Wednesday, March 26, 2014

My March Madness


My “March Madness” really started on Friday, February 28th with my visits throughout several states, including South Carolina, Illinois, Wisconsin and then back home to Philadelphia. I had the pleasure of visiting the South Carolina Hospital Association in Columbia, SC and continued with the Hospital Sisters Health System in Springfield, IL the following Friday, capped off by a trip to the Wisconsin Hospital Association in Kohler, WI – all in the span of two weeks! The highlight of the month, however, was our 14th Annual Population Health Colloquium, March 17-19.

The South Carolina and Wisconsin Hospital Associations really stand out in my mind as state organizations that promote the concept of physician leadership. They have supported physician leadership training for some time and it’s fantastic to see hospital leaders willing to invest resources into this important educational opportunity for doctors.  At least in South Carolina and Wisconsin, hospital executives recognize that they cannot succeed under Health Reform without a core group of committed physician leaders.

In between these outstanding programs – and prior to the Colloquium -- I delivered the plenary address at the Spring meeting of the Governance Institute in Tucson, AZ, to 250 attendees, representing 30 integrated delivery systems from 20 states.  My speech focused on implementing population health.  As part of a special preconference session,  accompanied by Denise Murphy and Jim Pelegano, we delivered a workshop  on improving “Governance for Quality and Safety” for board members only.  This is the third  time we have offered this important content to a key leadership audience.

Our 14th Annual Population Health Colloquium was the most successful one ever!  With nearly 600 persons from around the country and over 70 nationally prominent expert presenters, we “hit a home run” in terms of the level of interest and commitment in all aspects of population health.  From the President and CEO of Humana, Mr. Bruce Broussard, to the MacArthur Genius awardee from the Camden Coalition, Dr. Jeffrey Brenner, and everything in between, our colloquium tackled all the relevant issues, including pay for performance, bundled payment, Accountable Care Organizations, the social determinants of health and the future of private health exchanges.  Our team from the Jefferson School of Population Health all hunkered down in the headquarters hotel for three consecutive nights to ensure that our program exceeded expectations. 

I’m relieved and happy that my own “March Madness” is over and, like you, I’m very much looking forward to spring!

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Wednesday, February 26, 2014

Nash on the Road: Beautiful Boise




In 24 years of travelling throughout our great nation, I never had an opportunity to visit Idaho until now.  Recently, I had the privilege of being the plenary speaker at St. Luke’s Health System’s two-day, system-wide summit on Achieving the Triple Aim through Population Health. St. Luke’s, headquartered in Boise, the state capital, is the largest employer in all of Idaho, with more than 8,000 associates.  Their service area covers a staggering 22,000 square miles. Even more impressive – St. Luke’s is a system that makes operationalizing the Triple Aim their core goal! Their public strategy narrative states:
Our St. Luke’s strategy is to make your care higher in quality and more affordable and help you become the healthy person you want to be.  We believe doing that’s our job, because our mission is to improve the health of the people in our region”. 
They hope to achieve better health, better care and lower costs by transforming their clinical care model, the business model and the consumer experience.  In fact, their “one side of one page” strategic vision is probably the best such document I have ever seen. 

Embracing the Triple Aim enables St. Luke’s to quickly scope out the core components, such as connecting to their communities, eliminating waste, creating a clinically integrated network, becoming a national quality leader, and expanding what they mean by patient-centeredness. They’ve taken recent action to reorganize their governance structure and to streamline governance decision making.  They’ve formed a partnership with Select Health to create the Select Medical Network.  Select Health, of course, is a wholly owned subsidiary of Intermountain Healthcare in Salt Lake City, Utah.  Select Health will act as St. Luke’s insurance partner as they gain experience through their Medicare - Shared Savings Plan, (ACO), and other planned new entities.

Since Idaho has a population of just about 1.2 million , it’s conceivable to me that St. Luke’s has the opportunity to influence the healthcare of all of the citizens of Idaho.  Nestled in the Boise mountain foothills, the city of Boise was surprisingly cosmopolitan and the convention center, the site of the retreat, was ultra-modern.  What really fascinated me, in addition to dynamic physician leadership at all senior levels throughout the organization, was the commitment of their many board members.  Board members in Boise included persons active on the American Hospital Association board, persons who recently helped engineer the merger between Healthwise and the Informed Medical Decisions Foundation and the CEO of the largest privately held potato growing company in the world.  By 2015, I have no doubt that St. Luke’s Health System will be a recognized national quality and consumer satisfaction leader, based on national benchmarks, and they will be fully prepared to accept financial risk across the entire continuum of care.  Can your system make a similar claim?

Read St. Luke's President and CEO, Dr. Pate's blog at http://drpate.stlukesblogs.org/
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Tuesday, February 25, 2014

Guest Commentary: A Public Health Student's Reflection on Obesity Prevention


As a former health reporter for the Miami Herald, writing a story about obesity in adolescents – particularly focusing on Hispanic females – impacted me tremendously.

I was heartbroken to hear about the troubles these girls faced: being treated as outcasts and made fun of at school, crying themselves to sleep at night, having low self-esteem, and not understanding what led them to this point. 

When I decided to pursue a degree in public health and leave newspaper reporting behind, I knew there was one thing I never wanted to forget: Data alone can’t impact someone the way a story can.

When Dr. Shiriki Kumanyika came to speak to students at Thomas Jefferson University recently about policy and environmental change for obesity prevention, I was struck by her presentation.

Dr. Kumanyika, a public health leader and president-elect of the American Public Health Association, spoke about the importance of being socially aware when combating a challenging issue such as obesity and the steps necessary to achieving change. 

She is everything I aspire to one day be: A public health leader with drive, passion, determination, vision, and the ability to implement plans that lead to effective solutions.

Although every race and ethnicity is affected by obesity, disparities are vastly present. Obesity is more prevalent among minority populations, particularly African-Americans and Hispanics. This is seen in both adults and children.

Progress has been made, and there have been improvements. We’ve seen policy implementation, research and reports, media involvement and the First Lady’s campaign – just to name a few – but obesity persists.

Why?

Obesity prevention is challenging but it can be achieved through changing environments, community engagement, population oriented approaches, and policies.

“If you keep hammering away, change can happen,” she said. “We want to look back ten years from now and see the social movement. What should the world look like when we fix this?”

That is a question that has continuously ran through my mind, even almost two weeks after Dr. Kumanyika’s presentation: What would the world look like without obesity?

The data Dr. Kumanyika presented reinforced why achieving policy and environmental change for obesity prevention is so important but her passion and message is what stuck with me, and many other students, not the numbers or the charts.

When disparities are present, crafting a message becomes even more important. Data and research drives public health, but stories and impact drive the population. 

Elizabeth DeArmas is a student in the Master of Public Health Program, Jefferson School of Population Health
 

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Thursday, February 6, 2014

Nash on the Road: Seventh Annual Cohenca Safety Lecture

It’s not enough to be the top-ranked orthopedic hospital in the entire country every year and to recently celebrate your 150th birthday, but the Hospital for Special Surgery has gone one step further by hosting the seventh consecutive Cohenca Safety Day, a special day set aside to celebrate quality and safety.  Real leaders understand just how important it is  to continuously build this sort of a culture!

The day started with Journal Club, featuring some of the smartest house officers in orthopedic surgery.  We reviewed three articles, including one focused on wrong-site surgeries.  House officers were well acquainted with this literature and demonstrated that they understood the importance of a checklist in establishing a “just culture”.  Following Journal Club, I had the opportunity to address the medical staff leaders, where I spoke about the national movement to provide a broader and deeper curriculum in quality and safety as exemplified by the Jefferson School of Population Health and the recent AAMC strategy called Teaching for Quality.  I’ve written an editorial about this that you can find in an upcoming issue of Population Health Matters, JSPH’s quarterly newsletter.

Then it came time for the major staff presentation of the day, “Leadership for Quality and Safety”.  Here, in brief, I encouraged staff at this top hospital in the country to embrace their leadership role.  By doing so, they ought to set the tone for the rest of the country and promote transparency and accountability in everything they do.  Then, they should train a future set of leaders in orthopedic surgery who will centrally go forth and proselytize the mission to improve all surgical outcomes.

The busy morning concluded with a roundtable discussion, which was distinctly inter-professional, including the Chief Nursing Officer, the chief residents, members of the quality improvement team, risk managers and clinical service line leaders.  We had a free-wheeling one hour conversation that touched on sensitive topics, such as, behaviors in the operating room that need to be improved and related cultural challenges.  The Hospital for Special Surgery is indeed a special place!  It was a great privilege for me to be their seventh consecutive honoree and follow such luminaries as Jim Bagian, Bob Wachter and Peter Pronovost.  Does your institution take a day to celebrate the progress you’re making in promoting an organization-wide agenda for quality and safety?
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Friday, January 24, 2014

Nash on the Road: Back to the Future



Having spent my entire childhood in Merrick, Long Island, it was a real pleasure for me to return very recently to neighboring Plainview to address the South Nassau Communities Hospital Strategic Planning Board Retreat. Not only did I have the opportunity to enjoy a real New York bagel, but I also met some wonderful, hardworking leaders at an important community hospital.
Like many freestanding community hospitals in the nation, South Nassau is trying to assess the next steps it should take in our rapidly changing healthcare system. I spoke about “Population Health: The Secret Sauce” and I encouraged the leaders to start thinking about new ways to connect with their community.
I specifically addressed the recent National Quality Forum report regarding the  creation of measures for hospital-based community engagement. Given that most of its medical staff members are still in private practice, an institution like South Nassau has an additional challenge: there is a modest physician organizational hierarchy.  Most physicians, while well meaning, attend to areas of their own interest and expertise, with little regard for coordination across the entire continuum of care.  Part of the retreat was an opportunity to expose its board of directors to these very challenging issues and to generate a series of potential strategies to address them.
I was joined at the retreat by my longtime colleague, Nathan Kaufman, of Kaufman Strategic Advisors in San Diego.  Nate did a great job, entitling his presentation, “A Crucial Conversation about Healthcare-Acquired Inflections.”  Following my talk, Nate was able to build on the platform of population health and he further advised the attendees to consider some options, including joining another larger system on Long Island and working more closely with medical staff members in the emergency department and with hospitalist physicians.
Later that afternoon, Richard Murphy, President and CEO of South Nassau, led a panel discussion with many of his own senior leaders. We concluded the day with four breakout sessions, tackling such topics as network development, medical staff alignment, financial necessities, and enhancing the patient experience.
Is the freestanding community hospital a thing of the past?  Will institutions like South Nassau Communities still include the word “communities” in their title?  Can a freestanding institution marshal the necessary resources to create the tools critical for practicing population health, like a patient registry, population health analytics, and broad engagement with community resources?  In my closing comments, I counseled its board of trustees to invest in the most important attribute of all – developing a physician leadership class for the future.
In my view, the rate limiting step that all freestanding community hospitals face is exactly that—our lack of attention to the creation of specially trained doctors who can make community engagement at a freestanding hospital a tactical reality. I think they heard me loud and clear.
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Thursday, January 16, 2014

Brothers in Arms



No, you’re not seeing double! The other handsome guy in this picture is Ira S. Nash, MD; Executive Director of the North Shore Long Island Jewish (NSHS) Medical Group at the leadership retreat for his team at the Harvard Club in New York City. I had the distinct privilege of being the after dinner speaker.

The NSHS Medical Group is a powerful force in the metropolitan New York City area, with more than 2,500 practitioners spread across most of Long Island and a good part of the Manhattan marketplace as well. As a delivery system, NSHS is a juggernaut led by the charismatic Michael Dowling. They appear to be everywhere and have just formed their own insurance entity whereby they are now taking economic risk for some aspects of their clinical decision making. NSHS is already working as though it were 2017!

In my after dinner comments, I covered four key topics. First, I gave a brief overview of the impending value-based payment environment. By 2017 nearly 10 cents of every Medicare dollar will be tied to some type of performance measure.

Then I tackled some of the cultural challenges that clinicians face. I reminded the group that doctors have two jobs everyday. Job #1 is the job of doctoring. Job #2 is learning the skill-set to improve job #1.

In the third part of my comments I touched on the quality foundation of the Affordable Care Act. Here I admonished the attendees to recognize that reform can really be summarized in four words—“No Outcome, No Income”! Finally, I drew on my Humana board experience to describe the future of patient engagement and the retailization of the insurance market. A robust question and answer period followed my remarks well into the evening.

I’m confident that NSHS will be very well positioned to tackle the delivery system challenges we all face.
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Monday, December 9, 2013

A Population Health Toolkit that gets it Right




Last week, as the opening keynote speaker at the second annual Phytel Executive Summit, I had an opportunity to interact with literally scores of their customers (large, multi-group physician practices and integrated health systems) from around the country.  Each told an interesting story about how the Phytel tools enabled them to change the physician practice culture and promote an outcomes agenda based on population health measures. 

Peggy O’Kane, the founding President and CEO of the NCQA, followed me on stage. She reinforced many of these same messages, and together we delivered a “one-two punch” that helped to set the stage for the rest of the Phytel meeting.

Phytel’s software can integrate data from multiple sources across systems (think  Epic, Cerner and AllScripts) and deliver to doctors on the frontlines outstanding benchmark information about their own performance relative to both regional and national standards. The only way, in my view, that we will make progress under the ACA is with the use of such population-based registries.

Few firms, especially those in healthcare’s Information Technology sector, have population health tightly woven into their corporate DNA.  Phytel, headquartered in Dallas, is one of them. From their publications, including Population Health Management, a roadmap for provider-based automation in a new era of healthcare, to their Executive Summit in Dallas, this is an outfit that lives, breathes, and executes on the population health agenda!

Regular readers know that I am all about physician leadership, reducing waste, improving safety, and practicing based on the evidence. The Phytel toolkit enables us to do all of these things and get the job done.

Can your practitioners benchmark their daily performance?
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