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What's Current in Healthcare & Strategy

Home>SGM Articles and Resources>What's Current in Healthcare & Strategy

Tuesday, March 22, 2016

Get Comfortable with Bundles

The Centers for Medicare & Medicaid Services has mandated that hospitals in 67 markets participate in bundled payments for hip and knee replacements. It's part of an acceleration in the transition to risk-based payment arrangements, and about 800 hospitals will be subject to the new reimbursement regime.

Read the Article on HealthLeaders

Tuesday, March 15, 2016

Three Changes Consumers Can Expect In Next Year's Obamacare Coverage

Health insurance isn’t simple. Neither are government regulations. Put the two together and things can get confusing fast.

Read the Article on Kaiser Health News

Tuesday, March 8, 2016

Retail Clinics Increase Medical Spending

Retail clinics by design provide easier access to basic healthcare services that cost significantly less than a trip to the doctor's office or the emergency department.

While that care may be less expensive, retail clinics still drive up medical spending by creating a new demand for previously unmet medical services, according to a study from RAND Corporation and Harvard University published in Health Affairs.

Read the Article on HealthLeaders

Wednesday, February 23, 2016

Healthgrades Names Best Hospitals: 4 Things to Know

Here are four things to know about Healthgrades' highest distinction and the hospitals that received it this year.

Read the Story at Becker's

Monday, February 15, 2016

Rebooting the Quest for Value in Healthcare

After an acquisition, integrating new principles across a health system takes time—and a plan. SSM Health's new value-based task force pulls innovation and expertise out of their silos.

Read the Article in HealthLeaders

Friday, January 29, 2016

Average Cost Per Inpatient Day Across 50 States

Here are average costs per inpatient day in 2014, organized by hospital ownership type, in all 50 states and the District of Columbia, according to the latest statistics from Kaiser State Health Facts.

Read the Article on Beckers

Thursday, January 14, 2016

Average Cost Per Inpatient Day Across 50 States

Here are average costs per inpatient day in 2014, organized by hospital ownership type, in all 50 states and the District of Columbia, according to the latest statistics from Kaiser State Health Facts.

Read the Article on Becker's

Tuesday, January 12, 2016

CMS to Expand Care With 21 "Next Generation ACOs"

The accountable care organizations work to improve quality and lower costs, with measures as simple as making sure patients receive regular follow-up visits and stay on their medications.

Read More on Kaiser Health News

Thursday, January 7, 2016

CEOs and CFOs: 10 Things Demanding Your Attention This Year

How does one prioritize when everything is important? It's a familiar feeling for most hospital and health system executives. To simplify and focus, we spoke to experts who helped us identify 10 of the most pressing issues for healthcare leadership and financial teams in 2016. 

Read the Article on Beckers 

Monday, January 4, 2016

5 Focus Areas Hospital Marketers Must Perfect in 2016

Healthcare marketers revealed strength and innovation in 2015—hospitals nationwide expanded their digital marketing efforts, created impactful ads, and took risks experimenting with emerging media.

But with a new year around the corner, now is a time to look forward and uncover ways to push the boundaries even more. Here are five key focus areas that hospital marketers should strive to perfect in 2016.

Read the Article on HealthLeaders

Tuesday, December 22, 2015

Holiday Reading List: 7 CEOs Name Their Favorite Books This Year

That busy executives can find time for leisure reading is commendable in itself. Indeed, many make it a priority, as professionals at all levels — including those in the C-suite — can still learn a thing or two from a good book.

Read the article on Becker's

Thursday, December 17,  2015

9 Things to Know About How the $1.1 Trillion House Spending Bill Impacts Healthcare

The U.S. House posted a $1.1 trillion, 2,009-page omnibus spending bill early Wednesday morning with many implications in healthcare, including many provisions that would significantly change parts of the Affordable Care Act.

Read the Article on Becker's

Wednesday, December 9, 2015

4 Areas Primary Care Physicians Need to Improve for Value-Based Care

Primary care physicians around the world struggle to coordinate patient care, according to a new survey from the Commonwealth Fund. But out of the 10 countries surveyed, doctors from the United States appear to be having some of the most trouble connecting the dots, especially when it comes to managing patients with multiple chronic conditions.

Read the Article on Fierce Practice Management

Tuesday, December 8, 2015

Fortune Makes 10 Healthcare Predictions for 2016

Numerous trends, proposals and deals will come to a head in 2016. Fortune magazine has prepared 10 predictions for the healthcare industry next year.

Read the Story on Becker's

Friday, December 4, 2015

New Guidelines Boost Diabetes Screening For Overweight Adults

More people who are overweight or obese may get screened for diabetes under new guidelines released this week by a panel of prevention experts. Those whose blood sugar is higher than normal now can be referred to nutrition and exercise counseling without paying anything out of pocket for it.

Read the Article on Kaiser Health News

Monday, November 9, 2015

Everybody's Getting Smarter About Healthcare Value

A raft of new tools that rely on massive amounts of data are helping employers and their employees demystify the healthcare value equation. Even small employers and their employees are benefiting.

Read the Article on HealthLeaders

Wednesday, October 21, 2015

NFPs Beat For-Profit Insurers in Medicare Advantage Star Ratings, Again

"What makes nonprofits unique is our ability to focus on our mission. As a community benefit company our fiduciary responsibility is not to shareholders, it's to our community and our members," Wing explains. "Being a nonprofit means we can take a longer view in developing and nurturing quality-focused programs and processes that may not have immediate financial benefits but which we know in the long-run are the right things to do for our members and for enhancing quality."

Read the Article on HealthLeaders

Monday, October 19, 2015

The Care Management ACO

Back around 2007, Memorial Hermann Health System had only a distant promise when the Houston-based organization began to talk with area physicians about the concept of clinical integration. Terms like accountable care organization were still mostly left to theory. As Keith Fernandez, MD, recalls, the selling point that he and other leaders of the MHMD Memorial Hermann Physician Network had to offer was a more manageable life for physicians.

Read the Article on HealthLeaders

Friday, October 2, 2015

Doctors Urged to Practice Conservative Diagnosis

Internist Gordon Schiff, MD, says there's one thing he gives his patients that helps them deal with uncertainties in diagnosis: his cell phone number.

Read the Article on HealthLeaders

Thursday, September 24, 2015

The Drug With A 5,000% Price Hike: Everything You Need to Know

Martin Shkreli is the 32-year-old CEO of Turing Pharmaceuticals. After his company acquired an antiparasite medication developed 62 years ago, he increased the price from approximately $13.50 per pill to $750 overnight. 

Here are eight things to know about the medication and CEO that took global headlines this week.

Read the Article on Becker's

Tuesday, September 22, 2015

Attention Shoppers: New California Website Details Costs, Quality of Medical Procedures

Your average out-of-pocket costs for an uncomplicated birth could cost a lot less in San Mateo County ($920) than in Alameda County ($1,300), Santa Clara County ($1,500) or Orange County ($1,800). Thinking about a knee replacement?

Read the Article on Kaiser Health News

Thursday, September 17, 2015

The Pain Points of Innovation in Healthcare

Innovation is the name of the game, and everyone wants to play.

The rise of healthcare innovation centers responds to a growing need and desire to address some of the industry's biggest problem areas, but innovation itself is burdened with its own pain points.

Read the Article in Becker's

Monday, September 14, 2015

2015 Physician Total Cash Compensation by Specialty

Primary care physicians this year are experiencing bigger increases in total cash compensation than their specialist peers, according to the 2015 "Physician Compensation and Productivity Survey" from Minneapolis-based Sullivan, Cotter and Associates.

Combined with other findings in the survey, this may suggest the trend toward value-based, coordinated care — which puts primary care physicians in the driver's seat — could be starting to take hold. According to SullivanCotter, Primary care physicians saw a 3.4 percent median increase in total cash compensation between 2011 and 2015, compared to medical and surgical specialists, who saw 2.5 percent and 2.3 percent increases, respectively.

Read the Article on Becker's

Friday, July 16, 2015

Pharmacist Led Discharge Program Cuts Readmissions 46%

An initial partnership with a relatively small Indiana hospital begat Walgreens' WellTransitions program, which has shown a 46% reduction in unplanned hospital readmissions for the patients who use it.

Read the Article on HealthLeaders

Tuesday, July 14, 2015

Bundled Payments' Distruptive Effects Detailed

Hospitals and health systems are likely to respond quickly and ruthlessly to the announcement last week that the Centers for Medicare & Medicaid Services will soon require bundling of reimbursement for hip and knee surgeries, with profits tied closely to costs and quality metrics. With outcomes dictating reimbursement levels, postop facilities that can't make the grade are likely to be cut loose.

Read the Article on HealthLeaders

Thursday, July 9, 2015

100 Things to Know about Medicare and Medicaid--2015 Update

An overview of Medicare and Medicaid, including the history, innovation and the politics behind the programs.

Read the Article on Becker's

Wednesday, June 24, 2015

8 Biggest Healthcare Issues in 2015 So Far

As we move into the second half of the year, this article examines some of the biggest issues that have emerged so far.

Read the Article on Becker's

Thursday, June 4, 2015

Twenty Pieces of Advice from Hospital CFOs

From changing reimbursement levels to the evolving CFO role, hospital and health system financial leaders are dealing with a number of challenges. Regarding the numerous issues CFOs are facing, financial leaders from hospitals and systems across the nation shared the following pieces of advice with Becker's Hospital Review over the last five months.

Read the Article on Beckers

Tuesday, June 2, 2015

Bundled Payments May Be More Cost Effective Than ACOs

A new report on the Medicare program's attempt to remake the nation's healthcare finance system praised accountable care organizations (ACOs) but also pushed for the continued use of bundled payments to facilitate lower-cost, higher-quality care.

Read the Article on FierceHealth

Tuesday, May 5, 2015

Pioneer ACO Program Saves $384 Million, Ok'd for Expansion

The Pioneer ACO model, a controversial Medicare program geared to incent doctors and hospitals to improve quality and reduce costs and redundant care, in two years saved more than $300 per year for each of the 600,000 beneficiaries enrolled and is ready to be scaled up, Centers for Medicare & Medicaid Services officials said Monday.

Read the Article on HealthLeaders

Friday, May 2, 2105

Medicare Itemizes Its $103 Billion Drug Bill

The data show that 14 drugs cost the federal government and Medicare beneficiaries more than $1 billion each, accounting for nearly a quarter of Medicare prescription drug spending in 2013. Most of those drugs are used to treat chronic conditions that plague the elderly, including diabetes, depression, high cholesterol and blood pressure, dementia and asthma.

Read the Article on Kaiser Health News

Wednesday, April 22, 2015

Pioneer ACOs Saved Medicare $118 Million in Year One

Savings were similar in accountable care organizations with "financial integration" between hospitals and doctors, and those without, which suggests that this form of provider consolidation is not necessary for ACOs to reduce Medicare spending, research shows.

Read the Article on HealthLeaders

Friday April 10, 2015

Medical Schools Try to Reboot for the 21st Century

Medicine has changed a lot in the past 100 years. But medical training has not.  Until now.  Spurred on by the need to train a different type of doctor, medical schools around the country are tearing up the textbooks and starting from scratch.

Read the Article on Kaiser Health News

Thursday, March 26, 2015

Fee For Service vs. Value-Based Care

With HHS' new goals to overhaul healthcare reimbursement to shift away from the fee-for-service-based system over the next few years, it seems to be a foregone conclusion that the epoch of FFS medicine is coming to a close. However, there are still proponents of FFS payment models who argue FFS is not to blame for healthcare's high costs. In fact, they say, it leads to better care.

Read the Article on Beckers

Tuesday, March 24, 2015

Hospital CEOs "The Corner Office"

Each month, Becker's Hospital Review catches up with a hospital or health system CEO for a special feature called The Corner Office. Executives answer seven questions about their cities, interests outside the C-suite, favorite pieces of advice and healthcare issues that ruffle their feathers most.

Read the Article on Becker's

Tuesday March 3, 2015

The Diseases We Spend Healthcare Dollars On

People worry a lot about their health-care costs, such as the share they pay of their health premium or the size of their deductible. But they tend to have a harder time getting their heads around the measures experts use to talk about the national health-cost problem, such as health spending as a percentage of gross domestic product, or the rate of increase in national health spending, or the difference in per capita health spending in the U.S. vs. other countries. In a focus group I attended, a participant was asked whether he believed the Affordable Care Act would “bend the cost curve,” a concept often used to discuss health spending and to sell the ACA. His response: “I don’t know about bending any curves, but I don’t want to be bent.”

Read the Article on Wall Street Journal Think Tank

Thursday February 26, 2015

Lessons Learned From ACO Successes and Struggles

Given the Department of Health and Human Services' recent announcement that it plans to speed up its plans to shift to value-based payment models, it's more important than ever for providers to shift their priorities from volume to value. To that end, the CEO of one of the first accountable care organizations (ACOs) to form has advice for health leaders to map a way forward.

Read the Article on FierceHealthcare

Monday, February 16, 2015

CMS Announces Bundled Care Payments for Oncology

A radical cancer payment model introduced by Medicare officials Thursday will pay qualifying oncologists $160 per month for six months for each beneficiary receiving chemotherapy.

In exchange, qualifying providers must run round-the-clock outpatient clinics to manage common drug therapy complications that might otherwise send their patients to the hospital.

Read the Story on HealthLeaders

Friday, February 13, 2015

Price Transparency; Where is it Headed?

The proliferation of medical options, the general consumerization of healthcare and higher out-of-pocket costs for patients put a greater demand on providers to be more transparent about prices and costs to patients.

Read the Article on FierceHealthcare

Wednesday, February 4, 2015

Studies Shed Light on Measures to Improve Surgical Outcomes

Two new studies that evaluate attempts to improve surgical outcomes call into question the effectiveness of at least one of the key metrics for care quality performance in the current pay-for-performance model used to evaluate hospitals.

Read the Article on FierceHealthCare

Tuesday, January 13, 2015

Top Issues Facing Hospital CEOs

For the 11th year in a row, hospital CEOs ranked financial challenges as the No. 1 issue facing their organizations in 2014.

Each year, the American College of Healthcare Executives surveys community hospital CEOs to identify the top issues confronting their organizations. Findings reflect 338 CEOs' responses.

Read the Report on Becker's

Tuesday, January 13, 2015

What's So Great About Retail Health Clinics

For hospitals and health systems, relationships with retail clinics are a relatively easy sell: They help boost patient volume for inpatient and outpatient services while effectively outsourcing basic healthcare services such as vaccinations.

Read the Article on HealthLeaders

Friday, December 12, 2014

Retail Clinics Solidify Their Market Niche

A potent combination of established players such as CVS Health, Walgreens, and Walmart and a crop of new entrants have retail healthcare clinics cementing their hold on a slice of the continuum of care.

Read the Article on HealthLeaders

Wednesday, December 3, 2014

Consumers to Pay More Out of Pocket Next Year for Specialty Drugs

Americans with health coverage – including those who buy it through government insurance exchanges and Medicare beneficiaries – are likely to pay more out-of-pocket next year for so-called “specialty drugs,” which treat complex conditions...

Read the Article on KHN Morning Brief

Tuesday, December 2, 2014

5 Key CFO Concerns Regarding Healthcare in 2015

When hospital and health system leaders look ahead to next year, they see a number of serious financial challenges on the horizon. New payment realities are converging with more efficient, effective clinical protocols to create what many chief financial officers see as the most difficult time in healthcare.

Read the Article on HealthLeaders

Wednesday, November 12, 2014

Physician Practice Management Top Challenges for 2014

Medical Economics: Financial challenges continue to plague physician practices, as indicated by the latest survey from Medical Economics, which sheds light on the trends currently affecting physician incomes and office balance sheets. Highlights from the publication's 2014 survey include the following...

Read the Report on Fierce Practice Management

Tuesday October 21, 2014

100 Healthcare Statistics You Need to Know

The term “healthcare” encompasses a wide variety of issues ranging from insurance coverage controversies and workforce compensation trends to prescription drug administration and health information technology. Being able to master all matters of healthcare would likely take an inordinate amount of time, which is why Becker's Hospital Review has provided this list of 100 healthcare statistics to know covering a wide variety of industry topics.

Read the Article on Becker's

Friday October 10, 2014

ACO manifesto: 75 things to know about accountable care organizations

As accountable care organizations are a new model of care, formally created by the Patient Protection and Affordable Care Act in 2010, they are constantly evolving and changing. Much has changed even in a year's time. That is why Becker's Hospital Review has provided this new ACO manifesto, an updated version of the 2013 edition.

Topics include ACO basics, terminology, specifics about Medicare and Medicaid ACOs, ACOs by the numbers as well as the close relationship between health IT and ACOs

Read the Article on Becker's

Tuesday September 16, 2014

The Changing Healthcare World: 7 Trends to Watch

At a community leadership forum on healthcare hosted by U.S. Rep. Randy Hultgren (R-Ill.), Scott Becker, JD, chairman of the McGuireWoods healthcare department and publisher of Becker's Healthcare, discussed seven of the biggest healthcare trends in 2014.

Read the Article on Becker's

Friday September 12, 2014

5 Industry Trends that Could Transform Healthcare...and how they could fail

Healthcare reform is in full swing. Legislative reforms promise to push healthcare providers toward the type of collaboration and efficiency that will lead to better patient outcomes, and younger physicians are poised to offer more tech-savvy, modern care. However, these changes may not ultimately produce positive results, despite their potential benefits.

Read the Article on Beckers

Tuesday September 9, 2014

With Mayo Clinic announcing partnerships with Apple and IBM, they stand ready to benefit from these high tech alliances.

Mayo Clinic IBM Partner on New Plans for Watson

Now in its proof-of-concept phase, Watson is learning to sift through available Mayo Clinic trials, automating the process of matching patients with clinical trial options, a process currently done manually by clinical coordinators sorting through patient records and conditions.

Read the Article on Becker's

Monday September 8, 2014

Behind the CVS Health Rebranding Strategy

The rebranding of one of the nation's largest pharmacy retailers last week is sending "new entrant" ripples through the healthcare industry.

Read the Article on HealthLeaders

Wednesday August 6, 2014

Why Apple, Epic, and IBM Will Take Over Healthcare

Apple and IBM recently announced they were putting aside their 1980s rivalry to come together to develop a new set of business-facing mobile apps for iOS powered by IBM's big data capabilities and enterprise platform expertise.

Read the Article on Becker's

Monday August 4, 2014

A Doctor's Perspective on Obamacare Plans

"I cannot accept a plan [in which] potentially commercial-type reimbursement rates were now going to be reimbursed at Medicare rates,” Gerard says. “You have to maintain a certain mix in private practice between the low reimbursers and the high reimbursers to be able to keep the lights on."

Read the Article on Kaiser Health News

Tuesday July 22, 2014

CVS Ramps Up Clinics With Provider Affiliations

Relief for a common side effect of healthcare reform—increased demand for primary care services—may come from a place well known for soothing many ills.

CVS Caremark, one of the biggest retail pharmacy brands in the country is playing a major new-entrant role in healthcare delivery.

Read the Article on HealthLeaders

Monday July 21, 2014

10 Concerns and Trends Facing Hospitals Right Now

Hospitals and health systems are facing a large assortment of pressures, challenges and threats. Depending on their size and market, some of these issues are highly concerning, whereas others are more promising.

Read more on Becker's

Monday July 14, 2014

Healthcare in the US..."Skate to where the puck is going to be."

Gretzy's quote recently came up in a conversation I had with Kenneth Kaufman, managing director and chair of healthcare consulting firm KaufmanHall. Kaufman mentioned it as we were talking about hospitals' difficulty in transitioning to value-based payment models.

Read the Article on Becker's

Thursday July 10, 2014

Some of American's Biggest Companies are Poised to Shake Up Healthcare

Much of the waste in the healthcare industry currently can be attributed back to consumers — patients not adhering to their medication regimens or skipping appointments with physicians, leading to worse outcomes and higher costs.

This is why the successful new entrants to the industry will do what the banking, retail and other industries have been doing for years — develop new ways to engage consumers in their own healthcare by providing alternate or at-home services or products, often at a lower cost than traditional healthcare.

Read the Article on Becker's

Monday July 7, 2014

Healthcare is About to be Disrupted, and Today's Healthcare Leaders are not Ready

Healthcare organizations, though aware of and slowly preparing for significant change to business as usual, are more or less sitting ducks. Enter a true disruptor, and the healthcare environment could be drastically altered — perhaps leaving existing organizations without a business to operate.

Read the Article on Becker's

Monday June 9, 2014

Healthcare Competition Policy Needs a Makeover, Says Policy Analyst

Competition within the healthcare sector will improve only when providers offer products that have "intuitive and measurable value" to consumers, says a healthcare policy expert.

Read the Article on HealthLeaders

Monday June 2, 2014

Medical Homes: A Fix for our Broken Healthcare System

The healthcare system is broken; to fix it we need a new way of thinking about care delivery, healthcare industry experts said Friday at a briefing from the nonpartisan Alliance for Health Reform in the District of Columbia.

The patient-centered medical home (PCMH) offers that opportunity--it's more than just a single program or payment model, Amy Gibson, chief operating officer of the Patient-Centered Primary Care Collaborative said at the event, "Patient-Centered Medical Homes: The Promise and The Reality."

Read the Article on HealthLeaders

Friday May 30, 2014

The Hospital of the Future is Not a Hospital

Pursuing expensive inpatient volume in the traditional sense is a strategic dead end. Any new construction undertaken by hospitals and health systems should be based on adaptability, patient flow, and efficiency gains—not bed count.

Read the Article on HealthLeaders

Wednesday May 28 2014

Top 7 Strategic Priorities in the Hospital C Suite

Here are seven top strategic priorities hospital C-suite executives have for their organizations over the next three years, according to the American Hospital Association's survey, "Building a Leadership Team for the Health Care Organization of the Future."  

Findings are based on responses to an online survey of more than 1,100 executives, 95 percent of whom were CEOs. The respondents were asked to choose their top three priorities.

Read the Article on Becker's

Wednesday May 21 2014

10 Critical Success Factors for the Future of Healthcare

Insigniam has identified a set of critical success factors that provide clear opportunities for elevating the likelihood of success in the marketplace and for significantly impacting the success of a healthcare system moving in the future.

Read the Article on Becker's

Thursday, May 1, 2014

8 Top Priorities in the Hospital C-Suite

Most CEOs said improved efficiency is the key strategic priority for their organization over the next three years.

The finding is one of many from the American Hospital Association's latest survey, "Building a Leadership Team for the Health Care Organization of the Future."  

Here is how executives answered the question, "What are the key strategic priorities for your organization over the next three years?"

Read the Story on Becker's

Tuesday, April 8, 2014

4 Key Hospital Business Strategies for the World of Value-Based Care

As the healthcare industry shifts from a focus on volume to value-based arrangements, hospitals and health systems must adapt to the new model of care delivery, says Simon Gisby, managing director of Deloitte Corporate Finance.

Read the Article on Becker's

Friday, April 4, 2014

Who Wants an Empty Hospital?

If you don't, you should. A nearly empty hospital indicates you've achieved functional integration such that your continued existence doesn't depend on the hospital at all. It depends instead on how well you take care of people to make sure they seldom, if ever, end up there.

Read the Story on HealthLeaders

Monday March 31, 2014

Facing the Looming End of Fee-for-Service, Clinical Laboratories and Anatomic Pathology Groups Look for New Business Models

SGM Comments from Matt Modleski: It’s fairly rare that I send out an article that I read to senior leaders across a segment of our customer base.  However, this article met my criteria for doing just that to those of you competing in the Lab space. 


As we have discussed with all of you, your lab customers are beginning to panic a little.  Whenever you see one of the thought leaders in a business segment talking about “finding new business models in order to survive” you know that what used to be important to these customers will take a back seat to survival.  Our simple questions are these:


1.      Are your sales people armed with knowledge and confidence to discuss “why” this is happening?

2.      Are your organizations nimble enough to evolve your business models in support of the evolution of your customer’s business models?


Labs are looking for partners who understand the changes that are happening, why they are happening and can help them articulate their value in the new world.  Most importantly, they are looking for partners who can help them survive.  When your sales people interact with your customers how do you think they feel after they’ve left?


These questions deserve tremendous focus as you seek to build partnerships that survive in the coming years.  We look forward to helping you, help your customers succeed.


Read the Article on The Dark Report

Friday March 28, 2014

When Pay For Performance Hits Employee Paychecks

A main tenet of the accountable care movement is tying physician and hospital reimbursement to their performance. For instance, in an accountable care organization, providers are often rewarded for meeting certain quality improvement and cost saving goals. Additionally, hospitals can be penalized for poor performance in the form of Medicare reimbursement cuts.

Read the Article on Becker's

Friday March 21, 2014

Oncology Service Line: A Change in Focus

From genetic testing to advanced chemotherapy procedures, hospitals and health systems are changing the focus of oncology from merely ensuring survival to, in many cases, providing comprehensive long-term care and even cures.

Read the Article on HealthLeaders

Tuesday March 18, 2014

Big Changes Prep Medical Center for New Financial Realities

Despite the high cost of its EHR conversion, Wake Forest Baptist Medical Center's CFO says the spending is justified because improving the organization's population health strategy, data collection and sharing capabilities will be critical for successful healthcare delivery in the near future.

Read the Commentary on HealthLeaders

Monday March 17, 2014

Two-Midnight Rule Spells Grim Financial Forecast for Hospitals

Hospitals will take a financial hit this year as a result of the new federal rule that cuts the Medicare payment rate for most patient stays that span less than two midnights, Moody's predicts.

Read the Article on HealthLeaders

Monday February 24, 2014

Bumpy Road to an ACO Yields Value

On the long and winding road toward an accountable care organization, healthcare providers have to expect the potholes and steer around them. "It's a philosophy. It's a process that takes time," said Stephen Rosenthal, MBA, president, chief operating officer and CMO of the Bronx-based Montefiore Care Management on Sunday in the opening keynote to Sunday's Accountable Care Organization Symposium. "It doesn't happen overnight and there are no magic bullets."

Read the Article on Healthcare IT News

Friday February 21, 2014

What Are the 20 Costliest Surgical Procedures Performed in Hospitals?

Procedures performed in hospital operating rooms represent a large chunk of healthcare costs, but which procedures cost the system the most?

According to a statistical brief from the Agency for Healthcare Research and Quality, surgical procedures amount to almost half of all costs associated with hospital stays even though they only make up 29 percent of hospital stays.

Read the Article in Becker's

Tuesday February 11, 2014

Pharmacists Increasingly Taking On Clinical Roles

Once limited to filling and dispensing drugs, pharmacists are increasingly providing direct care to patients. Across the country, they are working with doctors to give immunizations and help patients safely manage medications. In some places, they can even write prescriptions after a physician's diagnosis.

Read the Article on Kaiser Health News

Tuesday February 4, 2014

Top 10 Strategic Questions for Hospitals and Health Systems

SGM Comment: You've learned that a strategic position requires an equally strategic understanding of the customer's world.  This article will help to give you insights and information that will give you the context for conducting high level, strategic discussions with influencers all across your customer organizations.

The American Hospital Association has outlined 10 of the top strategic questions hospitals and health systems should address to determine their plan for care transformation.

Read the Article on Becker's

Monday February 3, 2014

Hospitals Look at Retail Pharmacies With Renewed Interest

It's more than convenience: An integrated retail pharmacy provides hospitals with opportunities to boost patient satisfaction and lower readmission rates while producing modest revenue.

Read the Article in HealthLeaders

Thursday January 23, 2014

Falling Inpatient Revenues: Healthcare's Transition to Integrated Care and Lab Tx Usage

Spurred by the Affordable Care Act (ACA) and other market developments, payers now want to shift reimbursement away from fee-for-service to new models of reimbursement. This includes capitation or bundled payment models.

Read the Article on Dark Daily

Tuesday January 21, 2014

Is Academic Medicine As We Know It DOA?

Every hospital in America faces a challenging future: Reimbursement pressures are greater than ever. At the same time, providers must expend significant capital to prepare for a future that includes payment based on value, increased risk-sharing and population health management.

Read the Article on Becker's

Thursday January 16, 2014

Improving Quality of Care: How the VA Outpaces Other Systems in Delivering Patient Care

How does the VA measure up against other U.S. health care providers? To address this question, RAND researchers compared the medical records of VA patients with a national sample and evaluated how effectively health care is delivered to each group. Their findings:

Read the Article on the Rand Corporation Site

Thursday January 9, 2014

A Letter to Healthcare Providers From A Consumer

Now that the rules of healthcare delivery have changed so dramatically, we need to be clear about our new relationship. If you thought haggling with insurance companies was rough, just wait until you hear my expectations.

Read the Article on HealthLeaders

Tuesday January 7, 2014

Accountable Care Organizations 2013: A Year in Review

2013 represented another year of growth for accountable care organizations, but it also brought a few setbacks to the model's progression. Here is a look back at events that affected Medicare and commercial ACOs, as well as a look ahead to what 2014 may mean for the model.

Read the Article in Becker's

Monday January 6, 2014

"For all the talk about the Affordable Care Act, population health, value-based reimbursements and Accountable Care Organizations, arguably the biggest "curve bender" for healthcare costs will be growth of the high-deductible health plans that force patients to become smarter consumers."

Read the Article Retail Medicine, A Big Shift for 2014

Friday January 3, 2014

SGM Comments: There are two articles linked in today's Healthcare Terrain posting regarding new Healthcare Buzzwords.  Both are well worth the read and give you more information to use in your Strategic Business Call interactions.  Happy New Year and onward...

Big changes in healthcare mean big changes in the way providers and payers talk. Many terms being bandied about don't have clear or solid meanings, but this guide helps sort things out.

Part One of the Buzzwords Article on HealthLeaders

Part Two of the Buzzwords Article on HealthLeaders

Friday December 20, 2013

ACOs Poised for Growth

"After much enthusiasm but a sluggish start, insurers and healthcare providers appear to be gearing up for greater participation in accountable care organizations, according to a new survey from Premier, Inc."

Read the Article on HealthLeaders

Friday December 6, 2013

Five Biggest Healthcare Finance Trouble Spots

As healthcare providers brace themselves for the impact of the health insurance exchange products that will begin providing coverage on Jan. 1, 2014, perhaps the most difficult element involved is the uncertainty surrounding how they will impact revenue and bad debt levels.

Read the Article on HealthLeaders

Wednesday November 27, 2013

Are ACOs Really Different from HMOs?

[In the HMO Model]..."Utilization review was developed, implemented, and controlled by the insurance companies," Damore says. "In the accountable care model, it's driven by the providers. There are no preapproval processes. The providers are developing their own appropriateness criteria."

Read the Article in HealthLeaders

Monday November 25, 2013

A Chief Strategy Officer for Hospitals... finally!

Despite the benefits of the inside candidate, many experts suggest that the chief strategy officer role may be a good fit for executives who are making the transition to healthcare from other industries, given the importance of fresh thinking, strategy, business development, and marketing that is central to the CSO's role. Many systems, however, are reluctant to take that risk.

Read the Story on HealthLeaders

Friday, November 22, 2015

Unveiling the Cost of Care: How Transparency Changes the Patient Perspective.

As the pressure to cut costs increases and patients shoulder more of the burden of paying for care, healthcare price transparency has become an unavoidable issue for hospitals, health systems and other providers.

Read the Article in Becker's

Tuesday, November 12, 2013

Cost Reduction and Improved Efficiency Top Priorities for CEOs

Three out of four hospital and health systems CEOs cite overall cost reduction and efficiency as one of their top two financial priorities, so it was no surprise to hear a robust conversation on this hot topic at HealthLeaders Media's annual CEO Exchange.

Read the Article on HealthLeaders

Monday November 4, 2013

A 12 minute video by Clayton Christensen on disruption.  Think of this and consider how a Phase III Strategist might use this approach to change the game in the way customer interactions are built.  Some great examples here of how industries and organizations have moved through the strategic inflection point.

Link to Video on HBR

Thursday October 31, 2013

Should Sales Reps be Kept Out of OR?

The non-profit ECRI Institute suggests that "hospitals should be diligent about the presence of anyone who isn't a staff member in the OR because of potential risk management concerns."

Read the Article on HealthLeaders

Monday October 21, 2013

Residents Save $2M by Eliminating Needless Lab Tests

Having noticed that "the majority of tests we were ordering…really didn't impact the day-to-day care," a group of neurosurgery residents identified five lab tests that could be eliminated without affecting patient safety. They generated nearly $2 million in savings, including $75,000 in direct costs for their medical center.

Read the Story on HealthLeaders

Monday October 7, 2013

50 Things to Know About the Hospital Industry

Hospitals and health systems in the U.S. are undergoing a dramatic shift in their business models due to a number of forces that are expected to eventually turn the industry on its head — from providers concerned with the volume of services they provide, to providers who focus on offering high-value services that emphasize keeping populations healthy. For those unfamiliar with this shifting industry, or those who simply want to know more, here are 50 facts and statistics about the hospital industry in 2013.

Read the Article at Becker's

Thursday October 3, 2013

Is Hospital M&A Activity Going to Drive Patient Centered Care...or Hinder It

As a New York Times article, “New Laws and Rising Costs Create a Surge of Supersizing Hospitals,” reported last August, the number of hospital M&A deals doubled to 105 in 2012 from 50 in 2009. Consolidation is happening at a reckless pace. Not only are health systems — nonprofit and for-profit alike — acquiring hospitals, but they’re also buying up mom-and- pop practices at an unparalleled clip. Today, just 36% of physicians work in independent practices, down from 57% in 2000.

Read the Article on Market Watch

Tuesday October 1, 2013

Who Pays for Healthcare?

A designer from Georgia Tech turned some of the data captured in the California HealthCare Foundation‘s Health Care Costs 101 report into a time-lapse graph that shows the growth of both private and public third-party insurers over the last 51 years. Watch how out-of-pocket spending shrinks as Medicare and Medicaid appear in the mid-60s, and the big movements during the managed care era of the 90s.

Read the Story

Accountable Care Primer

SGM Comments: We often get asked to provide references to the nature of the Accountable Care Organization.  As someone once said, an ACO is like a unicorn, everyone has heard of them, but nobody has ever seen one.  Well, ACOs are beginning to take on their visible structure, and though they may not be the same in 2-3 years, they are having an impact on care delivery.  Below is a link to a Primer on Accountable Care provided by the American Academy of Ophthalmology.  Check it out...

A Primer on Accountable Care

Friday September 20, 2013

Why Healthcare is Stuck and How to Fix It

The pressures for fundamental change in health care have been building for decades, but meaningful change has been limited while the urgency of change only grows. The moment of discontinuity has arrived. Already unsustainable costs, an aging population, advances in medicine, and a growing proportion of patients in low reimbursement government programs have made the status quo unsustainable. Change is inevitable.

Read the Article on HBR

Friday September 6, 2013

How the Medical Home May Save Primary Care

Years ago, with his office in chaos, Peter Anderson, MD, looked for a better way to practice primary care. He found it by developing "family team care," a model that looks a lot like what we call today the patient centered medical home.

Read the Article on HealthLeaders

Thursday, September 5, 2013

One Can See the Momentum Building for Bundled Pricing

Conflating disease treatment with patient care against a backdrop of a fee-for-service reimbursement system is leading to more aggressive treatments for terminally ill oncology patients, research conducted for the Dartmouth Atlas Project suggests.

Read the Article in HealthLeaders

Tuesday, August 20, 2013

20% of Health Systems to Become Payers by 2018

Cost and reimbursement pressures, the explosion of boomers in the hospital patient mix, and the movement toward population health are spurring health systems to launch their own health insurance plans.

Read the Article on HealthLeaders

Monday, August 19, 2013

100 Accountable Care Organizations to Know

Medicare ACOs proliferated within the past year. CMS named the original 32 Pioneer ACOs in December 2011 and the first 27 Medicare Shared Savings Program ACOs in April 2012. It added 87 more ACOs to the MSSP program in July 2012 for the program's second performance period, and 106 ACOs for the program's third performance period, which began Jan. 1, 2013. CMS expects to add another 100 to 200 ACOs within the next two years.

Read the Article on Beckers Hospital Review

Friday, August 16, 2013

Top Healthcare Execs Talk Strategy

At HealthLeaders Media's third annual CFO Exchange, chief financial officers from hospitals and health systems across the country discussed cost reduction strategies and the impact of HIT initiatives on the revenue cycle.

Read the Article on HealthLeaders

Thursday, August 15, 2013

Talking Scales and Telemedicine: Tools of the ACO

As Hill, 75, steps on the scale, his weight appears 24 miles away on a computer monitor at Essentia Health in the northwestern Minnesota town of Duluth. There, registered nurse Denise Buxbaum monitors his health as part of a program that aims to keep about 300 heart failure patients out of the hospital.

Read the Article on Kaiser Health News

Monday, August 5, 2013

Pioneer ACOs Save Money But Lose Physicians

Physicians in nine large groups have dropped out of Medicare's pioneer accountable care organization initiative after just one year of participation, but health policy officials and doctors leading ACO groups said they are not turning their backs on coordinating care for beneficiaries.

Read the Article at American Medical News

Monday July 29 2013

11 Monsters Facing the Healthcare Industry

Former acting head of the Centers for Medicare & Medicaid Services, Don Berwick, MD, acknowledges healthcare providers have come a long way in the last few decades, but it's "by no means enough."

Read the Article on HealthLeaders

Wednesday July 24 2013

ACOs Alive and Well in Miami

"...Rivera, a Medicare beneficiary, coordinates all of his medical care through his internist, who referred all the specialists, and he now receives the kind of comprehensive treatment that he never experienced before the two heart attacks, including regular preventive screenings, management of his blood pressure and cholesterol levels, and convenient access to his doctors..."

Read the Article in Miami Herald Business

Read more here: http://www.miamiherald.com/2013/07/20/3511705/in-miami-a-new-healthcare-model.html#storylink=cpy

Tuesday July 23, 2013

SGM Comments: Though there is controversy among providers regarding the ACO system of reimbursement (especially among those who agreed to be in the Pioneer version of the plan) most healthcare executives agree that a similar version of care and reimbursement will be the future of healthcare.  We need to understand how we, as providers of products/services to these providers, fit into the equation. Certainly, the ability to be on a conversational level with your customers regarding this model will help you to build strategic relationships.

Keys to Success as an ACO

"Recently many journal articles and presentations have discussed how important it is under the Affordable Care Act to "get together" with physicians. However, those doing the espousing are often those whose actual physician integration experience has been in theory only. Most have never built and run a hospital-physician integrated system."

Read the Article on Becker's


Tuesday, July 16, 2013

Five Key Trends in Healthcare for 2013

It has been a fascinating first half of the year in the healthcare industry. The industry continues to evolve, due in part to several key issues impacting healthcare delivery today. Below we present what we believe are the five biggest issues facing hospitals and healthcare systems, surgery centers and physician practices this year.

Read the Article at Becker's


Monday, July 15, 2013

Medicare Physician Fees...Winners and Losers

"Some of the biggest cuts are aimed at independent testing laboratories, which see 26% of their fees slashed, followed by radiation therapy centers, which may lose 13% under CMS's "particularly complicated," proposed changes."

Read the Article on HealthLeaders


Tuesday July 2, 2013

Healthcare Quality Metrics "Abysmal"

"The nation's efforts to measure healthcare quality has improved in recent years, but that isn't saying much considering how much stakeholders are still in the dark, several quality experts told members of the Senate Finance Committee this week."

Read the Article  


Friday June 28, 2013

Killer Metric Separates Good Hospitals From Bad

"How can you tell a good hospital from a bad hospital? Aside from anecdotal information about bad coffee and surly nurses, we now have actual data to help make the distinction."

Read the Article in HealthLeaders


Monday June 24, 2013

Geisinger's CEO on Cost, Quality, Data Sharing

Glenn Steele, MD, discusses the need for healthcare organizations to collaborate and learn from each other with shared data that can offer real-time insights as healthcare leaders re-engineer the industry to provide real value.

Read the Article on HealthLeaders


Monday, June 17, 2013

Physician Pay Will Soon Depend on Outcomes

The Centers for Medicare & Medicaid Services is seeking feedback from doctors as it builds a model for reimbursing physicians based on actual outcomes rather than process measures.

Read the Article on HealthLeaders


Wednesday, June 12, 2013

Physicians Merging to Better Compete in an Age of ACOs

"Faced with few ACO options, physicians are increasingly considering merging their practices, which would enable them to reduce expenses and wield more clout in negotiations."

Read the Article in HealthLeaders


Wednesday, June 5, 2013

CMS Unveils Charges for Outpatient Hospital Procedures

"...HCA's Fawcett Memorial Hospital, a 238-bed facility in Port Charlotte, Fla., charged $13,984.79 for a level III ultrasound without contrast, and was reimbursed an average of $536.32. At 135-bed Logan (Utah) Regional Hospital, part of Intermountain Healthcare, the list price for the procedure is $678.24, and it was reimbursed $521.60..."

Read the Article at ModernHealthcare.com

Tuesday, June 4, 2013

Payer and Provider Views on Value-Based Contracting

"Value-based contracts can come in many forms and range from bundled payments to shared savings contracts to accountable care organizations. Payers and providers need to work together to form value-based contracts and be successful in the agreement.

Read the Article on Becker's Hospital Review


Thursday, May 23, 2013

Three Reasons Why Hospitals May Be Scared of Wal-Mart

SGM Comment: For a few years now, we've been saying that the minit clinic model could become more of a challenger than just a quick way to get a flu shot.  In this article the emphasis shifts to the impact of Wal-Mart Clinics (and others) on hospital business.  Since Primary Care Physicians are admitting more patients to hospitals now than specialists are, imagine the power of a national organization like Wal-Mart and a provider arrangement with a large integrated system like Kaiser. The next few years could see a major change in the way healthcare is delivered as retail becomes more involved. With Wal-Mart's strong position in the use of database technology, it seems it might be even easier for them to move into the healthcare arena in a big way.  Consider Wal-Mart's great potential ability to grow marketshare in healthcare and especially in Medicare.

"...In a video from the Advisory Board,Lisa Bielamowicz, MD, CMO of Health Care Advisory Board, said about a third of provider' patients shop at Wal-Mart on a weekly basis. "It's the cheapest place to buy groceries and ammunition, and it could become your [hospital's] most formidable competitor," Dr. Bielamowicz said in the video..."

Read the Article: Wal-Mart


Tuesday, May 21, 2013

Lower Your Healthcare Cost?  There May be an App for That

"In the fee-for-service world, this mattered little, because email consultations were not billable events. In an accountable care world, the physician is incentivized to keep the patient healthy, while at the same time keeping costs low, including minimizing office visits, as well as enhancing patient satisfaction."

Read the Article: Aetna to allow app communications with docs


Monday, May 20, 2013

Primary Care Physicians Generating More Hospital Revenue

"As the primary care physician evolves into this quarterback of the medical home model and if they truly do what they are being designed to do, which is to control the entire flux of that patient, in theory they would dictate what tests happen and what procedures are necessary, what specialist are brought in, what preventative care or home health measures are used," Singleton says."

Read the Article: PCP More Hospital Revenue


Wednesday, May 15, 2013

Transforming the Physician Medical Practice

SGM Comment: If you haven't already done so, and you call on office based physician practices, now is the time to have dialogue with them regarding how they see their practices changing.  A local primary care physician said that his four physician practice will stop seeing any patients except those who join their concierge practice and pay a monthly fee.  He said that he feels current reimbursement scenarios were forcing physicians to either become employees of IDNs or turn to solutions such as their's.  What might all of these mean to you and your strategies with such physicians?

"...Dr. Thomas Bellavia transformed his traditional medical practice in Hasbrouck Heights, N.J., into a so-called medical home where patients are seen by teams of doctors and nurses. He says it has paid off in better, more coordinated care for his patients and healthier income for the nurse practitioners and physicians in his group..."

Read the Article: Doctors Transform Practices


Monday, May 13, 2013

Kill Your Chargemaster: Hospital Procedure Pricing in the News

"...Hospital pricing, as we all know, is complex. But if you're the CEO of Brookwood Hospital in Birmingham, AL, and your hospital is charging $87,065 to treat chronic obstructive pulmonary disease while across town, St. Vincent Hospital is charging $23,245, you have a problem today where you didn't yesterday..."

Read the Article: HealthLeaders

Real Life Lessons and Key Concepts Regarding Clinical Service Lines

SGM Comment: 

The link below is to one of the areas most Service Line Leaders and other Hospital Administrators are focused on to move into the new value-based world.  There is great raw material for Strategic Business Calls in it.  Have a great week!



"...Physicians form a management LLC and strike a co-management service agreement with the hospital. Typically, co-management agreements focus on a particular service line, such as orthopedics or cardiovascular services. The arrangement is analogous to hospitals "outsourcing the management of a clinical service line to a group of physicians," said Mr. Minkin, and it's also a strategy to engage physicians and give them more control to achieve greater operational cost efficiencies and improved outcomes..."


Read the Article: Co-Management Agreements 

Thursday, May 9, 2013

CMS Releases Hospital Pricing Data

"In an unprecedented move Wednesday, the Centers for Medicare & Medicaid Services made public extensive hospital cost data, jolting healthcare providers, payers, and consumers alike."

Read the Article: CMS Hospital Pricing Data

Thursday, May 2, 2013

Michigan Blues Reaches Value-Based Payment Agreement with Trinity Hospital

SGM Comment: Michigan BC/BS developed an agreement last year to develop an ACO with the Trinity Hospital system. Yesterday Michigan BC/BS announces that they are working with Trinity to develop a new model that uses "value-based" reimbursement designed to "reduce premiums while coordinating care."

Something to consider...there is nothing in the article that says this is an effort just for medicare/medicaid or ACO patients. You can bet that a Patient Centered Medical Home model will also be part of this if it isn't already.  But this comment from the article is especially interesting:  "...Trinity's 12 hospitals and doctors will work to eliminate unnecessary and redundant medical tests and office visits...."

What does this mean for you and your team?  How connected are you to those influencers who are either already or about to build a similar arrangement with providers in your territory or area of responsibility?  And what might this mean if protocols are developed in your key accounts without your having any input whatsoever?  But more importantly, what kind of competitive immunity might you build if you and your organization were to get there first and work with such customers on the value that your solutions bring?

Read the Article, and think how you might use this "terrain" information in your calls tomorrow.  You may uncover information that could lead to significant competitive advantage for both you and your product/services.

Wednesday, May 1, 2013

Critical Success Factors for Bundled Payment Success

"Three health system leaders shared their experiences working with CMS to test one of four models of payments based on episodes of care at an executive briefing today at the American Hospital Associations annual meeting in Washington, D.C."

Read the Article: Bundled Payment Success

Tuesday, April 30, 2013

Predictive Analytics and Other Challenges

SGM Comment: Think of the potential this has on the use of your current products, services, or solutions?

"There's this concept of real-time healthcare, which is what the industry is moving toward, and predictive health, predictive analytics. [It's] basically looking at patients' current conditions, if they're in a hospital, and predicting they're going to get sepsis, and then treating them before they get sepsis."

Read the Article: Kaiser Permanentes' CIO Q&A


No One May Be Coordinating Care

"Betsy Gabay saw a rotating cast of at least 14 doctors when she was hospitalized at New York Hospital Queens for almost four weeks last year for a flare-up of ulcerative colitis. But the person she credits with saving her life is a spry, persistent 75-year-old with a vested interest -- her mother."

Read the Article: Healthcare's Dirty Little Secret


Monday, April 29, 2013

New Hospital Brands

SGM Comment: Since this is such a hot topic right now (hospital brands, strategic positioning) now might be a good time to reference this article and ask your customers how they feel they are differentiated from other clinical options that are available to patients/payers?  The value?  If I know their strategy, I have a foundation on which to build my competitive positioning. However, as a strategist, I must say that a new logo does not a strategy make!

"Hospitals and health systems across the country have been getting makeovers this year — several organizations have changed their name, brand and/or logo in the beginning of 2013. The following 10 healthcare name changes and new brands represent just a fraction of the organizations that have reinvented themselves this year."

Read the Article: What's Behind the Rash of New Hospital Brands?



Thursday, April 25, 2013

Diagnostic Lab Stocks in Trouble

"...companies like these are capital-intensive, labor-intensive and require massive infrastructure. And as Medicare cuts its reimbursement rates, diagnostic services companies will suffer along with the rest of the industry."

Read the Article: Diagnostic Lab Stocks


Tuesday, April 23, 2013

Diagnostic Errors Common, Costly, Harmful

"The correct premise is that correct therapy begins with correct diagnosis. Unfortunately the entire medical profession operates under the collective delusion that diagnoses are almost always right," Newman-Tucker says. "There are all kinds of things we track in the hospitals; quality measures of one kind or another. But nobody is tracking whether or not their diagnoses are right. It's either ironic or scary but it's not good."

Read the Article: Diagnostic Errors



Friday, April 19, 2013

Former ACP President: "We Have to be More Efficient"

SGM Comments: When the former President of the American College of Physicians speaks about the need for doctors to be more efficient, what does that mean?  Read this article and think what the outcomes of "physician efficiency" might be with regard to your products' usage?

"...We want patients to get the right care at the right time, and no more than necessary. I think there's a shift in thinking on this issue. There's a lot more realization we have to be prudent with resources. We have to get rid of the things that add no value in healthcare.  The payers are paying attention to this too. They're saying no when there's no indication for a screening test.  I don't recommend some of the tests I used to recommend, also, because science has come along and said, gee, we thought that was more useful than it ended up actually being. The PSA (prostate specific antigen) test for prostate cancer is one example..."

Read the Article: Physician Practice Efficiency


Thursday, April 18, 2013

Tips for Successful PCHM Transformation and Recognition

SGM Comments: Accountable Care Organizations and Patient Centered Medical Home models are proliferating.  It is incombent on you as a "Phase III, Strategist" to be conversant on these newer systems in healthcare.  You will want to uncover potential ways in which your products, services, and solutions will help as provider of care move more fully into these systems of care.

"Transforming primary care practices into patient-centered medical homes and achieving PCMH recognition from the National Committee for Quality Assurance is anything but easy. Many months or even years of work can go into the transition process, and the NCQA application can take more than 300 hours to complete."

Read the Article:  4 Tips


Wednesday, April 10, 2013

The Future for Hospitals and Healthcare Providers

"Hospitals and health systems today are confronted by a number of challenges that could ultimately impact how they deliver care. From reduced reimbursement to increased government scrutiny and anticipated provider shortages, we anticipate the future forecast for these providers will be a cloudy one. Here are six observations on the current climate surrounding hospitals and health systems."

Read the Article: 6 Observations and Concerns


Monday, April 8, 2013

Could the Toyota Playbook Help Improve Cardiac Treatment?

"The management principles used to improve quality and efficiency at Toyota Motor Corp. and other manufacturers also are linked to better delivery of cardiac care and lower death rates from heart attacks, according to research that demonstrates for the first time how well the so-called lean production system functions across a wide swath of U.S. hospitals."

Read the Article: amednews.com



Friday, April 5, 2013

Fee For Service Not Dead Yet?

"Despite growing pressure for hospitals to deliver higher quality, more patient-centered care, the fee-for-service model isn't dead yet--putting CEOs in the tough spot of continuing current fee-for-service reimbursement while simultaneously moving toward payment reform."

Read the Article: CEOs Navigate Transition


Thursday, April 4, 2013

Walgreens Becomes 1st Retail Chain to Diagnose and Treat Chronic Conditions

SGM Comment: Since healthcare providers are looking at how they can be successful through structuring for easier patient access, we can expect this trend to grow and expand.  How might this impact your products/solutions, and how does it change the "terrain" for you in your territory and/or area of responsibility? Who will have access to this "new" player in healthcare delivery, and can we simply wait to see what happens?

"It’s not just sore throats and flu shots anymore. Walgreens today became the first retail store chain to expand its health care services to include diagnosing and treating patients for chronic conditions such as asthma, diabetes and high cholesterol."

Read the Article: Walgreens


Wednesday, April 3, 2013

Hospital to End OB Services

SGM Comment: Do you know which Service Lines your Hospital customers are getting out of?  Do you know what it means to your business?

"This is not uncommon as hospitals throughout the State of Texas and across the nation, all face significant challenges with decreased reimbursements and rising underinsured/uninsured populations. Hospitals are implementing strategies to mitigate these negative impacts, and at the same time, are making changes which ensure their community strength for the long term."

Read the Article: Ending OB Services


Tuesday, April 2, 2013

Majority of Physicians Unfamiliar with ACOs, PCMHs

"The survey's findings are based off of 613 responses from primary care physicians, surgical specialists, non-surgical specialists and other physicians.  Most also believe that…

  • Medicaid and Medicare reimbursements may be problematic, prompting many physicians to limit or close their practices to these enrollees.
  • Physician-hospital integration is expected to increase.
  • Clinical decision support information technologies that reduce unnecessary services and increase clinician adherence to evidence-based practices are of interest to physicians."

Read the Article: Physicians Unfamiliar



Friday, March 29, 2013

"5 Leadership Traits for Accountable Care Leaders"

SGM Comment:  How do your products, services, solutions potentially impact the leadership of an organization striving for Accountable Care excellence?

"In a recent post on athenahealth's Leadership Forum, Amy Edmondson, PhD, a faculty member at Harvard Business School, discussed the leadership successes of two individuals closely involved in advancing accountable care models: Richard J. Gilfillan, MD, director of the Center for Medicare and Medicaid Innovation, and Susan Thompson, president and CEO of Iowa-based Trinity Health Systems, which participates in the Medicare Shared Savings Program, along with partner TriMark Physicians Group."

Read the Article: 5 Leadership Traits



Thursday, March 21, 2013

"We Are Your New Doctor"

"...These drugstore chains provide services people once turned to their primary-care physician for, such as wart removals, jellyfish stings, immunizations—and now, physicals. Nurse practitioners perform the actual examinations, while many pharmacists are certified to do immunizations and alter patients’ medication. And if the American Pharmacists Association gets its way, pharmacists will soon have more medical cred..."

Read the Article: 10 Things Your Durgstore Won't Say


Wednesday, March 13, 2013

Diabetes Costs Hit $245B in 2012

"The price tag includes $176 billion in direct medical costs for hospital and emergency care, office visits, and medications. The indirect medical costs were estimated at $69 billion to account for absenteeism, reduced productivity, unemployment caused by diabetes-related disability and lost productivity due to early mortality."

Read the Article: Diabetes Costs


 Monday, March 11, 2013

Specialty ACOs: The Next Step in Accountable Care

"The concept of accountable care organizations — of payors and care providers working together to achieve the triple aim of lowering healthcare costs while improving the quality of care and patient outcomes — has mainly been focused on primary care since the idea was formalized by the Patient Protection and Affordable Care Act in 2010.
Lately, however, the focus of ACOs has shifted slightly from primary care to specific chronic diseases, such as cancer, chronic kidney disease and end stage renal disease."

Read the Article: Specialty ACOs


Tuesday, February 26, 2013

Coordinated Care Could Save Billions in California Alone

"This could be a game changer in the state," said Stephen Shortell, dean of the School of Public Health at UC Berkeley and a coauthor of the report. "These are the CEOs of big insurers, big health systems and large medical groups saying it's time for a change, and these are the people who can get things done."

Read the Article: LA Times


Thursday, February 14, 2013

Service Lines Still Pay Off

"Positioning is the single most important aspect of hospital communications. Hospital leadership must have a clear view of brand position to accurately portray their organizations to the public and differentiate themselves from competitors."

Read the Article: Service Line Campaign at MGUH


Friday, February 8, 2013

The Physician Hospital Organization in 2013

"Hospitals and physicians have a great incentive right now to figure out how they should be working together going forward, and how they need to align legally and what model to use in order to engage those populations..."

Read the Article: The PHO in 2013


Wednesday, February 6, 2013

Providers Becoming Payors?

"A handful of health systems like Geisinger have successfully played the role of both provider and payor for the past 30-plus years, and it is one of the reasons President Barack Obama has heralded Geisinger as an exemplary system of healthcare delivery. As healthcare reform continues to evolve, more hospitals and health systems are exploring the option of starting their own health plans and insurance divisions. But managing care as both provider and payor is no easy task — and taking the wrong steps could be detrimental to an organization."

Read the Article: Providers Becoming Payors


Tuesday, February 5, 2013

ACO Readiness: 6 Chief Determinants

"That fact is, ACOs and HMOs are not one in the same, and many advancements have been made in care delivery over the last two decades. So in reality, since the ACO concept is still relatively new, there's little information based on real-life experiences that outlines how ready a system is to launch one."

Read the Article: ACO Readiness


Hang On for Risk-Bearing Contracts, Rewards

SGM Commentary: There is no doubt that the move towards Accountable Care is the current wave, but from our experience and simply looking at the past to predict the future, this move to Value Based Reimbursement is setting up more of a global capitation model that was predicted in the mid 90's.  What might that mean to you and your organization, products, services, and solutions?

"Of all the strategic shifts facing health systems in the coming years, none involves so many underlying fundamentals of the business as the shift away from a fee-for-service model of reimbursement to one based more on risk-bearing contracts and population health models."

Read the Article: HealthLeaders


Monday, February 4, 2013

CMS Releases Sunshine Act Final Rule

Officially called the "National Physician Payment Transparency Program: Open Payments," the final rule will require drug and device manufacturers that receive government reimbursements to collect data on gifts and payments to teaching hospitals and physicians, starting on Aug. 1.

Read the Article: FierceHealthcare

For Outreach to Outsourcing: Are Hospital Outreach Programs Vulnerable to Buyouts?

SGM Comments:

 I believe this article directly addresses the inflection point facing labs and healthcare in general. Have all  of your leaders read this before your next meeting and ask themto give you their best estimate as to how it will impact your business. Make them prioritize the impact they see biggest to smallest (2 or 3 separate issues).  You’ll get a real gauge on the strategic thinking in the room.  The next obvious question is then, “so what do we do about it and when?”  Do the same exercise, have them prioritize the top 2 or 3 imperatives they would take and then look at your current plans and see if you address them with urgency. (If you are not already a member of the AACC site, you will need to register for this free access, or email Matt Modleski for the information.)

Read the Article: American Association for Clinical Chemistry


CMS Unveils 4 Bundled Payment Models

"...those networks who figure out how to improve care and be more efficient, "who know how to manage populations and improve quality will deliver a value proposition, and they will be successful, and will be where the business is going. The future is not that far ahead. We think that by 2017, the whole system will be largely reformed."

Read the Article: HealthLeaders


Friday, February 1, 2013

7 Trends in Hospital-Employed Physician Compensation

SGM Comment: If you understand the trends in the way your customers get paid, it's not a bad way to look for areas of strategic advantage in your solutions.

"As more physicians become hospital and health system employees, it has become paramount to tackle the sometimes difficult process of benchmarking physician pay. In 2010, the MGMA-ACMPE reported the 25 highest-paid specialties among hospital-employed physicians included orthopedic surgeons, spine surgeons, neurosurgeons, cardiovascular surgeons and specialty pediatric surgeons, among others. The salaries of those 25 high-paid specialties ranged from a low of $465,543 for dermatologists to a high of $714,088 for orthopedic spine surgeons."

Read the Article: Physician Compensation Trends


CMS Launches Bundled Payment Program

"CMS hopes the bundled payments will encourage hospitals, physicians, post-acute facilities and other providers to work together across settings and specialties to improve outcomes, such as reducing readmissions and duplicative care, while lowering costs."

Read the Article: CMS Bundled Payments


Cost of Medication Non-Adherence in US Healthcare

Since the days of Hippocrates, medication non-adherence has been a significant healthcare problem. Recent research suggests that the total economic cost of non-adherence is $290 billion per year in the United States, rivaling the burden of cardiovascular disease. New quality measures have been established and implemented by CMS offering health plans unprecedented financial bonuses (through the ACO models) from improving medication adherence at a population level. Moreover, the cost effectiveness of efforts to improve adherence have never been greater given recent reductions in the average cost of many common chronic disease drug therapies due to the expiration of patent protection for many blockbuster drugs.

From another perspective, preventable hospital readmissions are a threat to patient safety, a burden to numerous stakeholders, occur far too often, and contribute to rising health care costs. Nationally, preventable readmissions cost an estimated $25 billion per year. Hospitals, attending physicians and other providers have been focusing on reducing preventable readmissions, as they seek to improve quality and improve outcomes, and due to Medicare policy and payment changes in this regard. Health plans, employers, care management organizations and other stakeholders also have a significant vested interest in managing readmissions for all applicable patient populations.

Despite recent momentum addressing medication adherence, major progress on improving adherence nationally is lacking because of the difficulty of identifying the specific patients who could most benefit from care management support to address common causes of non-adherence. Readmissions management also is challenged by the ability to predict those most as risk for readmission.

What do your products/services/solutions provide that might have an impact on adherence?

 Read the Article: Medication Adherence


Tuesday, January 29, 2013

Sun Tzu, Clayton Christensen, W. Chan Kim, Renee Mauborgne, Michael Porter...What might they tell Apple?

SGM Commentary: In most of our workshops, it is hard to get through a day without referring to "disruptive technology," "Blue Ocean Strategy," "Deciding what not to do," "Switching Costs."  We have also referred to Apple as an organization that has made it through, though sometimes not without many stumbles, several strategic inflection points.  And when Steve Jobs' health started to deteriorate, we also mentioned that the thing that had us concerned (as Strategists) was whether or not Steven Jobs himself might be the strategy that Apple owned.  This article picks up on the question regarding Apple's ability to make it through what might be its most difficult infection point yet.

Read the Article: Apple Versus the Strategy Professors


Monday, January 28, 2013

Who Causes Half of Healthcare Costs?

"Since I’ve written about quality of life vs. quality of death before, let’s focus on what conditions are driving the costs so high and what, if anything, can be done about it."

Read the Article: Forbes


1 in 5 Hospitals to Realign Over Next Decade

SGM Commentary: Much is in the news these days regarding mergers, acquisitions, affiliations, purchasing of physician practices, Bundling, formation of ACOs and PCMHs.  The reality is that there is no proven approach to making these adjustments, and this is especially true when healthcare is in the midst of a Strategic Inflection Point.  However, we do know that something must be changed since the path we've taken in US healthcare thus far is unsustainable financially.  Be prepared and have strategic business discussions with your key customers so that you can be proactive as the model for the future of healthcare builds. 

According to the article linked below: "The bottom line is that hospitals... standing alone... can't deliver quality of care that is appropriate and sufficient."

This article speaks about the Hospital Realignment we can expect over the next decade.  Consider how all of this might impact your strategies.

Read the Article: HealthLeaders


 Friday, January 25, 2013

The Hybrid Concierge Medical Practice Model

"...Graf opted for the middle ground. He is among a growing number of physicians who are dipping into concierge while maintaining a full-time practice, in a scenario that is aptly named "hybrid concierge." A hybrid model allows doctors to merge traditional and concierge programs. This gives them the option to care for patients who rely on Medicare or other government or private insurance programs."

Read the Article: HealthLeaders


Wednesday, January 23, 2013

11 Most Pressing Issues for Hospital CEOs

"The American College of Healthcare Executives asked CEOs to rank the following issues that confronted their organizations in 2012 in order of concern, with the lowest numbers reflecting the highest concerns. Rankings are based on responses from 472 CEOs from community hospitals, i.e. non-federal, non-specialty and short-term facilities."

Read the Article: Becker's Hospital Review


Tuesday, January 22, 2013

Four Healthcare Businesses That Will Benefit from Obama's 2nd Term

"Here are four key segments of the health care industry poised to take advantage of new benefits under the Affordable Care Act as well as rules and regulations that will bundle payments to medical care providers, rewarding those who provide higher quality medical treatment and lower costs health services."

Read the Article: Forbes


Monday, January 21, 2013

Is It Strategy or Execution?  You Mean We Have a Choice?  No, not really...

"...But any seasoned strategist knows that strategy is not just sloganeering. It is the series of choices you make on where to play and how to win to maximize long-term value. Execution is producing results in the context of those choices. Therefore, you cannot have good execution without having good strategy."

Read the Article: Strategy and Business


Physician goups, Michigan System Form ACO 

"Eight Michigan physician groups have partnered with the University of Michigan Health System to form an accountable care organization. The ACO, known as Physician Organization of Michigan ACO, or POM ACO, was one of 106 new ACO contracts announced by the CMS on Jan. 10, as part of the agency's Medicare Shared Savings Program."

Read the Article: Modern Physician

Thursday, January 17, 2013

Power of Pharmacists In Reducing Readmissions

"Many institutions are trying their best to come up with methods to meet the requirements, and pharmacists are an integral part of the solution," Robert Lee Page II, a physical medicine clinical specialist in the Division of Cardiology at the University of Colorado School of Pharmacy and Medicine."

Read the Article: St. Louis Business Journal


United Healthcare and Mayo Combine Researching Medical Treatments

"UnitedHealth and Mayo Clinic have agreed under a new partnership to combine their data for more than 110 million patients to help research methods to improve healthcare while lowering costs.

Read the Article: FierceHealth Payer


Friday, January 11, 2013

Staying on Top: Business Strategy

"Many are brought down by making a strategic error, of which there are six common varieties. There is the Do-It-All strategy, shorthand for failing to make real choices about priorities. The Don Quixote strategy unwisely attacks the company’s strongest competitor first. The Waterloo strategy pursues war on too many fronts at once. The Something-For-Everyone tries to capture every sort of customer at once, rather than prioritising. The Programme-Of-The-Month eschews distinctiveness for whatever strategy is currently fashionable in an industry. The Dreams-That-Never-Come-True strategy never translates ambitious mission statements into clear choices about which markets to compete in and how to win in them."

Read the Article: The Economist


Thursday, January 10, 2013

HHS Unveils 106 New ACOs

"If the ACOs meet the 33 quality measures of care coordination, patient safety and preventative health, they could realize savings of up to $940 million over four years, HHS said."

Read the Article: 106 New ACOs


Wednesday, January 9, 2013

No Time for Strategy?

"Without making an effort to 'do strategy,' though, a company runs the risk of its numerous daily choices having no coherence to them, of being contradictory across divisions and levels, and of amounting to very little of meaning. It doesn't have to be so. But it continues to be so because these leaders don't believe there is a better way."

Read the Article: HBR Blog


Tuesday, January 8, 2012

Can a Sub Specialty Physician be part of more than one ACO?

Patient assignment and physician exclusivity to an ACO are based on “primary care services” provided to a Medicare beneficiary under a Medicare billing number linked to the federal taxpayer identification number, or TIN, of an ACO participant.

Read the Article: American Medical News


Monday, January 7, 2013

Top 10 Quality Issues for 2013

"Section 2008 of the Patient Protection and Affordable Care Act says that payments for the care of Medicare patients discharged as of Oct. 1, 2014, will be reduced based on each hospital's track record of causing or failing to prevent hospital-acquired conditions (HACs) to their patients."

Read the Article: HealthLeaders


Piecework: Medicine's Money Problem

"Doctors have been paid on a piecework basis since at least the Code of Hammurabi; in Babylon during the eighteenth century B.C., a surgeon got ten shekels for any lifesaving operation he performed (only two shekels if the patient was a slave)."

Read the Article: The New Yorker Magazine


Is Fee for Service Heatlhcare Dead?

Health care policy experts on both the left and the right agree that ending the fee-for-service payment system will be necessary to control health care costs. The New England Journal of Medicine recently published back-to-back articles with how the two approaches would bend the health care cost curve.

Read the Article: What is the ideal payment system for healthcare delivery


Friday, January 4, 2013

Costly Care for Diabetes

"Fiona Clement, PhD, of the University of Calgary in Canada, and colleagues wanted to see if blood sugar control and kidney problems could affect the costs of caring for people with diabetes."

Read the Article: Daily Rx


Tuesday, January 1, 2013

Want to be a Warrior-Diplomat?: "Dining Like a Diplomat" and "Introduction to Sun Tzu" are the pre reqs

Team leaders with the Army's Green Berets and the Navy's SEALs do more than oversee action against enemies, and they must have the skills to know not only how to win on the battlefield but what fork to use for which course at a fancy dinner. Part of that training comes from courses based on competitive strategy, but also on how to manage yourself in a culture that may be very different from where you come.  At SGM, we would call this a deep knowledge of the "Terrain."

Read the Article: Tampa Bay Online

Could Patient Error Reports Make Pathologist Responsible for Other Provider Mistakes?

"...what happens when a patient is misdiagnosed because a patient’s physician reads a medical laboratory test report incorrectly? Or what happens when clinicians at a hospital rely on point of care testing (POCT) but fail to confirm the POCT results against those from tests run in the hospital’s core clinical lab..."

Read the Article: Dark Daily


Friday, December 28, 2012

Primary Care doctors may no longer be needed

"As a primary care doctor, my days are busy. Seeing patient after patient, I try to provide the most patient-centric, evidence based care that I can. But if I read anything about healthcare reform, it will tell me that 80-85% of the patients I see can be seen by a nurse practitioner or a physician’s assistant."

Read the Article: Doug Olson, MD

13 Top Healthcare Buzzwords for 2013

"It's that time of year, again,when any self-respecting healthcare provider looks to bone up on the latest terms in the lexicon."

Read the Article: HealthLeaders 


Wednesday, December 26, 2012

Building Clinical Integration, the New Wave?

Driving clinical integration, accountable care, and meeting the needs of the healthcare delivery system of today and tomorrow is part of what Scott & White's Physician lead delivery model is all about according to this article in HealthLeaders.  What will be of importance to any of us who view ourselves as "Phase III" is how we will fit into the mix....

Read the Article: Building Clinical Integration


Friday, December 21, 2012

Medicare Discloses Hospitals' Bonuses, Penalties Based on Quality

"New York-Presbyterian in Manhattan and Massachusetts General Hospital in Boston, both dominant hospitals in their cities, will have their payments reduced. Other leading names in the hospital industry, including the Cleveland Clinic and Intermountain Medical Center in Utah, will receive bonuses, although not the largest in their regions."

Read the Article: Kaiser Health News


Wednesday, December 19, 2012

Health system streamlines diabetes care to reduce readmission rate

Pam Shannon, a nurse and vice president of population management at TriHealth, said that everyone was surprised at the analysis of the readmission rates of people living with diabetes.  “With each condition — pneumonia, AMI, heart failure — people with diabetes were more likely to be readmitted to the hospital than people who don’t have it,” she said.

TriHealth’s chief medical officer gave Shannon a challenge: Reduce the percentage of readmit for those individuals with diabetes and the three targeted conditions.

Read the Article: MedCityNews


Thursday, December 13, 2012

Growing financial instability seen for not-for-profit hospitals

"Fitch believes that the next level of cost reduction within the industry will need to be realized from a change in the care delivery operating model through integrating clinical operations, implementing standardized protocols, coordinating care and managing population healthcare, which will be more difficult to accomplish," according to the report.

Read the Article: In Modern Healthcare Magazine


Monday, December 10, 2012

Don Berwick reflects on Healthcare Reform...

"DB: There was one case where a dentist was charging for root canals in little kids. Kids don't need root canals. He said he was doing a lot but he actually wasn't doing any. Well, when the fraud unit got to him, he started doing root canals on children."

Read the Article: HealthLeaders


Friday, December 7, 2012

Bundled Pricing in the Hospital

"Given looming deficits in Medicare and broad resistance to continuing private insurance premium increases, payors must find new payment models that lower utilization and improve costs. Bundled pricing represents a more market-based approach than accountable care organizations, and comes with less regulatory overhead. From that perspective, it's just a matter of time before payors demand bundled prices."

Read the Article: Hospital Review

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