innovation

Small Step Service Design Thinking – The Case of the Nurse Practitioner in the Fire Department

By M2|2019-03-22T14:05:22+00:00March 20th, 2019|Health Care Trends, Innovation, Providers, Uncategorized|

Small Step Service Design Thinking – The Case of the Nurse Practitioner in the Fire Department

As we a couple weeks ago, M2 authored a chapter entitled “Using Small Step Service Design Thinking to Create and Implement Services that Improve Patient Care,” in Service Design and Service Thinking in Healthcare and Hospital Management published by Springer. Today we share highlights from the second case study we feature in the chapter.

Fire department or health care provider?

When most of us think of health care organizations, we tend to think of our own experience, perhaps our physician’s office building, or a Kaiser-like integrated health system campus. But the fragmented U.S. health care system also relies on a “safety net” that includes community clinics, public hospitals, local health departments, and the emergency medical system (EMS).

As in the rest of the nation, in Los Angeles, (the second largest city in the U.S with 4+ million people) the 9-1-1 system serves as a safety net for health and social issues in the community. Perhaps surprisingly, the Los Angeles Fire Department (LAFD) is a key component of the city’s health care safety net. “The LAFD is the largest provider of acute, unscheduled medical care in Los Angeles,” and of the more than 425,000 annual calls for service, 85% are for medical services, not fire.

What would fire response look like if you put the patient first?

In 2016, Dr. Marc Eckstein, medical director of the LAFD, led the development and launch of the nurse practitioner response unit (NPRU) pilot project. A great example of using small step service design thinking, the creation of the NPRU was driven by a deep understanding of the people the LAFD serves. Leaders of the NPRU explained their thinking in creating the healthcare innovation: “This challenge naturally summons the need to better understand who our clients really are, and how we can work with other community partners to more collectively match our collective response to each client.”

What the team understood from years in the field talking and working with residents of Los Angeles County was that community members trusted the LAFD and that is why they called. Further, the team recognized, “for those with lower socioeconomic status, the fire department is their only means of access to healthcare, and has been for a number of years.” Additionally, Terrance Ito, DNP, FNP-BC, the LAFD EMS Nurse Practitioner supervisor explained, “many of them lacked health insurance for a number of years—and having recently become insured, we’ve found that they’re having difficulty with healthcare navigation.”

Meeting patients where they are – literally and figuratively

The NPRU model is designed to intervene with patients as early as possible in the course of emergency care, in part by focusing on what are called “prehospital” encounters. In a report prepared for the California HealthCare Foundation and California Emergency Medical Services Authority by Dr. Kenneth Kizer and his colleagues, prehospital services can include transporting patients who don’t need emergency care to non-emergency department (ED) locations, refer or release individuals at the scene of emergency response, and/or addressing the needs of frequent 9-1-1 callers (or ED visitors) “by helping them access primary care and other social services.”

The NPRU is a converted ambulance that is staffed by a range of emergency professionals including firefighters, paramedics, and nurse practitioners. The missions of the NPRU include providing mobile urgent care at the scene of an emergency call, and comprehensively assessing frequent users of emergency services, then connecting them to care or social services, as necessary.

A small step service design change, the NPRU allows patients to be served where the ambulance goes – often to a person’s home after he or she has called 9-1-1, instead of transporting the patient with little thought to where the patient can best be served. Notably, in February 2019, the Centers for Medicare and Medicaid Innovation announced a new payment model that will support exactly this kind of health service innovation. The Emergency Triage, Treat and Transport (ET3) Model will allow providers serving Medicare beneficiaries to be reimbursed not only for ambulance services to hospitals, but also for transport to lower level sites of care, for example a physician’s office or urgent care clinic. The ET3 Model would also allow reimbursement for models such as the LAFD NPRU that treat “in place with a qualified health care practitioner, either on the scene or connected using telehealth.”

Our book chapter on using small step service design thinking in health care used two case studies to highlight not just theories, but models that have been tested and proven effective in improving patient care. These models mirror what we hear from patients in our client work – ask us what we think would improve patient care and create policy accordingly. This simple idea drives our work every day. We hope you will consider it in your health care policy work as well.

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Innovation Series, Part 2: App for Substance Abuse Disorders

By M2|2018-01-10T22:28:15+00:00January 10th, 2018|Health Care Trends, Innovation, Uncategorized, What do we pay for and why|

Scientific Breakthroughs: From Gene Therapy to Creative New Approaches to Cancer Surgery, Patients Stand to Benefit Dramatically, But How Will We Pay For This Innovation?

Innovation Series, Part 2: App for Substance Abuse Disorders

From gene therapy to a “pen” that can detect cancerous tissue in 10 seconds, we live in a time of amazing scientific breakthroughs. Advances in technology and our understanding of the genetic basis of disease are resulting in a range of innovations that hold the promise of improving our approaches to treatment – including things like new treatment options for rare diseases and innovations that are more consumer friendly.

Last year, for example, the U.S. Food and Drug Administration (FDA) approved for marketing the first mobile application to help treat substance use disorders. Yes, there’s an app for that! Cognitive behavioral therapy (CBT) is a kind of talk therapy that is a proven treatment for a number of mental health and substance abuse disorders. The newly approved app, developed by Pear Therapeutics, essentially makes CBT digital. The app, called reSET®, is designed to be used in conjunction with counseling and would be prescribed as appropriate by a health care provider.

Digital therapeutics are a hot space for health care start-ups and Pear Technologies is leading the way. Founder and CEO of the company, Corey McCann told CNBC, “This is the moment for digital therapeutics.” While not yet available for sale in the U.S., the clinical data that led to FDA approval is promising. The trial included more than 500 patients with substance use disorder (SUD) over a 12-week period. The randomized trial compared intensive face-to-face counseling – a standard treatment for SUD – to reSET® combined with a reduced amount of face-to-face counseling. Of the patients using reSET® who were dependent on stimulants, marijuana, cocaine, or alcohol, nearly 60% were abstinent at the end of the study period, while just 30% of patients who received only the face-to-face counseling were abstinent.

Of note, data from the clinical studies indicated no side effects from the device. If a prescription digital therapy improves patient outcomes and has few or no side effects, should it be reimbursed at a higher rate than a competing intervention that is safe but has more side effects for the patient? Meeting the patient where she or he is seems obvious, and prescription digital therapeutics are another great example of innovation that is consumer-focused.

What do all of these new and potentially lifesaving innovations mean for the health care system? As with any innovation that offers new hope for patients, there will likely be high demand, but that will have to be considered in the context of limited resources. We are witnessing significant new innovations and scientific advancement; the usual questions of access and how to pay for it will be dramatically amplified in this modern era, given the unprecedented price tags.

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Scientific Breakthroughs: From Gene Therapy to Creative New Approaches to Cancer Surgery, Patients Stand to Benefit Dramatically, But How Will We Pay For This Innovation?

By M2|2018-01-03T21:04:29+00:00January 3rd, 2018|Health Reform, Innovation, Reimbursement, Uncategorized, What do we pay for and why|

Innovation Series: Gene Therapy

Scientific Breakthroughs: From Gene Therapy to Creative New Approaches to Cancer Surgery, Patients Stand to Benefit Dramatically, But How Will We Pay For This Innovation?

From gene therapy to a “pen” that can detect cancerous tissue in 10 seconds, we live in a time of amazing scientific breakthroughs. Advances in technology and our understanding of the genetic basis of disease are resulting in a range of innovations that hold the promise of improving our approaches to treatment – including things like new treatment options for rare diseases and improving the likelihood of success of something like cancer surgery. As we kick off 2018, I wonder what great new innovations the year will bring?

As just one example of innovation, consider the field of gene therapy: early last year the FDA approved the first gene therapy, Novartis’ Kymriah (tisagenlecleucel)‎, bringing “hope to the 3,100 people under the age of 20 in the United States who are diagnosed each year with acute lymphoblastic leukemia,” as the pharmacy benefit manager (PBM) Express Scripts describes in a recent post on its web site. Kymriah is “customized for each individual, using genetically modified versions of the patient’s own immune cells to target and kill leukemia cells.”

Gene therapies “are administered once, unlike nearly all other medications that are repeatedly taken over time,” Express Scripts notes. “And therein lies the challenge.”

The promise of gene therapy comes with a “dramatically higher price;” for example, Kymriah is priced at $475,000. Not only is this price significantly higher than more traditional types of drugs – it’s also much higher than other specialty drugs, the PBM says.

Paying for these types of breakthroughs will present challenges. “Pharmaceutical companies have a single opportunity per patient to get paid,” and “many gene therapies target extremely rare diseases, so there aren’t many patients to share the cost drug makers require to justify the expense of research, development and commercialization. The result is very high price tags,” Express Scripts says.

“The health care system isn’t set up for this type of economic model. Thus, making these therapies available to patients “requires novel collaboration,” the company says. A “new payment model” is needed, and Express Scripts is working with drug companies, policymakers, patient groups and payers on “innovative approaches to make gene therapies accessible for patients.”

For example, value-based contracting can “ensure that payers and patients aren’t on the hook when a treatment isn’t effective. Consultations involving pharma companies and payers can help set appropriate prices.” And “discussions with policymakers can help set an appropriate regulatory framework.”

“Ultimately…gene therapies will require payment and patient care systems which are as novel as the medications themselves,” Express Scripts says. “Ideas on the table include paying for a treatment over time, establishing insurer risk pools and financing one-time payments. A successful model must address patients who change insurers or employers, and tracking their health outcomes over time to ensure payments aren’t being made if the treatment stops being effective.”

What do all of these new and potentially lifesaving innovations mean for the health care system? As with any innovation that offers new hope for patients, there will likely be high demand, but that will have to be considered in the context of limited resources. We are witnessing significant new innovations and scientific advancement; the usual questions of access and how to pay for it will be dramatically amplified in this modern era, given the unprecedented price tags. Particularly in the case of gene therapy, this may require new types of conversations and collaborations between drug developers, payers and patients, along with new payment approaches.

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Spending More, but Getting Less: How Hospitals Can Work Together to Reap the Benefits of Increased Spending on New Technologies

By M2|2017-10-08T11:20:04+00:00September 25th, 2017|Health Information Technology, Uncategorized|

Spending More, but Getting Less: How Hospitals Can Work Together to Reap the Benefits of Increased Spending on New Technologies

Hospitals often buy new technologies without requiring that the technologies communicate with each other, even though this lack of interoperability results in lower physician productivity and an increased likelihood of medical errors occurring. Other hospitals, fearing exactly those inefficiencies, simply avoid buying innovative new technologies. Peter Pronovost and his colleagues at Johns Hopkins Medicine, give some advice on how to avoid these issues in “What Hospitals Can Learn from Airlines About Buying Equipment,” in the Harvard Business Review.

Hospitals’ spending on new technology “has ballooned,” the authors note. “For years, hospitals have invested in sophisticated devices and IT systems that, on their own, can be awe-inspiring,” the authors say. “Yet these technologies rarely share data, let alone leverage it to support better clinical care.”

“Part of the solution must involve hospitals,” the authors state. “If they truly want technologies that save lives and boost productivity, they will need to exert their considerable pressure as purchasers, requiring that manufacturers embrace openness and interoperability, and only purchasing devices that support this.”

“Too often, hospitals treat equipment and IT procurement in a siloed way, focusing on price without looking at how those devices will work as part of a larger system,” the authors say.

“For example, many new hospital beds come with a sophisticated array of sensors that can track such information as whether a patient is at risk of developing a bedsore, based on data about how often they move in bed. Such sensors may be 30% of a bed’s costs. Yet at one of our hospitals [within the Johns Hopkins system], that data is unusable — it’s in a format that our system cannot read.”

The situation is similar for “much of the data that is fed from wireless monitors of patients’ heart rate, blood oxygen levels, blood pressure, and breathing rate: This data doesn’t link to the medical record,” they note.

“The vision of an integrated hospital unit that is much safer and more productive will not be possible without widespread availability of products that share data openly and freely. Just as the U.S. Navy demands that its submarines and ships have interoperable technologies, this change can be driven by those who purchase these technologies,” they say. “Health care leaders that purchase technologies need to do the same.”

However, it is “unrealistic to think that each hospital should go it alone, exerting its purchasing power to move the marketplace,” the article states. “Hospitals could work together, writing specifications and functional requirements for the products that they will purchase and refusing to do business with manufacturers that don’t comply.” There may also be a role here for group purchasing organizations, they say.

As a further step, instead of assembling hospital rooms “one product at a time, hospitals should be able to purchase modules, sets of interoperable products that work together to support an aspect of care,” the authors continue. “This model makes sense, as few if any hospitals have the resources to design and manage all the connections between technologies, or to optimize how the data is used and displayed to support top-quality care. Ultimately, when a hospital is built or renovated, it would have the option to buy modular patient rooms, clinical units or floors — a ‘hospital in a box,’ built to its specifications.”

“We don’t expect airlines to build their own planes. They buy them from experienced system integrators such as Boeing or Airbus,” and hospitals should have a similar model, the authors note. “The question is whether health care leaders will have the resolve to require it.”

On the other hand, “even if digital devices communicate with one another, the lack of standards for health data puts full interoperability and data sharing out of reach,” according to an article in Healthcare Dive highlighting the opinion piece. “While we’ve made progress in the last three to four years and have the promise of FHIR (fast healthcare interoperability resources), the standards in health care from a data exchange standpoint are very weak,” explains Paul Shenenberger, CIO of Summit Health Management.

The lack of interoperability and data standards will be especially challenging as access to health care continues to change in the digital age, as a separate Healthcare Dive article points out. “From alternative care settings to telehealth companies, supply and demand for healthcare services is in flux.”

“Care is actually moving away from the hospitals,” the article quotes Dr. Rasu Shrestha, Chief Innovation Officer at UPMC, as saying during a panel at the National Health Policy Conference (NHPC) earlier this year. “’The brick and mortar hospitals that we know today will not be the focal point of healthcare delivery tomorrow.’ As care moves away from hospitals, whether at large or in part, it will be important to integrate health data from all over the care spectrum to get a full picture of a person’s well-being.”

This points to the persistent challenge related to use of new technologies in health care; in a siloed, non-standardized data world, how do we leverage the massive amounts of data generated in health care every day and facilitate data sharing in a way that actually makes health care more efficient and effective? The Hopkins op-ed authors take a step in the right direction – urging hospitals to leverage their significant purchasing power to demand interoperability. However, in order to do that, the data standards challenges will also need to be resolved. As Healthcare Dive summarizes, “though it may be a painful process, the need for standards and interoperability are desperately needed for innovative care to move forward.”

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Health Care Innovation is Hurtling Forward, Despite Policy Uncertainty

By M2|2017-10-08T11:32:37+00:00July 21st, 2017|Health Care Trends, Health Information Technology, Health Reform, Uncategorized|

Health Care Innovation is Hurtling Forward, Despite Policy Uncertainty

Yes, Washington, D.C. has been tied in knots for months over the future of Obamacare. Or more specifically, how and whether the federal government should pay for health insurance for certain consumers. In the meantime, health care innovation is hurtling forward as evidenced by investments and operational commitments by health care companies.

Digital Health Investments

StartUp Health’s 2017 Global Digital Health Funding Mid-Year Report compiles seed, venture, corporate venture, and private equity funding for the period January 1 through June 30, 2017 and shows 2017 investing in digital health “has already surpassed previous years in overall funding.” The second quarter of 2017 was the biggest ever, and that single quarter accounted for more money invested than total annual funding for 2010 and 2011 combined. In the first half of 2017, more than 300 digital health deals were inked, worth more than $6 billion.

CHART: Digital Health Funding 2010-2017 (YTD) from StartUp Health

Many of the digital health funding supports innovative ways of delivering health care.

For example, CareDox is a company focused on helping public school health programs be more efficient. More than 50 million students are served by school health care clinics in the U.S., making it one of the largest medical networks in the country. Innovating this front line of health care for kids could improve both the health care children receive and the coordination of care between schools, medical professionals, and parents.

One of the largest investments has been for GRAIL, a big data/analytics company that has received nearly $1 billion since its inception. GRAIL was started by Jeff Huber, who may not be a household name to health policy wonks, but I can guarantee you use something he’s built. Jeff was a senior engineering leader at Google who spearheaded the harnessing of massive data sets to create Google Ads, Apps, and Maps. After those projects, but just before starting GRAIL, he was working on big data at Google Life Sciences as part of Google X (aka The Moonshot Factory). Jeff’s vision is to combine “science, technology, and clinical studies to reveal cancer at its beginnings. To detect cancer early, when it can be cured.”

Being a glass half-full type of person, I get very excited to read about all the new health care ideas out there being turned into businesses. I’m just covering a few in this blog, but if you want to see a more detailed list, mobihealthnews covered the 81 digital health funding deals for Q2 2017.

Health Insurer Innovation

Several health insurers also announced innovative approaches recently (which we will cover more in upcoming blogs) indicating to me, that while big health policy issues are still up in the air, businesses need to keep providing services and coming up with new products to maintain current customers and win over new ones.

An innovative example of a company combining digital health innovation with health insurance is Bright Health. A Minneapolis-based health insurance company launched in 2016 by former UnitedHealthcare CEO, Bob Sheehy and two partners, Bright Health will be selling plans in the individual market in 2018 in select geographies, including Colorado. The company just landed $160 million in venture capital based on this thinking from one of their investors:

“We’re thrilled to continue our partnership with Bright Health to disrupt a complicated industry where consumers are demanding change and leading health systems are hungry to deliver.”

The innovation Bright Health is offering is the selection of a sole health system as a deep partner in a state, and to use apps and other tech tools to attract consumers. In Colorado, Bright Health has chosen to partner with Centura Health to deliver care to its members. While health policy types might bemoan this type of “ultra-narrow” network, time will tell if consumers prefer to trade less choice for lower premiums.

Watching big picture policy debates, it’s easy to forget that investors and companies across the U.S. are coming up with all kinds of new ways to serve health care customers. The dust will eventually settle (I think!) on whether 2017 is the year to change Obamacare, but in the meantime innovation is hurtling forward which is much better way to see what the future of health care looks like in the U.S.

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The third case study from our recently published book chapter in Service Business Model Innovation

By M2|2017-10-09T01:58:36+00:00April 4th, 2017|Uncategorized|

The third case study from our recently published book chapter in Service Business Model Innovation

As we a couple weeks ago, M2HCC authored a chapter entitled “Essential Characteristics of Service Business Model Innovation in Healthcare: A Case-Study Approach” in Service Business Model Innovation in Healthcare and Hospital Management published by Springer. Today we share highlights from the third case study we feature in the chapter.

The Massachusetts General Physicians Organization

The Massachusetts General Physicians Organization (MGPO) is a multi-specialty medical group that provides patient care, teaching, and research in partnership with the Massachusetts General Hospital and in cooperation with Partners HealthCare. Several of the hospitals in the Partners HealthCare system, including the Massachusetts General Hospital, are teaching affiliates of Harvard Medical School.

We talked with Dr. Daniel M. Horn, Assistant Medical Director for Ambulatory Quality at the MGPO whose work is focused on the next steps in quality in his role leading efforts to improve the quality of care for 160,000 patients across 21 primary care practices.

Quality measures and the binary fail

Measuring quality is a building block for payment and delivery system reforms, such as accountable care, integrated delivery, shared-savings or value-based approaches. However, there is a difference between true quality of care and quality measures. Improving patient outcomes is likely to represent high quality of care, but how would that be measured?

At MGPO, the organization is using the current “binary fail” method of measuring quality as an opportunity to build trust. For example, most healthcare providers are in some way subject to quality measures designed for health plans called the Healthcare Effectiveness Data and Information Set (HEDIS). Dr. Horn used the example of the HEDIS measure for controlling blood pressure to explain the problem of the “binary fail.” Heart disease and stroke is the leading cause of death in the U.S., and because high blood pressure (hypertension) increases the risk for heart disease and stroke, there is no question that controlling high blood pressure is important. What is at issue is the way providers are measured on the concept of “controlling.”

Controlling high blood pressure, according to HEDIS, is the measurement of the percentage of patients 18–85 years of age who had a diagnosis of hypertension and whose blood pressure (BP) was adequately controlled during the measurement year, for example, by showing the patient’s blood pressure was less than 140/90 mm Hg. In a clinical practice, this means the denominator is the number of patients who come into the practice in the first 6 months of the year where the clinician submitted a bill with the appropriate ICD-10 code related to an abnormal blood pressure reading without a hypertension diagnosis, and the numerator is the number of patients who come into the practice in the second 6 months of the year and have a blood pressure reading below 140/90 mm Hg.

Even a non-clinical reader can quickly see various patient scenarios that would fall outside of this narrow consideration of the quality measure called controlling high blood pressure; hence, Dr. Horn’s pronouncement that the HEDIS measure creates a binary fail for measuring the control of a patient’s blood pressure.

Building trust, then, is accomplished by rewriting the measures with an algorithm for all of your patients. MGPO developed a measure that is clinically valid and acknowledges what the clinician knows, which is that it might have taken 18 months to control a patient’s blood pressure, for example.

Dr. Horn explained that building trust and cooperation in order to achieve service business model innovation requires: 1) Building better quality measures; 2) Changing the mentality; and 3) Providing usable data.

Build better quality measures

Dr. Horn explained that in response to the changing healthcare environment, and in an effort to build trust with clinicians to show that their work and interest in patient care is paramount to the organization’s success, MGPO addressed the gap between payer-defined measures, such as HEDIS, and clinically valid and meaningful quality measures. His team, in close cooperation with other clinicians, has helped the organization rewrite measures used internally so they would be clinically valid in the healthcare provider’s point-of-view. “We have electronic health record (EHR)-based data sets to manage clinical care, so let’s build better measures, then maybe build that into contracts,” said Dr. Horn.

Change the mentality

Thinking first about how clinicians work and why they choose to serve patients, meant changing the rhetoric and mentality around payer-driven measures. Dr. Horn explained, “We want to empower you to do this work and we want to define it in clinically meaningful terms.” By doing this over the past 3 years, the system is, in a way, divorcing itself from the market-driven quality measures when it comes to thinking about true quality and patient outcomes

Provide usable data

Trust is also bolstered when data being used to measure quality and performance is actually usable. Clinicians are more likely to trust data with three characteristics, according to Dr. Horn. First, it must be reliable. Second, the measurement criteria being used “must represent something they believe in as a physician.” Third, the data must be timely. To incentivize behavior change, showing a clinician or clinical practice information from 6 to 12 months ago is simply too old. The data should be real-time, valid and represent clinician values. In Dr. Horn’s experience, showing data that has even a single mistake or two is enough to create some distrust with clinicians.

As we grapple with ways to improve health care quality and lower costs, the MGPO approach to quality measures is certainly an innovation. To create truly accountable care, quality measures that are valid, valued and usable by clinicians are needed to improve the provision of primary care.

*Daniel M. Horn, M.D., is the Assistant Medical Director for Ambulatory Quality at the Massachusetts General Physicians Organization (MGPO). Dr. Horn is also a primary care physician and Unit Chief at Internal Medicine Associates, where he provides comprehensive primary care and helps with day-to-day leadership of the largest primary care practices at Massachusetts General Hospital (MGH).

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Service Business Model Innovation, the second case study from our recently published book chapter

By M2|2017-10-09T02:00:19+00:00March 28th, 2017|Uncategorized|

Service Business Model Innovation, the second case study from our recently published book chapter

As we a couple weeks ago, M2HCC authored a chapter entitled “Essential Characteristics of Service Business Model Innovation in Healthcare: A Case-Study Approach” in Service Business Model Innovation in Healthcare and Hospital Management published by Springer. Today we share highlights from the second case study we feature in the chapter.

The BJC Collaborative
BJC HealthCare is based in St. Louis, Missouri and includes Barnes-Jewish Hospital and St. Louis Children’s Hospital. It is one of the largest nonprofit healthcare organizations in the U.S. and it is the largest provider of charity care in the state of Missouri. In 2012, Saint Luke’s Health System in Kansas City, Missouri, and CoxHealth in Springfield, Missouri, and Memorial Health System in Springfield, Illinois, joined BJC to form The BJC Collaborative. Over the past few years, four more organizations joined the Collaborative and members have combined annual revenues of over $9.3 billion but remain independent, serving residents of Illinois, Kansas, and Missouri.

The BJC Collaborative has three primary focus areas: 1) Implementing clinical programs and services to improve access to and quality of health care for patients; 2) Lowering health care costs and creating additional efficiencies that will be beneficial to patients and the communities served by the member organizations; and 3) Achieving cost savings. (BJC Collaborative 2016)

We talked with Sandra Van Trease*, group president of BJC HealthCare about how trust, cooperation and leadership have helped the Collaborative increase innovation year after year.

Common values and previous relationships
The importance of trust and relationships is on point, especially in this kind of organization, where entities are coming together as a collaborative, explained Van Trease. For example, the senior leadership of these organizations knew each other before the Collaborative was formed. “We already knew each other, we knew each entity was high performing, we held similar values, we all recognized a need for evolution and change in the healthcare system,” said Van Trease. Common values were a key component to building the Collaborative.

Service priorities should matter to staff and leadership
While it is clear that leadership and strong relationships drove the creation of the Collaborative, the process the Collaborative uses to determine priorities is also driven by a structure built on trust and leadership. It is essential to set service priorities that matter to both staff and leadership, not just one or the other.

Get results to improve results
Notably, Van Trease explained that getting results also helped to build trust, which in turn, drove improved results. High-performing systems are like competitive athletes, always wanting to improve and set higher goals. Getting results makes people more likely to trust each other, and the process, creating momentum that generates further progress, explained Van Trease.

Communicate what works
Finally, and one of the unique components of the four case studies M2 wrote, Van Trease explained that it is essential to celebrate and share successes and best practices that can be replicated is essential. At the BJC Collaborative, there is a dedicated communications roundtable that captures this information, writes it up, and then disseminates it to each local health system.

Talk to your team, then have them talk to each other. Have leaders work in close connection with team members. On paper, it doesn’t seem that difficult, but in practice, the BJC Collaborative worked hard to build trust, increase cooperation and show leadership to create a truly innovative service approach for their area of the United States.

*Blessing Health System in Quincy, Illinois (2013), Southern Illinois Healthcare in Carbondale, Illinois (2013), Sarah Bush Lincoln Health System of Mattoon, Illinois (2015), and Decatur Memorial Hospital in Decatur, Illinois (2016).

*Sandra Van Trease serves as a group president for BJC HealthCare, and provides strategic leadership and direction to the BJC Collaborative. In 2012, Van Trease was appointed president of BJC HealthCare’s Accountable Care Organization and leads BJC’s overall efforts in Population Health.

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Service Business Model Innovation, the first case study from our recently published book chapter

By M2|2017-10-24T02:32:10+00:00March 14th, 2017|Uncategorized|

Service Business Model Innovation, the first case study from our recently published book chapter

As we blogged about last week, M2HCC authored a chapter entitled “Essential Characteristics of Service Business Model Innovation in Healthcare: A Case-Study Approach” in Service Business Model Innovation in Healthcare and Hospital Management published by Springer. Today we share highlights from the first case study we feature in the chapter.

Baylor Scott & White Health’s collaboration with The Cleveland Clinic

In December 2014, three Baylor Scott & White Health hospitals—Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Baylor University Medical Center at Dallas and The Heart Hospital Baylor Plano—were invited to join the Cleveland Clinic’s National Cardiovascular Network, the first hospitals in the Southwest to be invited.

Joel Allison, CEO of Baylor Scott & White Health called it a “collaboration of the future,” in part because Baylor Scott & White Health’s (BSWH) collaboration with Cleveland Clinic spans geographies, but not medical specialties. Instead of cooperating in a geographic area with a broad range of health care provider types, this collaboration is based instead on the quality of a single medical area of focus: heart disease. However, similar to the other case studies M2 researched and wrote, this collaboration clearly demonstrated 1) trust is built over time and 2) leadership takes vision.

Trust is built over time

The importance of trust is multifaceted. Not only are these hospitals some of the most trusted in the world, a reputation they built over years of delivering excellent quality care, the leaders also knew each other for years before the collaboration was executed.

“The folks at Cleveland Clinic were known to us, and us to them,” Dr. Michael Mack* told us. The partnership wasn’t the result of “responding to a request for proposals.” That being said, even such deep-rooted trust was not enough to seal the deal. Only after a year-long intensive due diligence process was an invitation to participate in the network extended.

Leadership takes vision

“The idea behind the model is a vision of how the business of health care is going to change in the upcoming years,” explained Dr. Mack. “This was an opportunity to develop a business model to best adapt to that changing paradigm of health care going forward.” What does that paradigm look like? To BSWH and Cleveland Clinic, it is thinking less about serving a market based on geography, and thinking more about serving the entity who pays for the care, the patient or the employer, for example.

This particular service business model is uniquely innovative in that the network aims not only to provide high quality health care, but also to provide predictability and transparency to the final purchaser—whether a patient, an employer, or a payer. This model “shifts the risk from the insurer to the provider,” said Dr. Mack. “We are providing a high dollar operation, and we guarantee the price and quality.”

Pivoting to the new world of transparency

Providing “transparency of care, transparency of quality, and transparency of price,” said Dr. Mack, is moving the health care market closer to the way other markets function. “You wouldn’t go into a Best Buy without knowledge of the product and price of the product you are considering for purchase,” explained Dr. Mack.

Providing transparency of care, quality, and price to patients and payers shouldn’t feel like a cutting edge innovation. But in fact, it is. Time will tell whether this particular innovation is adopted more widely.

*Michael Mack, M.D., is the Medical Director of Cardiothoracic Surgery for Baylor Scott & White Health and the Chairman of The Heart Hospital Baylor Plano Research Center. Dr. Mack is on the team of physicians on the medical staff that oversees medical care provided in The Heart Valve Center of Texas in the Center for Advanced Cardiovascular Care.

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Service Business Model Innovation, an overview of our recently published book chapter

By M2|2017-10-09T02:03:42+00:00March 7th, 2017|Health Care Trends, Uncategorized|

Service Business Model Innovation, an overview of our recently published book chapter

We are proud to announce the publication of Service Business Model Innovation in Healthcare and Hospital Management by Springer. The book includes process innovations and toolkits that can be used to improve value generation and build competitive business architectures in the health care sector.

M2 authors contributed a chapter entitled “Essential Characteristics of Service Business Model Innovation in Healthcare: A Case-Study Approach.” The chapter highlights examples of successful service business model innovation at four different U.S. health systems, based on interviews with leaders from each institution. The next few blog posts will highlight key learnings from the case studies we wrote about Baylor Scott & White Health’s collaboration with The Cleveland Clinic, BJC HealthCare and the BJC Collaborative, the Massachusetts General Physician Organization, and Sutter Health and the Sutter Medical Network.*

Why did we write these cases?
In my work with clients, and as a lecturer for graduate students in public health, I have been given access to two unique viewpoints into the U.S. health care system, and in my opinion, each set of observers need to know more about the other. My clients are often grappling with creating health care system change, but don’t have a roadmap – they often have to create models from scratch. Graduate students, who are often academic learners and professionals in their field, are taught theoretical models or frameworks, but don’t have a good sense of how theory translates into practice.

In addition, the system of delivering and paying for health care in the U.S. is undergoing seismic changes. Some of this change is driven by federal, state and local governments, who pay for about half of all U.S. care, and some of the change is driven by innovation created by the marketplace. Health care organizations that have succeeded in creating service business model innovation in the new world of accountable care, integrated delivery, shared-savings, and value-based approaches have certain characteristics in common.

Based on the case studies we wrote, which represent a range of U.S. geographies, provider types, and collaborative arrangements, we found service business model innovation rests on the pillars of trust, leadership, and cooperation.

Why is innovation needed now?
The health care system is undergoing massive change, no doubt. But why is innovation needed now?

Thomas Robertson, the Executive Vice President of Member Relations and Insights for the University HealthSystem Consortium, an alliance of nonprofit academic medical centers and their affiliated hospitals, wrote in an opinion piece for Academic Medicine in 2015:

“Seemingly lost in the race to manage everything everywhere is the recognition that a very small subset of very sick patients account for the vast majority of health care spending. Any programs, prospective payment systems, or policies designed to curb health care spending must focus on improving the efficiency of complex episodes of care delivered to the sickest subset of the population. Whether a population is defined as a company, a county, or a country, the overwhelming majority of its health care spending comes from a small minority of the individuals, and the bulk of that spending is associated with either largely unavoidable and unpredictable single events or complex episodes of care. Achieving an economically sustainable health care system will require more efficient and effective delivery of those complex episodes of care.”

More efficient and effective delivery of complex care, however, requires a diverse set of providers to work together – which is not how the current system was built, nor is it how most payers reimburse health care practitioners for providing care. In these contexts, a health organization must trust its partners more than ever before.

Our chapter, “Essential Characteristics of Service Business Model Innovation in Healthcare: A Case-Study Approach”, provides a roadmap of the various ways organizations are meeting the challenge to efficiently and effectively deliver complex care by using the key skills of trust, leadership, and cooperation to create service business model innovation in the U.S. health care system. We hope this roadmap serves health care leaders, health care system students, and anyone else interested in creating health care change.

*A special thanks to Dr. Horn (MGPO), Sarah Krevans (Sutter), Dr. Mack (BSW), Sandra Van Trease (BJC) and Dr. Wreden (Sutter) for participating in interviews on behalf of their organizations.

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