient Experience in American Hospitals 2013: Positive
Trends and Opportunities for the Future,”the Institute cites a
2008 J.D.Power study that revealed that
hospitals scoring in the top quartile in
satisfaction had more than two times the
margin of those at the bottom. Another
soberingfactisthatasatisfiedpatienttells
three other people about the positive
experience while a dissatisfied patient
tells up to 25 people about a less-than-
satisfactory experience. Models suggest
that for every complaint the healthcare
organization hears,it could lose up to 18
patients,a clear threat to the bottom line.
“The patient experience is a top
priority for the Cleveland Clinic; it’s our North Star,” says
James Merlino,M.D.,chief experience officer.“We’ve worked
diligently to create a strategy and supporting processes to help
usfulfillthepatient-firstphilosophy.Wealignourpeoplearound
the patient service culture and that shapes how we manage
patient expectations.”
Merlino says Delos Cosgrove, M.D., Cleveland Clinic’s
president and CEO, set the expectations from the outset for
providingaworld-classexperiencebasedonpersonalencounters
he and his family had with the healthcare system.“He realized
REINVENTING
THE PATIENT
EXPERIENCE
Let patient-centric care be your guide
BY TOM PECK
THE LOU RUVO CENTER FOR
BRAIN HEALTH IN LAS VEGAS ONE
OF THE 22 SITES MANAGED BY THE
CLEVELAND CLINIC NATIONWIDE.
02

that the entire experience is very important to the patient and
he was determined to put patients first in our organization.”
The patient experience thread is woven into every aspect of
the Cleveland Clinic’s culture.Merlino calls this managing the
360.“What patients think about us,how they get access to us,
their first impression — everything comprises their experience
with us,”he says.
Patient-centriccarehasturnedhealthcareonitshead,causing
physicians, hospitals, and health systems to rethink how they
are treating their “customers”
and the long-term implications.
Jason Wolf, Ph.D., president
of The Beryl Institute, has seen
the evolution of the patient
experience. He says the patient
experience journey begins with
the integration of quality, safety,
and service.
“Thepatientandfamilydon’t
delineate between these three
imperatives,”Wolf says. “They
need to be aligned around
components of healthcare
delivery.That’s why we define
the patient experience as the
sum of all interactions, shaped
by an organization’s culture that
influences patient perceptions
across the continuum of care.”
The Institute’s members have
tackled the patient experience
fromavarietyofangles,focusing
on specific opportunities to
improve the environment, care processes, communication,
and other aspects of the experience. One hospital in Ohio
reduced the noise level on patient units. Another addressed
parking hassles.A hospital in North Carolina implemented
bedside barcoding to make care delivery more efficient and
accurate.Another hospital in Minnesota focused on improving
physician and patient communications while a healthcare
organizationinFloridacreatedablogfromtheCEOtoconnect
with staff, physicians, and the community. The list is endless
and demonstrates a nationwide commitment by healthcare
organizations to put patients first.Hospitals’intentional efforts
to improve the patient experience are based on careful analysis
of their patient satisfaction data and their Hospital Consumer
Assessment of Healthcare Providers and Systems (HCAHPS)
survey scores.
Press Ganey, a leader in capturing patient satisfaction
and perception, establishes a link between profitability and
satisfaction in its 2012 white paper “Return on Investment:
Increasing Profitability by Improving Patient Satisfaction.”A
key finding cites a study of 82 hospitals where a 1 percent
standard deviation change in the quality score resulted in a
2 percent increase in operating margin.Another study of 51
hospitals found that approximately 30 percent of variance in
hospital profitability can be attributed to patient perceptions
of the quality of care. Finally,
another study estimated that
the financial implications of
movingallpatientswithaverage
Press Ganey ratings between
three and four to between four
and five was $2.3 million in
additional annual revenue.
The white paper highlights
hospitalrespondents’toppatient
experience priorities.The list is
comprised of mostly tactical
topics including reducing noise,
improving pain management,
enhancingthedischargeprocess,
improving communication
among all stakeholders
(patients, staff, and physicians),
concentrating on cleanliness,
committingtohourlyrounding,
and more.
Merlino and Wolf agree
that the investments healthcare
organizations make in
improving the patient experience will be repaid in the new
environment of population health management, where
coordination,communication,and collaboration are rewarded.
“Every encounter makes a difference across the continuum
of care,” explains Wolf.“All care delivery models are based
on one fundamental idea, the need to take care of patients
throughout their journey in the healthcare system. Creating
a truly great experience means concentrating on every aspect
of the experience.This includes hand-offs, communication
between staff,patients,and their families to technology,design
and functionality of space,and transitions from one care setting
to another.”
Recognizing the importance of patient and family
involvement in improvement efforts, the Cleveland Clinic
formed family councils that channel valuable feedback to the
THE INVESTMENTS
HEALTHCARE
ORGANIZATIONS MAKE
IN IMPROVING THE
PATIENT EXPERIENCE
WILL BE REPAID IN THE
NEW ENVIRONMENT OF
POPULATION HEALTH
MANAGEMENT, WHERE
COORDINATION,
COMMUNICATION, AND
COLLABORATION ARE
REWARDED.

organization.The Digestive Disease Institute is a perfect
example.Leaders were puzzled over low patient scores on
cleanliness.The council pointed to the bathrooms — an
importantcomponentofthepatientexperienceinthisarea
— astheculprit.Poororganizationandinsufficientlighting
contributedtotheperceptionthatthebathroomsweredirty.
Shelves were added and lighting was improved.The result?
Patient satisfaction scores improved significantly.
Merlinoreliesonanumberofsourcestomeasuresuccess,
including HCAHPS, which reflect the voice of patient
experience. Others include councils, focus groups with
former and current patients,and other anecdotal feedback.
“The entire management group reads letters and shares
patient stories with our staff at every opportunity,” says
Merlino.“We pay close attention to anecdotal comments,
both compliments and complaints, and distribute them
throughout the organization.”
The patient experience isn’t just an American
phenomenon,as evidenced by the work that the Cleveland
Clinic andThe Beryl Institute are doing with international
partners.Wolf says the Institute has strong collaborative
relationships with the United Kingdom, South Africa,
Australia,and India.
He points to the Cleveland Clinic’s co-sponsorship of
PATIENT
EXPERIENCE
BY THE NUMBERS
Amountastudyof51hospitalsfoundofvariance
in hospital profitability that can be attributed to
patient perceptions of the quality of care.
$2.3 MILLION
Another study estimated that the financial
implications of moving all patients with average
Press Ganey ratings between three and four
to between four and five was $2.3 million in
additional annual revenue.
Thenumberofpeopleadissatisfied
patient tells about a less-than-
satisfactory experience versus the
three a satisfied patient tells about
a positive experience.25
Models suggest that
for every complaint the
healthcare organization
hears, it could be losing
up to 18 patients, a clear
threat to the bottom line.18
30%

02 CRITICAL
SUCCESS
FACTOR
Reinvent patient experience:
Work with patients to re-
engineer core patient processes
to leverage technologies and
drive dramatically better patient
engagement and experience.
There is a major distinction
between understanding the role
of the patient in healthcare and
actually working with the patient
to redesign patient care.
a leadership conference in Turkey for ministers of health in
emerging markets and its work with the UnitedArab Emirates,
aswellasDr.Cosgrove’smembershipontheadvisorycommittee
forthehealthministerof SaudiArabia,andafuturepresentation
on empathy to healthcare leaders in the Netherlands.
As the patient experience movement gains momentum,
experts like Merlino will shape the profession.Wolf says
The Beryl Institute sees the C-suite of the future including
a new member — chief experience officer. Anthony
Cirillo, president of Fast Forward, a patient experience and
marketing firm, agrees.With the growing importance of
the HCAHPS results,having a senior executive at the table
concentrating specifically on the patient experience makes
sense.The chief experience officer plays a critical role in
operationalizing the concept of the patient experience
throughout the organization by being the champion for
employees and medical staff and providing resources to
help identify and realize improvement opportunities.The
Institute is developing a certification program and has
introduced a patient experience peer-reviewed journal to
support this effort.
“At the end of the day,no one organization holds the rights
tothepatientexperience—weallhavetoshareandlearnfrom
each other,”says Merlino.“After all,it’s the right thing to do.”

Is your revenue cycle designed for the future?
BY LIZ WILLDING
03
WHILE ADDRESSING REVENUE CYCLE ISSUES IN
healthcare varies from region to region around the world due
to different payer systems,one thing is for certain –– everyone
wants more for less.
“Fundamentally, the big question is, ‘How do we deliver
better healthcare outcomes with less healthcare dollars,’” says
Elizabeth H.Bradley,Ph.D.,faculty director of theYale Global
Health Institute.“The U.S.spends more than 17 percent of the
GDP on healthcare costs. This is one and a half times more
than any other country.The thing that executives struggle with
the most in any geography is how to influence the biggest
cost drivers, over which they may have very little control. In
particular, healthcare executives worry about how they can
impact wellness,”she says.
Dr. Bradley adds, “They can’t control the things that
contribute to poor health.”
Jennifer Zimmer, an Insigniam partner, says a large part of
the problem is that systems aren’t designed for the future,either
for treatment or preventive care. “Today’s systems, especially
in the U.S., are based on traditional, fee-for-service financial
models,” she says. “They are quickly becoming archaic and
need to be redesigned to serve a patient’s goals.”
Corinne Le Goff, president of Roche SAS, agrees,
especially as it relates to a growing trend toward innovations in
personalized medicine.
“Our system is set up for reimbursement of generalized

“OUR SYSTEM IS SET UP
FOR REIMBURSEMENT OF
GENERALIZED MEDICINE AND IS
NOT DIFFERENTIATED FOR THE
DISEASE STAGE.”
-CORINNE LE GOFF, PRESIDENT
OF ROCHE SAS
medicine and is not differentiated for the disease stage,” she
says.In oncology,for instance,she says advanced treatments may
combine different biologics based on the patient’s biomarkers.
“The system is not set up for that,”says Le Goff,who notes
that there are reimbursement pilot programs in place, but
questions whether actual information technology (IT) systems
are up to the task.
“When you talk to the government, it can be overwhelming
to say,‘You have to totally redo your reimbursement system,’”
Le Goff says.
The ultimate answer, according to Zimmer, is redesigning
the revenue cycle.“While many models are being explored, it
essentially involves ‘establishing greater integrity or structural
soundness in the way you collect money,’” she says. “The
revenue cycle needs to be whole and intact for the realties of
healthcare in the future,and,oh,by the way,the future is rapidly
becoming now.”
Zimmer cites a recent example with U.S.-based Advanced
Homecare (AHC), a very large (Top 75) home care agency,

where their process was redesigned to make it easier for patients
to interact with the organization, so that multiple financial
touch points impact the patient just once.
“When we started in June,Advanced
Homecare had significant revenue
leakage, losing hundreds of thousands
per month on co-pays alone,” Zimmer
explains.Today the company is collecting
co-pays up front from patients,turning a
profit, and, in less than six months, is 80
percent to its fully captured goal.
“The employees,who are on the front
line with the patient, now understand
the impact their interactions about
payment have on the patient experience
and on the viability of the company.
And AHC is starting to see the money
come in. Their approach is the future
of healthcare and proof that you can
reinvent the process,”Zimmer says.
According to Joel Mills, CEO of
AHC, his organization was “stuck,”
essentially blaming a new computing
system for the organization’s financial issues.
“We were doing enough business to be successful, but not
getting the full potential from our hard work,” says Mills.“We
were stuck in not being able to bill for all the things we were
doing.We weren’t able to focus on the whole business.”
Mills adds that, “Reshaping our processes,and putting things
in the context of what’s best for the patient, turned things
around. It also helped our workforce and leaders to become
more engaged.”
Getting on top of coding issues is
another area where gains are to be made,
especially in the U.S., where healthcare
providers face sweeping changes when
new ICD-10 requirements go into
effect in October.
Mario A. Singleton, MBA/MHA,
who is the director of Hematology/
Oncology at Cone Health-Annie Penn
Cancer Center, made it his mission to
understand and address why revenue
wasn’t matching up with volume.Upon
doing a deep dive,he discovered that the
center was a couple of months behind
on billing, largely due to a coding
bottleneck.
“I didn’t think we had the proper
number of coders to keep up with the
volume and after implementing EPIC,
our new electronic medical record. After some discussions
with our oncology executive leadership team, we brought in
contract coders,” he explains. Singleton also did an audit on
recent patients and discovered that, in many cases, the system
was picking up the wrong J-codes.
“RESHAPING OUR
PROCESSES, AND
PUTTING THINGS
IN THE CONTEXT OF
WHAT’S BEST FOR
THE PATIENT, TURNED
THINGS AROUND. IT
ALSO HELPED OUR
WORKFORCE AND
LEADERS TO BECOME
MORE ENGAGED.”
- JOE MILLS, CEO OF AHC
ROCHE HAS SEEN A GROWING TREND TOWARD INNOVATIONS
IN PERSONALIZED MEDICINE — AND HAS ESTABLISHED PILOT
PROGRAMS TO ADDRESS EMERGING NEEDS AND ISSUES.

BY THE NUMBERS
COUNTRIES WITH THE HIGHEST
HEALTHCARE COSTS (AS PART OF GDP)
AMOUNT CONE HEALTH-ANNIE PENN
CANCER CENTER WENT FROM LOSING
TO GAINING, PERYEAR, AFTER
ADDRESSING CODING ISSUES.
11% 9.5%
SWEDEN ENGLAND
$500,000
03
CRITICAL
SUCCESS
FACTOR
New revenue cycle: Develop a
highly effective, productive, and
efficient (i.e., simplified) revenue
cycle.
“I asked myself if we could get the coding done in five days,”
says Singleton.“How would that impact our finances? What if
the data was input correctly the first time? ”
When the issues were addressed, the Annie Penn Cancer
Center went from losing half a million per year to gaining as
much in two years’time.
“One thing I found was that we needed a strong team lead to
oversee the coders and to make them understand their impact
on the revenue cycle,” Singleton says.“We needed to paint the
picture and let them realize their contributions to the team. We
put a strong team lead in place and when the coders discovered
that their role was vitally important, they became much more
invested in their work.”
Meanwhile, Singleton says his organization is gearing up for
the ICD-10 shift, with preparation including training and use
of a new electronic records management system that facilitates
tracking,both for the organization and patients.
“It is always disheartening and disconcerting when a patient
brings in a big binder documenting charges that are incorrect,”
he says.“With electronic health records, they can electronically
check their bills.It adds a lot of transparency.”
Singleton says he believes that better revenue cycle
management is a differentiator and will ultimately help address
other strategic issues,including wellness.
“When you are maximizing your revenue cycle management
withaccuracy,efficiency,andcost-effectiveness,yourorganization
can realize the possibilities of caring for the patients,” says
Singleton. “Caring for each other, and the community, while
delivering measureable results in areas of quality,service,and cost
is something we strive to do daily. Before long, you really can
begin to see the possibilities.”
17%
UNITED STATES

DIVERSIFIED,YET
INTEGRATED
SPECIALIZATION
How population health is putting the heart back into healing.
BY ROBERT ITO
04
SHRINKING REIMBURSEMENTS AND INTENSE
cost cutting have left many physicians scratching their heads,
wonderingwhytheygotintomedicineinthefirstplace.Buried
under mountains of paperwork and feeling pulled in a million
directions,the impact of today’s changing healthcare landscape
has been a particularly harsh pill to swallow for those who are
at the heart of healing on any continent.
However, thanks to a global focus on population health,
which seeks to manage an individual’s health issues in a holistic
way,practitionersmayyethaveafightingchanceatreturningto
theirrightfulplaceashealers. Restoringandsustaininghealthis
today’s mantra,versus just caring for patients when they fall ill.
OneveritableforceadvocatingforpopulationhealthisAmerica’s
AccountableCareOrganization(ACO).Arelativelynew — and
controversial — departure from the traditional,volume-driven
fee-for-service model,the aim ofACOs is to create a system that
incentivizes practitioners to keep patients well.
SaysDr.MikeWeiss, chiefmedicalofficeratOptumMedical
Group, Southern California. “The biggest dysfunctional piece
of healthcare today is the reactive nature. Patients come to a
physician with a problem, they fix it, and move on.We need
to proactively reach out to patients of all populations, young
Incentivizing practitioners to
be more proactive — as in
the case of diabetes care —
is a way to shift care back to a
more holistic model.

and old.”
In this sense,he says the old saying,“An ounce of prevention
is worth a pound of cure,”has never been truer.However,he is
quick to add that executing is not without its challenges,which
he sees as two-fold.“First, physicians have to understand how
important it is to provide proactive care.Initially,it’s more work
because you have to look for ways to keep patients healthy.
Second, it is critical to engage the patient so they understand
the importance of their participation.”
Following a care protocol for diabetes is a good example.
“Diabetes doesn’t hurt and most people don’t even know they
have it until it is revealed,” Weiss says.“Our job is to intervene
before it hurts.”
Monarch took a novel approach when launching its top-
performing ACO several years ago,
initially developing the network with
its highest-performing physicians.
“Our Medicare Advantage physicians
already were coordinating care
very well,” explains Colin LeClair,
Monarch’s executive director. A
proprietary practice management
systemwasmodeledafterthatusedwith
Medicare Advantage, putting valuable
informationatthephysicians’fingertips
for fee-for-service patients.
“Previously the physicians had no
means of seeing data on these patients
unless they came in. Now they can see their MRIs, therapies,
etc.Itgivestheprimarycarephysicianmorevisibilityintowhat’s
going on with the patients’ healthcare,” LeClair says. Just as
important, the ACO provides patients with a wide range of
services most aren’t even aware are available,like transportation
to appointments or to pick up medications.
So, in the ACO world, what exactly does preventive care
look like?
“The patient is compliant with his or her medication
regimen, fulfills required screenings, and is up-to-date on
scheduledscreenings,”explainsDr.Weiss.“Whatwearelooking
at is providing patients with all the information they need to
be successful.”
Along with happier, healthier patients, he says physician
satisfaction also improves.“Physicians want to do what’s best
for patients and the best way to do that is through access to
timely, accurate data.The data informs physicians so they can
providebettercare.This, inturn, improvesphysiciansatisfaction
because their patients are doing better.”
If the population is kept healthy, the physician also benefits
financially, he explains.“In an ACO model, compensation is
based on quality. Instead of getting paid for more widgets, for
instance,we get paid for making higher-quality widgets.”
LATE TO THE GAME
AlthoughabigshiftfortheUnitedStates,thisapproachisalso
shared by the healthcare systems of European Organization for
EconomicCo-operationandDevelopment(OECD)countries
like the U.K.,France,Germany,the Netherlands,and Sweden,
many of whom manage to do it in a much more efficient
manner — and nearly always at a much lower price.
There are currently 300ACOs in the U.S.and counting,and
theyhavealotincommonwiththeirinternationalcounterparts.
Recent healthcare legislation like Ontario’s Excellent Care for
AllAct(2010)andEngland’sHealthand
SocialCareBill(2011),sharetheACO’s
focus on performance monitoring —
usually with increasingly more specific
means of monitoring improvement
in healthcare systems — and include
similar financial incentives to keep
patients from getting sick in the first
place.
There’s also been a shared focus
worldwide on how best to deal with
chronically ill patients –– that tiny 1
percent of utilizers who, according
to an oft-cited study by Rutgers
University economistAlan Monheit,account for nearly a third
of all healthcare spending in the U.S.
All of these programs seek to create more coordinated
and collaborative systems of care, with an integrated network
of doctors and specialists all working together to best serve
its population. In many ways, the U.S., with its historically
decentralized healthcare system, has a marked disadvantage to
thiscomparedtoitsneighborsinEurope,withtheirsingle-payer
healthcaremodels.Theinfrastructureisn’tnearlyasstronginthe
U.S.,letaloneconducivetoacollaborativemindset.Howdoyou
get all those physicians to work together — particularly doctors
who,in the past,might not have tended to collaborate at all?
“Youhavetodesignsystemsbywhichtherightthingtodois
also the easiest thing,”says Michael Ogden,M.D.,chief clinical
integration officer at Cornerstone Healthcare,a medical group
with more than 90 locations in North Carolina.Cornerstone’s
recently acquired software tools allow doctors to identify their
community’s most at-risk patients.
It’s a trend that’s already well in place in New Zealand, a
country second only to Denmark in its use of electronic patient
300THE CURRENT
NUMBER OF ACOS
IN THE U.S.TODAY

records by primary care physicians (90 percent of the country’s
PCPs communicate online via secure networks).Additionally,
95 percent of New Zealanders are registered in the National
Health Index, an integrated system that allows hospitals and
health agencies to share information anywhere in the country.
Once high-risk patients at Cornerstone are identified,
says Ogden, they’re directed to centers like Cornerstone’s
Personalized Life Care Clinic, a specialized, coordinated care
center that focuses on the top 3 to 5 percent of the group’s
neediest patients.“They have a navigator, someone who can
coordinate care between different specialists,”he says.“We have
a dietician,a pharmacist, and access to psychology all clustered
within a life care clinic.”
WELCOME TO THE NEIGHBORHOOD
One of the most recent experiments in clinically integrated
networks is the Patient Centered Medical Neighborhood
(PCMN),a healthcare model that expands on the concept of
the Patient Centered Medical Home. In 2012, Kansas-based
TransforMED received a $21 million, three-year grant from
the Centers for Medicare and Medicaid Innovation (CMMI)
to create Medical Neighborhoods in 15 communities around
the country.
By definition, the medical neighborhood concept
encompasses everything from wellness to complex care, with
coordinationoriginatingthroughtheprimarycarepracticeand
extending to hospital systems, medical specialties, and other
community health services to support a fully integrated care
approach.
For example, TransforMED CEO Bruce Bagley, M.D.,
foreseesadaywhenawomancanseeherfamilyphysicianabout
a breast lump at 10 in the morning,get a mammogram at 11,
and talk with someone about the results at 1.“By the time she
goes home for dinner,she’s had a biopsy and gotten the results,
and is holding in her hand a CD-ROM of a decision aid that
canhelpherunderstandherchoicesandoptionsinanunbiased
way,”he says.“That’s clinical integration.”
For ACOs, integration can apply to something as narrow
as one-on-one, doctor-to-doctor communication, or to
something as broad as previously competing healthcare
providers sharing patient records.“If you have a community
that has three hospital systems,historically those three systems
haven’t worked together very well,”says RussellW.Kohl,M.D.,
medical director atTransforMED’s Innovation for Centers of
Excellence,who is currently spearheading the group’s PCMN
project.“They’ve been focused on trying to control market
Countries such as the
U.K., France, Germany,
the Netherlands, and
Sweden have long utilized
benefits of an ACO-type
healthcare structure.

04
CRITICAL
SUCCESS
FACTOR
Diversified, yet integrated
specialization: Optimize physician
network with strong physician
leadership, collaboration, diversity of
specialization, and alignment.
Amount
chronically
ill patients
account for of
all healthcare
spending in the U.S. These
patients only make up 1
percent of utilizers.
1/3
$13MILLION
Amount Pioneer ACO at
Banner Health Network in
Arizona netted in shared
savings in its first year of
existence.
30%
95%Number of New Zealand
citizens registered in the
National Health Index,
an integrated system
that allows hospitals and
health agencies to share
information anywhere in the
country.
SPECIALIZATION
BY THE NUMBERS
Percentage
of current
healthcare
spending that
is duplicative
and wasteful.
share,so in areas where you have limited specialist availability,that can
certainly be an issue,”says Kohl.
A possible solution: getting these former foes to realize the cost-
cutting value of shared services.“ACOs need to look at things like,‘Do
we really need to have five cardiac catheterization labs within one mile
of each other in the city of Boston,’”saysThomas Concannon,Ph.D.,
a policy researcher at the RAND Corporation.“They need to look at
the mechanisms they could use to coordinate service and technology.”
It’s that sort of coordination,say the proponents ofACOs,that’s key
to driving down healthcare costs.According to the DartmouthAtlas of
Healthcare,an ongoing project under the auspices of the Dartmouth
Institute for Health Policy and Clinical Practice, up to 30 percent of
current healthcare spending is duplicative and wasteful. One of the
primary missions of the ACO is to reduce that waste,with the shared
savings being distributed between CMS and the participatingACO.
Those shared savings are the carrot, but many healthcare systems
overseas also utilize a pretty big stick. One example: Under their
diagnosis-related groups (DRG) system, hospitals in most European
countries won’t receive a second payment if a patient has to be
readmitted for the same medical issue within 30 days.
In its first year of existence, the Pioneer ACO at Banner Health
Network inArizona netted $13.3 million in shared savings.One of its
most successful programs involves an algorithm that identifies its most
high-riskpatientsbeforethey’rerolledintotheER(amongthetriggers
are patients who are on more than seven medications a year).In some
cases, R.N.s are dispatched right into providers’ offices and patients’
homes. But it’s the sort of integration of services that’s helping to drive
Banner’s health costs ever downward.
“There’sbeenalearningcurveforourproviders,”admitsMattHorn,
director of Banner Health’s Pioneer ACO.“Providers haven’t always
been willing to allow another care provider to come into their office
who hasn’t historically been there,” says Horn.“But the beneficiaries
appreciate it.They appreciate having that extra person there.”

MINDSET OF WELL-BEING
Shifting the focus is all about engagement
BY LIZ WILLDING
05
TO PULL OFF POPULATION HEALTH,NO MATTER
your geography, everyone in the continuum — executives,
physicians,the clinical support staff,administrative workers,and
ultimately the patient — must be locked on one central goal:
well-being.This mindset is a quantum shift from providing care
primarily when an illness presents itself. It starts by engaging
every individual in the healthcare workforce on how their
part of the process impacts patients and ultimately extends to
fostering healthy lifestyle changes by patients themselves.
What will it take for everyone in a healthcare organization
to understand their impact on patients? It begins by showing
everyone in the healthcare delivery process how their role
impacts patients, especially by their actions or inactions, says
Jordan Safirstein, M.D., a cardiologist and member of the
Google Healthcare Advisory Board, and assistant director
of the Cardiac Catheterization Laboratories at the Gagnon
Cardiovascular Institute, Morristown Medical Center. Dr.
Safirstein gave an example of how this can impact the life —
or death — of patients requiring an emergency catheterization
procedure.
“It is important to show the emergency management
system (EMS) crews and the first responders how they can
affect door-to-balloon times if they do not meet certain time
points, and the emergency room staff is crucial to expediting
the patient once they arrive in the ER,” says Safirstein.“Then
the cath lab receiving staff is essential to rapid prepping and
troubleshooting,even before the physician steps into the room.
Safirstein continues,“Finally,there’s the role the doctor plays
in the technical achievement of timely success.All of these time
points and goals are reviewed monthly and consistent sore spots
are remedied with changes in protocols.It is an ever-improving
process, like healthcare itself, as technologies and paradigms
change.The strategy is to get people to understand their roles,
make sure they see the results on the end product, and to be
accountable by making those results visible to the rest of the
team.”
While the impact on well-being is most dramatically
illustratedinanemergencysituation,itisimportantforeveryone
in the continuum of care to understand the importance of their
job and its impact on the patient, from physicians and nurses
to the administrative staff.Healthcare executives might assume
that all the players are sensitized to the patient impact,but,says
Jennifer Zimmer,Insigniam partner,this isn’t always the case.
Making such false assumptions is a huge barrier in the
workplace, she explains. “This behavior does not create
innovative or breakthrough results.It’s business as usual.”
GOING BEYOND TREATMENT TO LIFESTYLE
While the healthcare industry traditionally defines the
“continuum” as actions taken to address a patient’s particular
disease state,addressing lifestyle issues is no less important when
it comes to preventing or slowing the progression of disease.
Again, engagement is key, especially in the workplace, directly
reaching patients with interventions that motivate healthy
behaviors.
Based on research conducted by Gallup in 2012, engaged
employees are more likely to report a healthier lifestyle than
their unhealthy counterparts,and they are less likely to be obese

or have chronic diseases.Although obesity,as a general category,
is hard to quantify,one study,published by the Harvard School
of Public Health in 2012,estimated that 21 percent of the total
U.S. spending on healthcare was devoted to obesity related
issues.
Insurance providers and the private sector are jumping into
the game,providing tools and incentives to encourage lifestyle
changes. “We’ve done a good job reaching people who are
inclined toward a healthy lifestyle,” explains Joan Kennedy,
Cigna vice president, customer health engagement. However,
she acknowledges that these people aren’t in the majority.
A universal problem, Kennedy notes, is that countries such
as China are equally befuddled about how to motivate their
society on wellness, which is facing a growing epidemic of
obesity and diabetes.China’s woes are largely due to an increase
in sedentary jobs as the country becomes more industrialized,
as well as adoption of a more westernized diet.
PRESCRIBING A DOSE OF EMPATHY
Reaching at-risk individuals revolves around empathy, says
Alexandra Drane,founder and president of Eliza Corporation,
which provides health engagement management solutions.
Teaming with the Altarum Institute, a healthcare research
organization, they surveyed more than 30,000 individuals and
found, overwhelmingly, that life obstacles often made it too
difficult for people to make health a priority.
“Life obstacles like caregiving, financial, and relationship
stress were cited as key factors throwing life out of balance,”
Draneexplains, addingthatunlesshealthcareorganizationshelp
people address these stressors,which she calls“unmentionables,”
their wellness efforts are likely to fall on deaf ears.
This is why programs traditionally focused on disease states
have been met with low enthusiasm, she says. Simply put,
messaging that lectures people about what they aren’t doing,
hasn’t worked well for the broader population.
“People have told us that they simply don’t have time to
focus on their weight,for instance,because they are too stressed
out caring for an elderly parent.When we listened, and we
offer information on resources, nearly all of those surveyed
sought help.”
Building on the research, Eliza developed a tool called the
Vulnerability Index that helps health organizations quantify
the prevalence and impact of contextual life factors,which are
influenced by negative and positive coping responses.
Believing in the directional vision of this approach has
helped Cigna rethink its messaging, Kennedy explains. “We
asked ourselves, is there a way to re-architect our approach to
wellness, putting the pressing issues first? We found that once
you get the larger stressors calmed,you have a better chance of
addressing a person’s underlying health issues.”
Today, Cigna is in the midst of a pilot, which, based on
vulnerability, leads to different types of interventions.“We are
architecting incentives and interventions to tie to the whole
person,instead of using a fragmented approach,”Kennedy says.
Part of the solution involves tying Cigna coaches with members
and their physicians,both receiving rewards for improvement.
The approach is also driving better use of employee
assistance programs, or EAPs, which have become stigmatized
for singling out individuals seeking emotional help. “We
encourage organizations to reinvent EAPs so people feel
comfortable turning to them as a resource.”
How well is this kinder,gentler approach working?
“We are getting good participation in our pilot,” Kennedy
says; however, she is cautiously optimistic, adding that “none
of us know the answer,because we’ve never tried this before.”
THE IMPACT OF TECHNOLOGY
The use of mobile technology is also emerging as an
important enabler, with apps and fitness devices helping
individuals monitor their progress. “There are more than
40,000 health and wellness apps currently in the marketplace,
which is a bit overwhelming,” Kennedy explains.“We have a
team of experts who are evaluating and recommending some
for our online ‘GoYou’ marketplace.” GoYou, a Cigna portal,
allows members to access tools and services that monitor their
wellness activities.
She notes that use of apps especially makes sense in countries
where the population is highly mobile.
“In South Korea,for instance,people are entirely mobile and
you have to reach them through their phone.In other regions
of the world, you may have to work around the healthcare
architecture.”
The main point,says Kennedy,is to give support in ways that
people want to receive it — and in a way that shows you care.
05
CRITICAL
SUCCESS
FACTOR
Mindset of well-being: Create a mindset
for patient care that looks from a broad view
of the overall patient’s health and well-being
across a continuum of care.

06
IN 2015, WOMEN’S COLLEGE HOSPITAL IN
TORONTO, CANADA, WILL RELOCATE TO A
STATE-OF-THE ART FACILITY (PICTURED)
THAT COMPLEMENTS THEIR VISIONARY
APPROACH TO HEALTHCARE.

WHATHAPPENSWHEN YOUMAKE A180DEGREE
shift in your business model, moving from acute care to
an ambulatory care model? Women’s College Hospital
in Toronto, Ontario, Canada, did just that, challenging
traditional thinking at all levels of its organization about
healthcare delivery.An inpatient acute-care hospital with
130 years of service, this radical shift was precipitated by a
pre-arranged merger with two other healthcare institutions
in 1998. Eight years later, administrators successfully
negotiated with the government of Ontario to once again
be a stand-alone organization.
“Part of the price that we paid for independence was a
stipulation from the government of Ontario that we could
operate only as an ambulatory facility,”says Marilyn Emery,
president and chief executive officer of Women’s College
Hospital.“We could have chosen to go down the mainstream
route,but we chose instead to take a visionary approach,one
more suited to where we felt healthcare is headed.While we
continue to focus on advancing healthcare for women,we
are aggressively addressing the transitions between acute-
care and post-acute care.”
Why hasWomen’s College Hospital thrived in its pursuit
of outpatient excellence? How has it succeeded when
others are struggling? What does the future look like for
the organization?
Emery credits a comprehensive 2½ year strategic planning
process guided by the hospital’s mission as the foundation
upon which all programming has been built.The process
was driven by the need to answer two questions — who
is Women’s College Hospital and what did it provide
to the community? The honest conversations that took
place among key stakeholders, including board members,
physicians, staff, and the community, provided a bridge
between women’s healthcare and ambulatory care. A key
driver was the provincial government’s interest in shifting
people from inpatient care,the most expensive type of care,
to outpatient care through innovation that could ultimately
result in people never being hospitalized in the first place.
The strategic roadmap that emerged defined a clear vision
and focused on identifying gaps and developing innovative
services, not duplicating existing services.
To achieve its mission, the organization identified three
NEW HORIZONS
A model for the future of healthcare:Women’s College Hospital
BY TOM PECK
THE HOSPITAL DEFINES ITS VISION AS BEING, “CANADA’S
LEADING ACADEMIC, AMBULATORY HOSPITAL AND A WORLD
LEADER IN WOMEN’S HEALTH.”

specific areas of focus: health for women, health system
solutions, and complex chronic conditions. These are
supported by six innovation streams: driving systematic
solutions in healthcare for women,
preventing acute care admission
and readmission, enabling superior
coordinated care, transforming
inpatient care models to outpatient
care, enabling system integration
and care transitions, and building
a virtual hospital.Three corporate
directives guide the hospital’s
decision-making and action
planning: drive the innovation
agenda, strengthen the capacity to
lead from its mandate, and grow its
academic impact.
Emery says the senior team talks
about the corporate directives
daily. “It really is the culture of
the organization. The directives
enable close integration between
research, clinical care and everything else that goes on in
the organization,” she says.
Women’s College Hospital has been deliberate about
designing outpatient programs to serve marginalized and
underserved patients — a gap identified in its strategic
plan. An example is the Toronto Birthing Center, a
midwife run program located in
a free-standing facility in a high-
needs neighborhood. The center
is designed to improve access for a
variety of frequently underserved
groups, including Aboriginal
women, immigrant women, inner
city women, women who identify
as LGBTQ,refugees,teens,and the
noninsured.
The hospital operates in an
undefined space in healthcare, so it
is difficult for people to grasp what
it does.It is used as an incubator for
the rest of Canada’s health system.
The work it is doing has grabbed
the attention of health leaders across
Canada and around the world.
“We are often contacted by other
organizations interested in learning who we are, what we
do,and how we do it,”says Emery.“We just hosted a group
fromVietnam and our physicians and scientists are frequent
“WE CAN’T
FALL BACK
ON INPATIENT
BEDS, SO THAT’S
CREATED A
TREMENDOUS
OPPORTUNITY
FOR INNOVATION.”
- MARILYN EMERY, CEO AND
PRESIDENT, WOMEN’S COLLEGE
HOSPITAL

speakers on the international scene.We’ve adapted concepts
such as the virtual ward from the United Kingdom. A
U.K. delegation visited our organization, studied the
improvements we had made,and took our ideas back with
them.”
Partnering with other healthcare providers and
government agencies has been vital to Women’s College
Hospital’s success. “We need the ability to refer patients
to inpatient facilities,” says Emery.“When you’re looking
to solve problems that are difficult for everyone, you need
multiple perspectives and resources.We constantly ask other
providers what we can do to help them meet the challenges
and resolve the problems they are facing.”
Heather McPherson, Women’s College Hospital’s
executive vice president of patient care and ambulatory
innovation, says data related to patients’ expectation of
ambulatory care has helped align physicians and staff with
the hospital’s mission and strategic plan. Patients expect
to wait around 20 minutes for service in an outpatient
care setting. Benchmarking the organization’s actual
performance against these expectations, as well as against
the performance of peer organizations and incorporating
patient feedback on their experience,has provided evidence
to help the hospital improve.
“We can’t fall back on inpatient beds, so that’s created a
tremendous opportunity for innovation,” explains Emery.
“We have one of the biggest breast reconstruction surgical
programs in Ontario.The average length of stay for this
procedure is five to six days. Our interdisciplinary teams
spent one year developing a care pathway that created higher
quality care,increased patient satisfaction,and reduced the
amount of time at the hospital to 18 hours.”
By adopting systematic innovations across their business
model,Women’s College Hospital is a living embodiment
of what’s on the horizon for the healthcare industry.
06
CRITICAL
SUCCESS
FACTOR
New horizons: Expand patient care
beyond physician-centered and
acute-hospital-located care delivery.
BY FOCUSING ON
INCREASED PATIENT
SATISFACTION,
WOMEN’S COLLEGE
HOSPITAL DEVELOPED
A PATHWAY TO
INTERDISCIPLINARY
IMPROVEMENT.

HEALTHCARE LEADERS,
OUR TIME IS NOW
“Innovation” is today’s critical objective.
BY LIZ WILLDING
07
WITH SO MANY DRAMATIC SHIFTS HAPPENING
across the healthcare landscape, now is the time for innovation.
Business as usual will no longer suffice, whether it’s coping
with an aging population fraught with noncommunicable
diseases or shifting to a focus on wellness.
“This is our moment in time to transform healthcare,” says
Nathan Owen Rosenberg, Insigniam founding partner.“It is
time for healthcare leaders to define and realize a new, bold
future for the care and health of our population.”
Globally, a host of forward-thinking organizations already
have read the tea leaves, actively innovating demonstrations
into what global healthcare will look like in the future.At the
Mayo Clinic,for instance,approximately 65 people are actively
dedicated to identifying and testing new ideas, using human-
centered design methods.
“Our approach is to transform the way people experience
healthcare,”explainsDouglasL.Wood,M.D.,whoisthedirector
of the Center for Innovation at Mayo Clinic. Emphasizing
that “we are fundamentally interested in putting the needs of
people first,” he references research that identifies key reasons
why people often don’t seek care due to barriers created by
providers and the system.

“We listen to people’s needs,and we often try to force them
into care, blaming them if they are noncompliant. People also
spend most of their time out of clinics; we need to develop
and deliver care where they are, instead
of forcing them to go to clinics where
they may not feel comfortable.”
Dr. Wood adds that “we have lots
of roles for sickness care, but not a lot
for health. Our systems force protocols
on people that are rigid and not very
helpful.”
Types of innovation projects coming
out of Mayo Clinic’s Center for
Innovation range from changing the
delivery of care for expectant mothers
–– even equipping them with Doppler
ultrasound machines so they can
listen to their babies — to creating a
laboratory in an assisted-living facility to
manage transitions from hospital to home settings, and even
embedding“designers”who are studying ways to mitigate the
stresses of campus life into the campus environment atArizona
State University.
Similarly, integrated care consortium, Kaiser Permanente,
operates its “Hospital of the Future”
project, creating scale models of an
integrated system linking doctors
and clinics, as well as a health
insurance component, all housed
inside its 37,000-square-foot Garfield
Innovation Center in San Leandro,
California.
Cross the ocean to China and there’s
the “Innovation City” on the outskirts
ofWuhan,the country’s newest symbol
of the government’s mandate for
innovation. Complete with two dozen
structures, it was no more than rolling
farmland just two years ago.
The European Union has also
embraced the concept of innovation, establishing the
“Innovation Union – A European 2020 Initiative.” One of
“IT IS TIME FOR
HEALTHCARE LEADERS
TO DEFINE AND
REALIZE A NEW, BOLD
FUTURE FOR THE CARE
AND HEALTH OF OUR
POPULATION.”
- NATHAN OWEN ROSENBERG,
INSIGNIAM CO-FOUNDING
PARTNER

LEADERSHIP
MANDATE
PROPRIETARY
PROCESSES
INSIGNIAM’S FOUR
PILLARS FOR INNOVATION
its goals is to create a single European research area to attract
science and technology talent and funding as a means to
compete with U.S.andAsian markets.
In Switzerland, heavy emphasis also is being placed on
innovating business processes, with a new hospital financing
system, launched in 2012, addressing access to capital and
encouraging competition and consolidation.This program is
focused not only on efficiency,but also on care and quality.
CREATE VALUE
At the end of the day,“Innovation is about delivering new
value,” says Nathan Owen Rosenberg, Insigniam co-founder,
noting that there are “huge challenges in the delivery of
services.”
Indeed,says Rosenberg,who believes the only way to survive
in today’s volatile environment is to innovate with a focus on
accountability.The simple truth,he says,is that patients,as they
become more accountable for their care, “are going to be
shopping,”which creates a new layer of competition.
Robert E. Johnston, Insigniam consultant and co-author
with J. Douglas Bate of The Power of Strategy Innovation, agrees.
Since publishing in 2003, he says he has observed global
healthcare innovation mature to a place outside of research and
development.
“We are now moving from ad hoc to breakthrough,
quantum innovation,”he explains.“That is the new high bar.”
To innovate effectively requires a very deliberate and
organized effort, he explains, with Insigniam’s approach based
on four pillars for innovation:
1. Leadership mandate
2. Dedicated infrastructure
3. Proprietary processes
4. Supportive culture
“First,the C-Suite must send a very loud and clear mandate
for innovation across the enterprise that is relevant to all
employees,” Johnston says.“They also must give the necessary
permission to do fresh thinking, and they must back this up
with funding,people,time,and space.”
Johnston says that the creation of innovation labs on the scale
of Mayo and Kaiser Permamente is becoming an increasingly
common phenomenon; however, it is possible to scale up in a
less grandiose way.

“One way to jump-start embedded innovation in the DNA
of an organization is to commit to a yearlong innovation
immersion,” he explains. “Once you have a vision for your
future organization, you plan backwards. This way you
eliminate all the noise that over time becomes irrelevant.”
The metaphor he says he uses the most these days is that
“every organization is on its own innovation journey.You have
to get from pointA to point B.”
Working with an organization in
South Africa, Johnston describes an
innovation immersion experience
that began with two executive teams.
In short order, they chartered 26
additional innovation, or I-Teams, to
address both tactical and strategic issues.
After the initial launch, a mid-year
“jam session” was held, and the energy
and enthusiasm level was “palatable,”
he says. By the end of the year, which
wrapped up with a celebration, many
of the teams had completed their work,
resulting in pipelines of new business
opportunities and significant cost-
saving opportunities.
For this company, what began as a
one-year effort is now in the third year
of its journey.
While attending a recent conference hosted by the
Massachusetts Institute of Technology (MIT), Johnston
recalls watching “Hack-a-Thons,” which involve participants
“hacking their way through how clinical trials are conducted
today.”
“It’s difficult to enroll patients and even tougher to keep
them in the program,” says Johnston.“The idea was to attract
and keep patients in for the long haul by offering them, up
front, free drug therapy, pending approval by the Food and
DrugAdministration (FDA).”
MIT has staged 10 of its“Hack-a-Thons”around the world
in hospital organizations, and out of these have come 10 new
ventures that are receiving third-party funding.
BEWARE THE BARRIERS
However, while innovation can breathe new life into an
organization, there are barriers that can derail even the best
efforts.
Rosenberg says executives should also be aware of their
“corporate immune system,” which repels ideas because
“that wouldn’t happen here” and “senior management will
never go for that.” Equally debilitating is corporate myopia,
where organizations “have a very narrow lens for how they
define business,” and corporate gravity, which holds down
organizations that operate under a“can’t-do mindset.”
Ultimately, innovation is only as good as its execution.
Insigniam conducted an Executive Sentiment survey in 2013,
asking 200 executives how prepared they are to innovate
and execute on their innovation ideas. An overwhelming
87 percent said innovation is the
most important or a very important
factor in their organizations’ ability
to succeed and strengthen their
competitive advantage in the next
12 to 13 months. However, only 15
percent felt their organizations were
well prepared to generate the needed
level of innovation.
“Many of today’s health leaders
are in shock by all the changes facing
healthcare,” Johnston says. “They
are catatonic. I’ve heard leaders say,
‘When we look into the future, we
don’t know what is going to happen.
It is like we’re walking into a dark
room.’
“Well, at some point, the lights are
going to come on.The organizations that are most prepared
to handle the opportunities will win … and the others will be
left behind.”
He adds that while it is entirely impossible to predict what
the future will hold, “you don’t want to be surprised by it
either.You can’t predict,but you can influence,”which is what
innovation,at its core,is all about.
07
CRITICAL
SUCCESS
FACTOR
Embedded innovation: Embed
in the organization a competency
for creativity to continually innovate
and rapidly execute innovation and
change.
“WE NEED TO
DEVELOP AND DELIVER
CARE WHERE THEY
ARE, INSTEAD OF
FORCING THEM TO GO
TO CLINICS WHERE
THEY MAY NOT FEEL
COMFORTABLE.”
- DR. DOUGLAS L. WOOD,
DIRECTOR OF THE CENTER FOR
INNOVATION, MAYO CLINIC

IT IS AN INDISPUTABLE FACT THAT INFORMATION
technology is revolutionizing healthcare. An explosion
of mobile applications (mHealth) is enabling patients to
use their smartphones to monitor their chronic conditions
and connect with their physicians. Blood pressure, cardiac
monitoring, and blood glucose monitoring are early entrants
in the world of mHealth. As an enabler, IT is helping to
care for patients in their home versus the hospital, providing
real-time information that physicians can monitor and react
to immediately.
The implications are fantastic and seemingly once relegated
to the world of science fiction. For instance, Proteus, a digital
healthcompany,recentlyreceivedFDAapprovaltomanufacture
pillswithedibleelectronicsensors.Anonline
mHealthappreceivesdatatransmittedbythe
sensors,enablingphysicianstotrackapatient’s
medication compliance. This technology
addresses the costly problem of medication
noncompliance, estimated to cost the U.S.
healthcare system alone as much as $290
billion.
A report published by research2guidance predicts that by
2017,themHealthmarketwillreachbillionsofpeoplearound
the globe via their smartphones and tablets. Research and
Markets, an international market research firm, estimates
the current value of the global mHealth apps market at $6.6
billion, growing to $20.7 billion by 2018. The mHealth apps
marketintheUnitedStateswasestimatedtobevaluedat$2.9
billion in 2013.
The report predicts the highest growth will occur in diabetes
management devices due to the increasing global burden of the
disease.The proliferation of apps related to diabetes validates the
prediction.OnTrack forAndroid smartphones allows diabetics
to track blood glucose highs and lows,food intake,medications,
LEVERAGING NEW
TECHNOLOGY
Take technology to a personal level
BY TOM PECK
08

blood pressure, pulse, exercise, and weight all in one place.
SiDiary captures, stores, and analyzes relevant data for use in
diabetic therapy.The Diabetes Diet app contains hundreds of
healthy recipes. A recent clinical trial conducted byWellDoc
demonstrated that combining patient behavioral coaching via
mobile applications with blood glucose data,lifestyle behaviors,
andpatientself-managementdatasubstantiallyreducesglycated
hemoglobin levels over one year.
The Food and DrugAdministration projects that the mobile
appmarketwillgrowby25percentannuallyforthenearfuture,
with companies investing record amounts in developing new
health apps.Consumers will find more and more options from
which to choose.There are more than 40,000 health apps
currently on iTunes, including calorie counters, prescription
reminders,and physician and hospital locators.
As of September 2013, the FDA had cleared nearly 100
mobile medical apps including blood pressure monitors, apps
thatsendreal-timereadingsofelectrocardiographstophysicians,
andappsthataccessvitalsignsforuseinemergencycardiaccare.
“Mobile apps are unleashing amazing creativity, and we
intend to encourage these exciting innovations,” says Bakul
Patel, M.S.,MBA,seniorpolicyadvisortothedirectorofFDA’s
CenterforDevicesandRadiologicalHealth.“Atthesametime,
we have set risk-based priorities and are focusing the FDA’s
oversight on mobile apps that are devices for which safety and
effectiveness are critical.”
Physicians also are embracing mobile technology via their
tablets to access a variety of data including EMR information
and drug reference facts.A 2012 survey by InformationWeek
asked IT teams which mobile computing devices physicians in
their organization were using for medical purposes,and more
than two-thirds,66 percent,reported iPads or other tablets — a
21 percent increase in just 12 months.
TheexpansionofmHealthalsopromisestoaddressalooming
physician shortage by enabling physicians to monitor large
numbersofpatientsremotely,respondtotheirquestionsquickly,
and make better,more informed decisions about their care.
In a recent TED Talk, Eric Dishman, director of proactive
health research at Intel Corporation,said the current healthcare
system “must change,” and it’s up to individuals to wake up
and take control of their health.Dishman’s vision is one where
patients will no longer be tethered to a central location for care.
They will be able to take an active role in their own well-being.
Informationtechnologywillfacilitatecarecoordinationamong
a team of caregivers,eliminating the all-too-common practice
ofdisparatespecialistsprescribingduplicativeorcontraindicated
drugs to patients,often resulting in costly hospital admissions.
“Information technology has moved from a position of
dread to a position of desire,”
says David Muntz, former
principal deputy director of
the Office of the National
Coordinator on Health
Information Technology.
“Healthcare really wants
technology now, and I see
that as a real sea change,” he
says. “The government has
beenusingastimulusprogram
effectively in combination
with policy to encourage
healthcare organizations
to adopt technologies that
are interoperable. This will
revolutionize healthcare
because it will enable people
to go where they want to go, without duplication, and they
will be able to access all points along the continuum of care.”
Dishman also advocates using information technology to
accelerate care customization.The ability to map individuals’
entire genetic makeup will allow healthcare providers to
build specific predictive models that will eliminate the costly
guesswork that often plagues today’s system and replace it with
targeted therapies that will improve effectiveness and reduce
costs.
Muntz seems to concur,adding“Information technology is
unlike anyotherresourceavailableinhealthcare. Itallowsyouto
hardwire processes that you can’t control and assure outcomes,”
he says.“Health information technology helps create better
avenues and opportunities for communication, coordination,
and collaboration.
08
CRITICAL
SUCCESS
FACTOR
Leveraging new technology:
Establish a strong capability and
capacity to leverage information
technology, including but not limited to
mobile and web technology.
BILLION
$2.9THE MHEALTH APPS
MARKET ESTIMATED
VALUE IN 2013.

AS THE HEALTHCARE INDUSTRY EMBARKS ON
reinventing itself, going about the hard work of transforming
managers into leaders truly is a critical success factor.However,
does an industry that is currently stymied by outdated
hierarchical management structures, functional silos, and
cultures based on rewarding activity versus outcomes have the
institutional fortitude to step up and invest in“making”leaders
who can redefine the future? If so,where will the next wave of
leaders come from? As the industry moves toward population
health,how will physician leaders factor into the equation?
Executives at Cone Health, a successful, six-hospital
healthcaresysteminNorthCarolinawithapproximately10,000
employees,haveaskedall
of these questions and
more. In a process that
began by envisioning
the future, they set out
several years ago to
define new goals and
values.At the behest of
R.Timothy Rice,Cone
Health’s CEO, they set
the “audacious goal” to rank in the top decile nationally on
all major quality measures by 2015, realizing, of course, that a
“business as usual”management style no longer would suffice.
“We needed a highly motivated and empowered team that
consistently put patients and their needs first,” explains Joan
Evans,ConeHealth’svicepresident,organizationaleffectiveness
and performance.“Our managers had to make the shift to
being leaders for the future.They had to learn how to ask hard
questions, including,‘What’s the value? How do we measure
it? Who is going to be accountable?’ We had to teach them
how to do that.”
With the shift to population health,it also became clear that
TRANSFORMATIONAL
LEADERSHIP
For Cone Health, “unleashing the tiger” of
transformation begins with empowerment.
BY NATHAN OWEN ROSENBERG
09

more physician leaders would be needed. Since many lacked
the necessary collaboration skills for group decision-making,a
dedicated training program was required.
SHIFTING FROM MANAGERS TO LEADERS
Cone’s first step began with an increased focus on
communication skills. “Because
systemthinkingiscritical,moving
from hospital to population
health, our leaders now had to
thinkupstreamanddownstream,”
Evansexplains.“What’shappened
before to the patient? What’s
happening after we care for
them? Tobemindfulofthevoice
of the customer, they needed to
learn how to be fully present
with patients and employees,
developing deep listening skills.”
Fromthere,thefocusexpanded
to culture, working with leaders
to help them inspire and motivate the employee base.“We
needed a leadership team who could talk about
what mattered most in a new way and who were
abletogenerateactiontoinformournewfuture,”
Evans says. “To do this, we had to learn how
to unhook from the past, invent the future, and
engage employees.”
Although it may sound simplistic, Evans says
a key realization for leaders and employees alike
was that“the transformation starts with you.It’s
a rude awakening for some,but as leaders,that’s
what we have to focus on.”
“We also emphasize the importance of
language in what we say and how we say it,”says
Evans.“You can use the power of language to
create a different response in people and to align
themaroundapossibilitybiggerthanthemselves.”
ENLISTING PHYSICIANS
In addition, Cone created a dedicated
physician leadership academy, identifying and
training “rising stars with leadership potential,”
says Amy Martinez, director of organizational
development.“Because of the changes coming
about with population health, physicians have
to be able to collaborate in ways as never before,
which is new for them. In the case of primary
physicians,theyarebecomingthehubwitheveryoneelsebeing
the spokes turning around them.It’s a big paradigm shift.”
Consisting of a yearlong commitment, the curriculum
includes a personal assessment, measuring everything from
leadership competencies and personality attributes, to an
individual’s appetite for approaching and accepting change.
Executive coaching is also
built in at all stages, including
feedback on action learning
projects, which are designed
to address critical systemic
challenges while serving as
a leadership development
opportunity.
One cohort consisting of 18
physicians has completed the
academy, while another group
of 20 is just beginning. Several
of the physicians who have
completed the program are now
integrallyinvolvedinthesystem’s
strategy effort;another is leading Cone’sACO;and yet another
“THE TRANSFORMATION
STARTS WITH YOU. IT’S
A RUDE AWAKENING,
BUT AS LEADERS,
THAT’S WHAT YOU HAVE
TO FOCUS ON.”
- JOAN EVANS, VICE PRESIDENT, CONE
HEALTH

Insigniam Quarterly 2014 Special Edition - Healthcare

Insigniam Quarterly 2014 Special Edition - Healthcare

Recommended

Recommended

More Related Content

Similar to Insigniam Quarterly 2014 Special Edition - Healthcare

Similar to Insigniam Quarterly 2014 Special Edition - Healthcare (20)

More from Insigniam International Management Consulting Firm

More from Insigniam International Management Consulting Firm (11)

Recently uploaded

Recently uploaded (13)

Insigniam Quarterly 2014 Special Edition - Healthcare