Archive for the ‘Healthcare Administration’ Category

Infographic: Lack of Supply-Chain Visibility Is High Cost for Hospitals

March 21st, 2014 by Jackie Lyons

Seventy percent of executives say keeping supply chain costs low is very important to addressing key financial hospital issues, according to a new infographic from the Global Healthcare Exchange.

This infographic also identifies inefficiencies in current hospital supply chains, the cost of these inefficiencies, the origin of surgical delays and disconnected systems leading to unsatisfied patients and more.

Another major cost to hospitals is unnecessary readmissions. Therefore, you may also be interested in Health Care Operations and Supply Chain Management: Strategy, Operations, Planning, and Control. This resource offers a thorough foundation in operations management, supply chain management, and the strategic implementation of programs, techniques, and tools for reducing costs and improving quality in health care organizations.

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Infographic: is Fundamentally Flawed

November 22nd, 2013 by Jackie Lyons

The launch of the website was plagued with large-scale problems, and some of the issues have yet to be fixed.

Only .38 percent of visitors- or 36,000 people - were able to complete enrollment on the website, according to a new infographic from This infographic also outlines specific issues with the site, market efficiency, repercussions of centralizing health data and more. is Fundamentally Flawed

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You may also be interested in this related resource: The Financial Professional's Guide to Healthcare Reform.

Infographic: Healthcare Principles That Should Inform Any Business Leader

October 14th, 2013 by Jackie Lyons

Fundamental principles regarding equitable access, quality and innovation are essential to informing not only healthcare providers, but business leaders as well.

The annual healthcare industry revenue is $1.68 trillion, and there are over 784,000 healthcare businesses, according to a new infographic from The George Washington University School of Business. This infographic translates important healthcare principles for business across various sectors.

Healthcare Principles That Should Inform Any Business Leader

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You may also be interested in this related resource: The Business of Medical Practice: Transformational Health 2.0 Skills for Doctors, Third Edition.

Pioneer ACO to Specialists: If the Care Coordination Role Fits, Wear It

September 24th, 2013 by Patricia Donovan

Monarch HealthCare took top honors in quality performance in year one of the CMS Pioneer ACO program.

As far as Medicare beneficiaries are concerned, it's time for healthcare to acknowledge specialists as principal caregivers of the chronically ill, advises Monarch HealthCare, a top-performing CMS Pioneer ACO.

Monarch came to this realization in year one of participation in CMS's Pioneer ACO program, when it discovered that 70 to 80 percent of office visits by its 14,000 accountable care organization (ACO) patients were to specialists.

"We have to start treating [specialists] like a primary care provider (PCP), especially for those patients that are chronically ill, where it is actually appropriate that a cardiologist is the primary care giver for a patient with CHF and coronary artery disease (CAD)," said Colin LeClair, Monarch HealthCare's executive director of ACO.

Engaging and incentivizing specialists in its ACO are two key facets of Monarch's year three performance strategy, noted LeClair during a recent webinar on Medicare Pioneer ACO Year One: Lessons from a Top-Performer. Going forward, Monarch plans to tap patient data from specialist encounters to enhance its care management and quality improvement efforts.

Despite its regret at not engaging specialists earlier, Monarch's Pioneer ACO has plenty to be pleased about at the outset of year two, in which the number of ACO-attributed patients has swelled to 22,000 patients.

In terms of quality performance, Monarch, the largest IPA in Orange County, Calif., was year one's top scorer in several patient-centered metrics in the Pioneer ACO program, and the second highest performer in the area of medical cost reduction — a result largely driven by reductions in hospital and skilled nursing facility (SNF) utilization and unit costs, noted LeClair.

Monarch is one of 32 originally selected CMS Pioneer ACOs. Today, 23 remain in the program.

During the 45-minute program, LeClair outlined Monarch's six-step ACO implementation strategy, a patient-centered approach built around risk stratification, ACO team-building, and care management. Trial and error during the first year yielded some interesting findings, such as the optimal time to engage a patient, he said.

Among the four success drivers LeClair shared was a coterie of Web-based population health management tools Monarch developed for its ACO team, he said, that are supported with Web and face-to-face training.

One such tool is the annual senior health risk assessment (ASHA) reviewed by the patient and doctor during the Medicare Annual Wellness Visit. The free annual well visit provides an opportunity to identify key risk factors, perform screenings and reconcile medications.

Unfortunately, the new CMS benefit is largely unfamiliar to patients, LeClair added.

Another year one lesson learned was the value of the office staff in ACO rollout. As Monarch tweaks its ACO architecture, it is considering incentivizing the office staff as well. "Too often, incentives are focused on the physicians, and the office staff actually drives most of the work to support the ACO population," said LeClair.

In closing, LeClair said Monarch remains committed to the ACO model, and as it looks ahead to year three, it hopes to identify mini-networks of physicians, explore episodic or bundled payments, and partner with hospitals, SNFs and ancillary vendors to reduce avoidable utilization.

Click here to listen to an interview with Colin LeClair.

Infographic: Investment in Public Health Slipping

May 23rd, 2013 by Patricia Donovan

The public health systems in the United States are meant to be at the forefront of prevention, but state and federal investments are shrinking.

This infographic published on the Pew Charitable Trusts Web site illustrates how public funding levels vary from state to state. For example, in 2012, Alaska received the most public funding from the Centers for Disease Control and Prevention (CDC) and the Health Resources Services Administration (HRSA), while Indiana received the least.

Investment in Public Health Slipping

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You may also be interested in this related resource: Forces of Change: New Strategies for the Evolving Health Care Marketplace.

Infographic: Diversity in the Nursing Workforce

April 19th, 2013 by Melanie Matthews

Today's nursing workforce is not nearly as diverse as the country, finds a new study by the Robet Wood Johnson Foundation (RWJF).

While numerous studies find that a more diverse nursing workforce can provide care that is more culturally competent, offering benefits to patients, the health care system, and communities, RWJF released an infographic based on the study that shows the lack of diversity in the nursing field.

Nursing Diversity

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You may also be interested in this related resource: Nursing Leadership for Patient-Centered Care: Authenticity, Presence, Intuition, Expertise.

Payment Bundling Requires Suspension of FFS State of Mind

March 25th, 2013 by Patricia Donovan
payment bundling shared savings

Webinar Replay: Moving Forward with Payment Bundling

Four hundred healthcare providers — about a tenth of all hospitals in the United States — can't be wrong, can they?

That's the number signed on to participate in a Medicare payment bundling pilot run by CMS, their biggest payor. And while it's too early to know if the reimbursement concept will stick, one thing's for certain, noted Jay Sultan during a recent webinar on Moving Forward with Payment Bundling: there's a growing body of proof that the payment model works.

As an example, Sultan, associate vice president and chief product portfolio architect for TriZetto® shared some data from California's Hoag Orthopedic Institute, formerly two surgical groups who have collaborated in a bundled payment model and "reengineered every aspect of care, from beginning to end, significantly lowering its common cost structure." In one proof point shared by Sultan, Hoag reduced infection rates for knee replacements to 0.1 percent, significantly below the national 2 percent average, Sultan explained during the advice-filled session. The savings per avoided infection is about $60,000, he said.

While the federal payor has yet to report, early feedback from CMS's recently concluded ACE bundled payment demo is largely positive in terms of revenue for participating payors, hospitals, physicians — even the patients in the pilot received a rebate from CMS, he added.

Based on Sultan's own research, he is "not aware of any prospective payment, bundled payment program that was not beneficial for the providers, the payor and the members." He contrasted prospective payments with retrospective payments, which he characterized as similar to fee-for-service (FFS) but with the possibility of receiving a bonus afterward.

There is a place for both payment types, but prospective does a better job of transforming care, Sultan noted.

Sultan went on to outline the general challenges for both payors and providers of crafting an episodic payment program, which could take up to 12 months. A strong analytics framework for both health plan and provider use is essential. What is also required is a mind shift on the part of entities unused to working together and sharing data, who need to realize that "under payment bundles, the provider and the payor have an opportunity to collaborate, instead of competing against each other in a zero sum way."

For payors, some prickly areas early on might include provider contracting, claims administration, and impact on member responsibility.

Providers, for their part, must become adept at managing risk. Providers "need to be able to get the data, to develop analytics, and to develop methods for collaborating with each other — including the fact that some providers are going to lose," he emphasized.

Sultan offered a wealth of advice for each entity contemplating a shift to bundled payments. For all stakeholders, what will be required is a paradigm shift away from FFS, the foundation for much of the industry's day in, day out day out operations. "We measure our utilization by it, we evaluate our quality by it, we do all these things based on fee-for-service.

"When you change that, whether you’re changing it for shared savings ACOs, moving from FFS to capitation, or going from FFS to payment bundling, it has profound impacts throughout the entire organization."

Sultan provides more advice on bundled payments, from two key factors to keep in mind when trying to engage physicians in the model to the major decision facing primary care now that CMS has introduced bundled payments for care coordination tasks, in this expanded interview.

Guest Post: Accountable Care and the Power of Partnerships

March 7th, 2013 by Ally C. Evans
Ally C. Evans

Ally C. Evans is an industrial engineer specializing in process and system improvement in healthcare.

In the first of a three-part series on "Accountable Care: The Power of Partnerships," guest blogger Ally C. Evans, healthcare consultant with Freed Associates, outlines the platform and root causes of the current conundrum: despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance relative to other countries.

The Burning Platform

“Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries.”(The Commonwealth Fund) 1

Many tout the American health system as being the “greatest in the world,” yet an ever-present barrage of evidence tells a very different tale. The health of those who live in America is deteriorating. Patients in the United States are experiencing more complex and costly health conditions than ever before. In 2005, 133 million Americans were living with at least one chronic condition. In 2020, this number is expected to reach 157 million.2To make matters worse, a growing proportion of this population have multiple chronic conditions and many do not receive the care they require to efficiently and safely manage their health.

According to the 2009-2010 National Health Interview Survey, 21 percent of adults ages 45-64 had multiple, self-reported chronic conditions between 2009-2010, a 4.9 percent increase from 1999-2000.3 Of this population, almost one-quarter delayed or did not receive necessary medical care, and 22 percent did not fill prescriptions due to cost.3 The implications of these trends are significant, and result in a vicious cycle: The high cost of care leads to care-avoidance, which exacerbates the condition and ultimately results in even higher costs of care to treat the higher-acuity condition.

National health expenditures in the United States are forecasted to reach $4.6 trillion by 2020, a massive 19.8 percent of GDP. 4. Fifty percent of this will be government-sponsored spending through Medicare, Medicaid, and the new health insurance exchanges, part of the Affordable Care Act coverage expansion. Chronic illness consumes a vast proportion of these healthcare costs, and is predicted to reach a $4.2 trillion spend by 2023.5. To put these numbers in perspective, the United States has the highest per capita and total healthcare spend of any country in the world, while simultaneously scoring among the lowest countries on key health indicators such as life expectancy (as shown in the accompanying figure), infant mortality, obesity, death from asthma and amputations due to diabetes.6

The Root Cause

We are not facing a new problem. Rising costs have been an economic concern for decades, culminating in various rounds of healthcare reform and ‘crisis mode’ change initiatives. Numerous factors have influenced this cost conundrum; two of the most significant drivers are the fee-for-service (FFS) payment model and the fragmented design of care delivery.

The FFS model boils down to a simple equation: More services = more money. There is limited accounting for quality, service or outcomes. It is a pure “keep ‘em sick, keep ‘em coming” volume model that offers incentives to providers based on the services they bill for, not for the quality or outcomes of those services. This is analogous to paying factory workers for each unit they produce, regardless of the quality. The big difference here is that we’re not dealing with products; we’re dealing with lives. The challenge now lies in modifying practices and cultures in order to move away from the high-utilization and over-ordering that has resulted from the FFS model.

Fragmented systems of care are another immense contributor to the current cost position of healthcare. Provider ‘silos’ generate substantial overuse of services due to ineffective or non-existent systems of communication. The same patient may receive the same tests from two or three different providers simply because providers don’t talk, systems don’t talk and each provider is incentivized to deliver those services. Not only is this a huge waste of resources, but this approach also fails the patient.


  1. Davis, K., Schoen, C., Stremikis, K. Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update. The Commonwealth Fund. June 23, 2010. Available Online
  2. Wu, S.Y. and Green, A. Projection of Chronic Illness Prevalence and Cost Inflation. Santa Monica, Calif.: RAND, October 2000.
  3. Freid VM, Bernstein AB, Bush MA. Multiple chronic conditions among adults aged 45 and over: Trends over the past 10 years. NCHS data brief, no 100. Hyattsville, MD: National Center for Health Statistics. 2012.
  4. Centers for Medicare and Medicaid Services, Office of the Actuary. National Health Expenditure Predictions 2010-2020. July 2011. Available Online
  5. DeVol, R., and Bedroussian, A. An unhealthy America: The economic burden of chronic disease. 2007. Santa Monica, CA: Milken Institute.

(Editor's Note: In subsequent posts, Ms. Evans will discuss the volume to value paradigm shift, and then introduce ACOs as a panacea.)

Ally C. Evans is an industrial engineer specializing in process and system improvement in healthcare. Most recently, she has driven various initiatives in the accountable care arena, focusing on the design and implementation of ACO strategy and tactical interventions. She is a consultant with Freed Associates, a California-based healthcare consulting firm. Their work is to provide sustainable solutions that enable healthcare organizations to improve patient care services, reduce costs and increase operational efficiency.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

Infographic: Strategies to Slow Health Spending Growth

March 4th, 2013 by Patricia Donovan

This set of policies proposed by the Commonwealth Fund Commission on a High Performance Health System to accelerate innovation in care delivery could slow health spending growth by $2 trillion over 10 years. Suggestions include provider payment reforms, high-value consumer choices and healthcare market improvements.

healthcare spending

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You may also be interested in this related resource: Moving Forward with Payment Bundling.

7 High-Impact Ideas to Prioritize Prevention

February 22nd, 2013 by Jessica Fornarotto

Reimbursement for prevention efforts and employer engagement are among seven high-impact recommendations from the Trust for America’s Health (TFAH) to prioritize prevention and improve the health of Americans.

"A Healthier America 2013: Strategies to Move from Sick Care to Health Care in Four Years", a new TFAH report, illustrates the importance of taking innovative approaches and building partnerships with a wide range of sectors in order to be effective.

The report outlines top policy approaches to respond to studies that show that more than half of Americans are living with one or more serious, chronic diseases, a majority of which could have been prevented; and also that today’s children could be on track to be the first in U.S. history to live shorter, less healthy lives than their parents.

The seven recommendations documented in the report are:

  1. Advance the nation’s public health system by adopting a set of foundational capabilities, restructuring federal public health programs and ensuring sufficient, sustained funding to meet these defined foundational capabilities;

  2. Ensure insurance providers reimburse for effective prevention approaches both inside and outside the doctor’s office;
  3. Integrate community-based strategies into new healthcare models, such as by expanding ACOs into accountable care communities;
  4. Work with nonprofit hospitals to identify the most effective ways they can expand support for prevention through community benefit programs;
  5. Maintain the prevention and public health fund and expand the community transformation grant program so all Americans can benefit;
  6. Implement all recommendations for each of the 17 federal agency partners in the National Prevention Strategy; and
  7. Encourage all employers, including federal, state and local governments, to provide effective, evidence-based workplace wellness programs.

"A Healthier America" also features more than 15 case studies from across the country that show the report’s recommendations in action.

The report also includes recommendations for a series of 10 key public health issues: reversing the obesity epidemic; preventing tobacco use and exposure; encouraging healthy aging; improving the health of low-income and minority communities; strengthening healthy women and healthy babies; reducing environmental health threats; enhancing injury prevention; preventing and controlling infectious diseases; prioritizing health emergencies and bioterrorism preparedness; and fixing food safety.