The document summarizes key takeaways from a roundtable discussion between Governor Michael Leavitt and healthcare executives on transitioning to value-based care models.
1) The momentum for value-based care is strong and accelerating, driven by government targets and payment reforms, and there is no turning back from this transition.
2) Most organizations have very poor readiness for value-based care due to lack of competencies and cultural barriers.
3) Timing the transition is critical as markets will change at different paces; leaders need to assess where their market lies on the path to value.
Five Data-driven Patient Empowerment StrategiesHealth Catalyst
Data plays a big role toward empowering patients to become more involved in their care. With data, digital tools, and education, patient empowerment can act like a blockbuster drug to produce exceptional outcomes.
Data empowers patients five ways:
Promotes patient engagement.
Produces patient-centered outcomes.
Helps patients practice self-care.
Improves communication with clinicians.
Leads to faster healing and independence.
Clinicians using creative, innovative care strategies, and patients with access to the right tools and technology, can produce remarkable results in terms of cost, health outcomes, and experience.
Four Keys to Increase Healthcare Market ShareHealth Catalyst
With leadership alignment, easy access to data, and a roadmap to reach their objectives, health systems can drastically increase revenue and grow market share by applying four principles:
Key 1. Alignment.
Key 2. Vehicles.
Key 3: Five tools: access to data, data acumen; finance, vision to execution, and prioritizing outcomes.
Key 4: Education.
Access to the right data can drive changes that generate $48M in revenue, surpassing the year three market share goals in year two.
Strategies for Successful Human Factors Collaborations with Medical Device De...Eric Shaver, PhD
Human factors is vital for discovering, designing, developing, & deploying medical devices that are safe, effective, usable, and innovative. But, it can’t do it alone. Instead, it must successfully collaborate with numerous roles on the medical device development team.
This document for communities and hospitals contains examples of successful partnerships, information about new models of care, and tips for making the case to hospitals for funding and support for population health work.
Five Data-driven Patient Empowerment StrategiesHealth Catalyst
Data plays a big role toward empowering patients to become more involved in their care. With data, digital tools, and education, patient empowerment can act like a blockbuster drug to produce exceptional outcomes.
Data empowers patients five ways:
Promotes patient engagement.
Produces patient-centered outcomes.
Helps patients practice self-care.
Improves communication with clinicians.
Leads to faster healing and independence.
Clinicians using creative, innovative care strategies, and patients with access to the right tools and technology, can produce remarkable results in terms of cost, health outcomes, and experience.
Four Keys to Increase Healthcare Market ShareHealth Catalyst
With leadership alignment, easy access to data, and a roadmap to reach their objectives, health systems can drastically increase revenue and grow market share by applying four principles:
Key 1. Alignment.
Key 2. Vehicles.
Key 3: Five tools: access to data, data acumen; finance, vision to execution, and prioritizing outcomes.
Key 4: Education.
Access to the right data can drive changes that generate $48M in revenue, surpassing the year three market share goals in year two.
Strategies for Successful Human Factors Collaborations with Medical Device De...Eric Shaver, PhD
Human factors is vital for discovering, designing, developing, & deploying medical devices that are safe, effective, usable, and innovative. But, it can’t do it alone. Instead, it must successfully collaborate with numerous roles on the medical device development team.
This document for communities and hospitals contains examples of successful partnerships, information about new models of care, and tips for making the case to hospitals for funding and support for population health work.
In presentation to Texas Business Group on Health, HCMS Group shows how data analytics and risk metrics can be harnessed to identify and reduce waste in healthcare spending.
Analytics and Small Hospitals: Embracing Data to Thrive in the New Era of Val...Health Catalyst
Value-based care has remade the healthcare landscape for small hospitals. Many are struggling to compete with the larger, better-funded medical centers in the communities they serve. Embracing data and analytics is no longer a luxury for these organizations if they are to succeed and remain competitive. Data analysis can assist senior leaders in identifying opportunities for improvement while balancing long-term goals with short-term pressures. Incorporating data in to the culture and making it a part of everyday decision making will enable smaller hospitals to not only survive, but thrive in the new era of value-based care.
Preparing physicians for a future will likely look very different than things look today. Increasing costs, value-based payment models (e.g., PDGM), and personalized care (in the home) are all coming together to disrupt traditional health care ecosystems.
This presentation addresses:
- What's driving physician changes
- Physician burnout
- Evolving care model
- Technology advances
- Physician's changing roles
Enterprise systems in healthcare: leveraging what we know from other industr...CONFENIS 2012
Dr. Carol Brown - distinguished professor at Stevens Institute of Technology , The Howe School of Technology Management
enterprise systems in healthcare: leveraging what we know from other industries
Why One Attendee Is Traveling From the U.S. Virgin Islands to the 2019 Health...Health Catalyst
After two Category 5 hurricanes in one year, the Schneider Regional Medical Center (SRMC) has a unique healthcare improvement journey ahead. Tina Comissiong, legal counsel and chief compliance officer of SRMC, knew she needed to attend the Healthcare Analytics Summit as soon as she learned about the event.
SRMC was severely damaged by hurricanes Irma and Maria in 2017, and recovery efforts have been underway ever since. In this article, Comissiong explains why she’s excited to attend this year’s summit and how she will apply what she learns to SRMC’s unique healthcare improvement journey.
As a customer of JDN MONOCRANE, you will discover the advantages of dealing with a company committed to satisfying customer needs, by providing superior standard products of custom built lifting and storage solutions...... http://www.jdn.com.au
Recently I have been doing some research on event-driven applications and non-blocking I/O model. Then I had a chance to conduct a tech talk at Virtusa Polaris and my aim was to present how we can built event-driven and non-blocking applications using NodeJS and SocketIO. Here you can find the slide deck of the tech talk I have done.
In presentation to Texas Business Group on Health, HCMS Group shows how data analytics and risk metrics can be harnessed to identify and reduce waste in healthcare spending.
Analytics and Small Hospitals: Embracing Data to Thrive in the New Era of Val...Health Catalyst
Value-based care has remade the healthcare landscape for small hospitals. Many are struggling to compete with the larger, better-funded medical centers in the communities they serve. Embracing data and analytics is no longer a luxury for these organizations if they are to succeed and remain competitive. Data analysis can assist senior leaders in identifying opportunities for improvement while balancing long-term goals with short-term pressures. Incorporating data in to the culture and making it a part of everyday decision making will enable smaller hospitals to not only survive, but thrive in the new era of value-based care.
Preparing physicians for a future will likely look very different than things look today. Increasing costs, value-based payment models (e.g., PDGM), and personalized care (in the home) are all coming together to disrupt traditional health care ecosystems.
This presentation addresses:
- What's driving physician changes
- Physician burnout
- Evolving care model
- Technology advances
- Physician's changing roles
Enterprise systems in healthcare: leveraging what we know from other industr...CONFENIS 2012
Dr. Carol Brown - distinguished professor at Stevens Institute of Technology , The Howe School of Technology Management
enterprise systems in healthcare: leveraging what we know from other industries
Why One Attendee Is Traveling From the U.S. Virgin Islands to the 2019 Health...Health Catalyst
After two Category 5 hurricanes in one year, the Schneider Regional Medical Center (SRMC) has a unique healthcare improvement journey ahead. Tina Comissiong, legal counsel and chief compliance officer of SRMC, knew she needed to attend the Healthcare Analytics Summit as soon as she learned about the event.
SRMC was severely damaged by hurricanes Irma and Maria in 2017, and recovery efforts have been underway ever since. In this article, Comissiong explains why she’s excited to attend this year’s summit and how she will apply what she learns to SRMC’s unique healthcare improvement journey.
As a customer of JDN MONOCRANE, you will discover the advantages of dealing with a company committed to satisfying customer needs, by providing superior standard products of custom built lifting and storage solutions...... http://www.jdn.com.au
Recently I have been doing some research on event-driven applications and non-blocking I/O model. Then I had a chance to conduct a tech talk at Virtusa Polaris and my aim was to present how we can built event-driven and non-blocking applications using NodeJS and SocketIO. Here you can find the slide deck of the tech talk I have done.
CENTER FORHEALTHCAREGOVERNANCENurses on HealthcareBo.docxtroutmanboris
CENTER FOR
HEALTHCARE
GOVERNANCE
Nurses on Healthcare
Boards
A smart and logical move to make.
As the spotlight on healthcare reform
continues, it is becoming clear that
hospitals need to focus on improving
value by optimizing the balance
among healthcare cost, quality and
accessibility for patients and other
stakeholders. In moving toward a
more value-driven basis for healthcare
delivery, hospital boards and leaders
will benefit from tapping resources
with clinical care expertise and an
understanding of patient and com-
munity needs. Add to that skills in
communications, decision making,
management and leadership, and you
have the basic job description of
many of todays nurse executives.
Research on nonprofit hospital gov-
erning boards indicates that only
about 2 percent of their members are
nurses. In this column we examine
why hospital boards should take a
closer look At nurses—a governance
resource that remains largely
untapped by most boards.
The value nurses can bring to the
board table has been acknowledged
and supported by many healthcare
leaders. Donald M. Berwick, MD,
president and CEO ofthe Institute
for Healthcare Improvement, noted
in the April 2005 issue oîBoardRoom
Press, '̂It is key that nurses be as
involved as physicians, and I think
boards should understand that the
performance ofthe organization
depends as much on the well-being,
engagement, and capabilities of nurs-
ing and nursing leaders as it does on
physicians. I would encourage much
closer relationship between nursing
and the board."
Because nurses have the most
contact with patients, families
and physicians, nurses have
in-depth knowledge of
healthcare delivery that could
prove valuable to a board of
trustees on relevant issues.
In 2007, the Center for Healthcare
Govertiatice's Blue Ribbon Panel on
Health Care Governance recom-
mended that boards "include physi-
cians, nurses and other clinicians on
the board. Their clinical competence
and viewpoints are valuable to other
board members and will help the
board better understand the needs
and concerns of several ofthe orga-
nization's stakeholders."
And a 2009 Grant Thornton LLP
study of governance in community
health systems urged that "All boards
should consider enriching their mem-
bership with greater racial and gender
diversity; they also should consider
the appointment of highly respected
and experienced nursing leaders as
voting members ofthe board to com-
plement physician members and
strengthen clinical input in board
deliberations." The study also said,
"Engaging leaders in the nursing
profession on hospital and health sys-
tem boards has not yet become the
norm, nor has it been accepted as a
benchmark of good governance.
However, given the importance of
nursing in the provision of̂ patient
care, it seems likely that the idea of
engaging nurses on boards and board
committees will receive growing con-
sideration in the future."
Exploring Nurse Executive Skills
Nurses are the largest group o.
CJA is monitoring the development of the field of catalyst initiatives. Catalysts seek to help local regions transform health and health care in their regions. This is the second in the series.
Running head HEALTH SERVICES IN RELATION TO ENVIRONMENTAL ANALY.docxcharisellington63520
Running head: HEALTH SERVICES IN RELATION TO ENVIRONMENTAL ANALYSIS 1
HEALTH SERVICES IN RELATION TO ENVRIRONMENTAL ANALYSIS 8
Health Services In Relation to Environmental Analysis
Dr. Mountasser Kadrie
July 27, 2014
As a manager in Ford Rehabilitation centre, I have encountered several challenges in both external environment and internal environment that have greatly challenged the increasing demands of my patients’ services as well as failure of the reimbursements of funds by the insurance providers. Environmental conditions normally affect human health in varied means. Interactions between the environment and human health usually lead to very complex ethical queries that are related to health policy decisions. There are various factors in the environment that can lead to risks and the same time benefits. They include genetically modified plants, nanotechnology, bio fuels and other technology. There is a body of evidence that have emerged saying that environment can affect the health of human being and at the same time human health can have impact to the environment.
The external factors are factors in the environment that cannot be controlled by an organization. There are several external factors that affect many health organizations; these factors include political conditions, government policies and regulations, technological environment and social environment. In my organization the two key external factors affecting my company are the social environment and technological environment. Social factors have developed challenge in the Ford rehabilitation centre. This is because many patient customers have varied and different types of beliefs which make the relations in the health centre challenged. It have become problematic to deal with some patients since it is difficult to know the type of services they need based on where they have come from. Various patients have diverse transformation in attitude towards health care. The patients are however very demanding in my organization because each one of them needs to be handled differently based on community variations. In order to curb this, as manager I have decided to implement several programs that will promote cooperation between my patients as well amendments that will bring in suitable services to each patient. Implementation of this programs will enable my organization to continue being indispensible and financially stable despite the social challenges affecting the availability of patients in the organization.
Another external factor in the environment that will have a great impact in my company is technological environment. Implementation of more advanced methods to serve my customers is likely to improve patients’ attendance and this will boost the compan.
Healthcare Analytics Careers: New Roles for the Brave, New World of Value-bas...Health Catalyst
Job titles can be leading indicators of the direction an industry is moving and the same holds true for healthcare. The new healthcare economic model—from fee-for-service (FFS) to value-based—is driving a change in roles and responsibilities for professionals seeking healthcare analytics careers. Motivated by CMS and commercial payers, healthcare organizations are realizing the need to find and hire new types of healthcare professionals, a Chief Population Health Officer or Vice President of Clinical Informatics, who are focused on value. Senior leaders are seeking to build teams that have the ability to bring together analytics, best-practice clinical content, and process improvement to create long-term, sustainable change across their healthcare systems.
The market shift toward value-based care presents unprecedented opportunities and challenges for the US health care system. Instead of rewarding volume, new
value-based payment models reward better results in terms of cost, quality, and outcome measures. These largely untested models have the potential to upend health care stakeholders’ traditional patient care and business models.
Healthcare is in crisis. While this is not news for many
countries, we believe what is now different is that the
current paths of many healthcare systems around the
world will become unsustainable by 2015.
This may seem a contrarian conclusion, given the efforts
of competent and dedicated healthcare professionals
and the promise of genomics, regenerative medicine, and
information-based medicine. Yet, it is also true that costs
are rising rapidly; quality is poor or inconsistent; and
access or choice in many countries is inadequate.
2015 and Beyond: 6 Predictions for Healthcare and Population HealthHealth Catalyst
Healthcare will undergo a number of changes in 2015, particularly as organizations look to manage population health. Dr. David A. Burton outlines what he believes will happen in terms of at-risk contracting, risk evaluation, network optimization, quality and safety, cost reduction, and infrastructure, and how 2015 can develop into opportunity for all.
2016 Survey of US Physicians: Physician awareness, perspectives, and readines...Deloitte United States
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a Medicare payment law intended to drive health care payment and delivery system reform for clinicians, health systems, Medicare, and other government and commercial payers. Deloitte’s 2016 Survey of US Physicians sought to shed light on physicians’ awareness of MACRA, their perspectives on its implications, and their attitudes and readiness for change. The survey found that many physicians are unaware of MACRA. Regardless of their awareness level, most physicians surveyed would have to change aspects of their practice to meet the law’s requirements and to do well under its incentives. Many physicians surveyed recognize they will need to bear increased financial risk (under MACRA and in general) and need support and resources to develop the capabilities do so. http://www.deloitte.com/us/macra?id=us:2sm:3ss:macra:eng:lshc:071216
Engaging Physicians to Be Good Financial StewardsHealth Catalyst
This article, first published by in July 2016 by hfma, outlines how hospitals can get physicians to understand the financial impact of their clinical decisions and become actively engaged in improving the value of care. Texas Children’s Hospital was successful through recognizing the need for cultural transformation and ensuring quality came first. The organization engaged clinicians with financial data, including educating them on key financial principles, linking quality improvement training with financial accountability, and accompanying financial choices with clinical choices.
An interview with Dr LaTonya Washington, the Chairperson at the marcus evans National Healthcare CMO Summit 2023, on how healthcare organizations can improve patient care by achieving health equity and having a truly diverse workforce.
Midas+ Executive Insights: Population Health ManagementMelissa Luongo
Midas+ Executive Insights | May 2015
Population Health: Securing Data Assets and Assessing Organizational Readiness
With Insights from Ashish Jha, MD, MPH
K. T. Li Professor of International Health and Health Policy Harvard School of Public Health
Professor of Medicine, Harvard Medical School
Director, Harvard Global Health Institute
Midas+ Executive Insights: Population Health Management
JA16_F3_reprint
1. EXECUTING ON VALUE
A R O U N D T A B L E D I S C U S S I O N
W I T H G O V . M I C H A E L L E A V I T T
BY JENNIFER A. WILLIAMS
2. Reprinted with permission. All rights reserved.
Healthcare Executive
JULY/AUG 2016
33
When it comes to the move toward value-based pay-
ment, “You can fight it and die; you can accept it
and have a chance; or you can lead it and prosper,” says
Michael O. Leavitt, former governor of Utah, former secre-
tary, U.S. Department of Health and Human Services, and
founder and chairman, Leavitt Partners, Salt Lake City.
Leavitt, who spoke at ACHE’s Congress on Healthcare
Leadership this past March, led an exclusive small-group
discussion at Congress with leading healthcare executives
representing 12 hospitals and health systems, each of
which have achieved varying degrees of success in moving
away from fee-for-service payment toward adoption of
value-based business models. The conversation was
moderated by Rulon F. Stacey, PhD, FACHE, who now
serves as managing director, Navigant Leadership
Institute, Navigant Healthcare, Minneapolis, and is a
former ACHE Chairman.
“There are moments we all have as senior leaders—career
inflection points; defining moments for which we will be
remembered no matter how well or how badly they turn
out,” Leavitt told healthcare executives during the ACHE
roundtable discussion. The transition away from fee-for-
service payment toward value-based business models is
one such moment, he said.
Since leaving HHS in 2009, Leavitt says he has spent
much of his time examining the shift away from fee for
service toward payment models that reward high-quality
care, improved outcomes and reductions in the cost of
care delivery. He’s come to the conclusion that “misper-
ceiving how quickly [the move toward value-based
business models] is occurring is dangerous”—and the way
in which healthcare’s senior leaders lead their organizations
on the value journey will ultimately be their legacy.
What can healthcare executives learn from Leavitt and
leaders of progressive hospitals and health systems
about what it takes to advance their organization’s
value readiness—and what action steps should executives
be taking now to lead their teams and their communities
on this journey? Four takeaways from ACHE’s roundtable
on value stand out.
No. 1: The momentum for value is strong enough that
there is no turning back. “The move away from fee for
service toward value-based business models is a massive
change, and I am persuaded that it is happening, it is
going to continue to happen and that it is, in fact, accel-
erating,” Leavitt told roundtable participants.
Consider that the federal government was 11 months
ahead of schedule in transitioning 30 percent of
Medicare payment to value-based business models by
the end of 2016, achieving its goal in January 2016; the
government is now focused on transitioning 50 percent
of Medicare payment to value-based payment arrange-
ments by the end of 2018. Meanwhile, new Medicare
Part B payment models are being tested that will dra-
matically change how prescription drugs, which totaled
$457 billion in 2015, are reimbursed in hospitals. And
the Centers for Medicare & Medicaid Services is testing
bundled payments for fee-for-service Medicare hip- and
knee-replacement patients, an initiative that is expected
to save $343 million over five years.
3. EXECUTING ON VALUE
Reprinted with permission. All rights reserved.
When the tipping point in the transi-
tion away from fee-for-service models
occurs, “We will see systems compet-
ing on the ability to deliver care in a
systematic way,” Leavitt says.
Leavitt and his team at Leavitt
Partners have identified 26 factors
that determine how quickly the
transition away from fee-for-service
payment occurs in any given
market. These factors include:
• Success of early accountable care
organizations in a given market
• Vertical consolidation among payers
• Level of integration/hospital sys-
tem growth in a market
• Physician employment
relationships
• Presence of restricted networks
• Physician supply
• Availability of inpatient/
outpatient healthcare IT
Knowing how to perceive the
speed with which this is occur-
ring in your marketplace is a vital
and important key to success.
“Monitoring the pace of the move toward value in your
market is critical,” Leavitt said. “I would not want to
be a board member who gets caught behind the curve
on this.”
There are three critical questions healthcare executives
should ask as they consider how to navigate the value
journey and at what pace, Leavitt said:
• Will value actually replace volume? “Answer that ques-
tion wrong and it will be a very significant moment in
your career,” Leavitt told roundtable participants.
• If it is going to happen, how
quickly will it occur in my
market?
• Do my organization and its
partners possess the competen-
cies that are required to succeed
in a value-based world?
Progressive leaders—those who
saw the early signs of transition to
a new payment model and worked
with their boards and their teams
to develop plans of action—view
the work ahead as “a tremendous
opportunity to fix some of what’s
broken in the industry,” according
to a CEO from the East Coast.
In one large, integrated delivery sys-
tem, “Our process of learning is accel-
erating as we begin to understand the
many nuances of delivering value-
based care,” the system’s CEO said.
“The lead time is significant because
we needed years of a learning curve to
prepare for this transition.”
No. 2: The value-readiness of
most organizations could be
characterized as “very poor,” CEOs for leading
health systems agree. “I see a lot of systems that lack
readiness for the move toward value, and as a nation, we
lack readiness,” Leavitt told healthcare executives during
the ACHE roundtable discussion.
One participant shared that in his state, “There are only two
organizations that have gotten their arms around this,” and
both are large systems. Across the rest of the state, efforts to
experiment with value-based models or to use data informat-
ics to redesign care delivery for improved quality, outcomes
and cost “don’t exist,” the CEO said.
Healthcare Executive
JULY/AUG 2016
34
“Monitoring the pace of
the move toward value in
your market is critical. I
would not want to be a
board member who gets
caught behind the curve
on this.”
GOV. MICHAEL O. LEAVITT
4. Reprinted with permission. All rights reserved.
A first step toward value is to define the competencies
required to succeed under value-based payment models
and the extent to which an organization is capable of
meeting the requirements of these models, Leavitt said.
For example, “Being able to assess your own risk
capacity and that of your partners is an important
task,” he said.
Transformation also requires leaders to break through
cultural barriers to improving value—both inside
Healthcare Executive
JULY/AUG 2016
35
ABOUT ACHE’S ROUNDTABLE ON VALUE
ACHE’s CEO Roundtable on Value, held during ACHE’s Congress on Healthcare Leadership in March 2016, presented a
unique opportunity for a select group of healthcare CEOs and other healthcare executives to discuss one of the most pressing
issues facing our field: the transition from a fee-for-service care delivery model to a value-based model of care.
“These are certainly challenging times for all of us as we address the changes ahead, especially the leadership con-
cerns and policy implications,” said Rulon F. Stacey, PhD, FACHE, managing director, Navigant Leadership
Institute, Navigant Healthcare, Minneapolis, and a former ACHE Chairman, who moderated the event. “It is our
hope that programs like this will continue to advance and strengthen healthcare leadership.”
ACHE plans to host similar events in the future, based on feedback from participants at the inaugural roundtable
event. The following healthcare leaders participated in ACHE’s Roundtable on Value:
Anthony A. Armada, FACHE, executive vice president
and chief executive, Western Washington, Providence
Health and Services, Seattle
Deborah J. Bowen, FACHE, CAE, president and CEO,
American College of Healthcare Executives, Chicago
David R. Brandon, FACHE, president and CEO,
UnityPoint Health, Dubuque, Iowa
Christine M. Candio, RN, FACHE, president and
CEO, St. Luke’s Hospital, St. Louis
Michael D. Connelly, FACHE, president and CEO,
Mercy Health, Cincinnati
Michael H. Covert, FACHE, president and CEO,
St. Luke’s Health, Houston
Peter S. Fine, FACHE, president and CEO, Banner
Health, Phoenix
John M. Haupert, FACHE, president and CEO,
Grady Health System, Atlanta
Elliot Joseph, FACHE, president and CEO, Hartford
(Conn.) HealthCare
Edward H. Lamb, FACHE, division president, western
division, IASIS Healthcare, South Jordan, Utah
Gov. Michael O. Leavitt, founder and chairman,
Leavitt Partners, Salt Lake City
John (Jack) Lynch III, FACHE, president and CEO,
Main Line Health, Bryn Mawr, Pa.
Stephanie S. McCutcheon, FACHE, innovation and trans-
formation advisor, Health Employer Exchange, Pasadena, Md.
Diana L. Smalley, FACHE, regional president, Mercy,
Oklahoma City
Rulon F. Stacey, PhD, FACHE, managing director,
Navigant Leadership Institute, Navigant Healthcare,
Minneapolis
5. Reprinted with permission. All rights reserved.
Healthcare Executive
JULY/AUG 2016
36
EXECUTING ON VALUE
healthcare organizations and among consumers. “What
are we doing to prepare the second, third and fourth lev-
els of the organization for the culture change needed in
our organizations to make this transition—and how do
we explain this to our patients?” Leavitt said.
Just as airlines have begun to redefine quality as “a
safe trip between point A and point B,” Leavitt said,
“We’re having to redefine what a quality experience is
in healthcare.”
Mobilizing healthcare employees to drive improved value
takes leaders who can define their organization’s strategic
vision for value in such a way that employees understand
how they can make an impact.
The move toward value-based business models also
requires training, particularly for physicians, clinicians
and medical students, who may be asked to act in ways
that run counter to care and business practices of the
past. Education—both for staff and for patients, who
need to understand the “Why?” behind new
approaches—also is key.
“It’s important for us to recognize that a deficiency in
value readiness is not a technical problem; it’s a behav-
ioral problem,” one CEO said.
No. 3: When it comes to embarking on value-based
initiatives, timing is everything. “You can be right on
this issue way too soon,” Leavitt said.
“The shift to value-based business models will happen
differently by market, with some markets being ready for
it sooner than others,” he said. “The question is: What
time is it in your market?” Judging the extent to which
your market is ready for value-based approaches to care
delivery and population health management is a critical
step in formulating your organization’s value strategy.
Fee for service is a uniquely American system, one
roundtable participant commented, and it is so deeply
rooted that resistance to replacing it with a new pay-
ment model is coming from a number of sides. “We’re
trapped in a sort of limbo because culturally, we have
consumers who say, ‘I want what I want, and I want it
now,’” one roundtable participant commented, while
another said four of the largest payers in his organiza-
tion’s market are equally reluctant to move away from
fee for service: “They’re holding onto this [old model]
with a death grip.”
“Our view is that CMS is going to lead the way” in the
transition to value-based business models, commented one
CEO from the East Coast, whose organization brought in
ABOUT THE SPEAKER
Michael O. Leavitt is a former governor of Utah, former secretary, U.S. Department of Health and Human Services,
and founder and chairman, Leavitt Partners, Salt Lake City, where he advises healthcare clients in the move toward
value-based care.
While leading HHS, Leavitt oversaw the implementation of the Medicare Part D prescription drug program. That
responsibility required the design, systematization and implementation of a plan to provide 43 million seniors with a
new prescription drug benefit.
Leavitt also is a seasoned diplomat, having led U.S. delegations to more than 50 countries. He has conducted negotiations
on matters related to health, the environment and trade.
6. Reprinted with permission. All rights reserved.
One health system in the South
attributes its success in transitioning
to value-based care to its collabora-
tion with one of its payers. “Our sys-
tem is working very closely with an
insurance company to better under-
stand its thinking,” the CEO for the
system said—to which Leavitt
responded, “That relationship is a
recipe for the future.”
Healthcare executives also should
work closely with medical schools to ensure future phy-
sicians are trained in value-based theory and practices,
leaders who attended the roundtable agreed. Looking out-
side the industry for best practices that can be applied to
healthcare in the move toward value—particularly
around improving efficiency and reducing waste—also is
an approach healthcare leaders should embrace.
LEADING SUSTAINABLE CHANGE
Now more than ever, the field is going to need healthcare
executives who are adept at responding to market forces
and skilled in leading their teams through change.
“I hope that as we think about this topic, we can
strengthen the pathways to develop leadership readiness
for the transition to value,” said Deborah J. Bowen,
FACHE, CAE, president and CEO, ACHE.
The move toward value-based business models is a test for
today’s healthcare leaders, Leavitt said—one that leaders must
pass if their organizations are to survive in an era of
transformation.
“We’ve got to figure out ways to deal with more people in
more coordinated ways for less money without compro-
mising our humanity,” one CEO said.
Jennifer A. Williams is editor-in-chief and content manager,
American College of Healthcare Executives (jwilliams@ache.org).
a consultant to help executives
determine, actuarially, how the
organization could become profit-
able under Medicare Advantage.
Although the Medicare Shared
Savings Program “was a great cata-
lyst” for the move toward value, the
risk-adjustment methodology used
by CMS is “too confusing,” the
CEO said.
In developing an approach to value
that is right for a specific market, incremental change is
best, ACHE roundtable participants agreed. “This is a
good time for testing changes that can be replicated
across systems,” one healthcare executive said.
No. 4: Attaining value-readiness will require providers to
collaborate with payers, physicians, employers, consum-
ers—and each other. “We can learn a lot more from each
other in the transition to value than we think,” Leavitt said.
That sentiment was echoed by roundtable participants.
When asked what keeps CEOs up at night in contemplat-
ing the transition to value-based business models, one
CEO responded, “Incentive alignment”—especially in
determining how to engage both employed and indepen-
dent physicians in value-based initiatives. “That is the
cultural piece of the transition toward value that we are
trying to wrap our arms around,” the CEO said.
Also needed, according to roundtable participants: new
approaches to working with payers in moving away from
fee for service.
Healthcare executives attending the roundtable share
the belief that insurance companies are reluctant to
move away from a fee-for-service model; they also agree
that significant progress toward value-based business
models of care cannot be achieved without payer
partnerships.
Transformation also requires
leaders to break through
cultural barriers to improving
value—both inside
healthcare organizations
and among consumers.
Healthcare Executive
JULY/AUG 2016
38
EXECUTING ON VALUE