Thoughts

Health Technology: Sometimes You Just Need a Different Lens

Tuesday, May 15th, 2012

Mirena Bagur
Health Technology Practice Leader, Revive

We recently had the opportunity to engage in conversation with some of the country’s top health technology CIOs, strategists and architects at the annual InterConnected Health forum.

Our main topic?  The acceptance of Web-based applications and technology solutions in health systems.

The key take away from those conversations was the need for health systems’ and providers’ IT departments to start deploying Web applications and technology solutions.  If they were to view deployment of Web-enabled applications through the lens of business benefits, they would be closer to health care’s Holy Grail – effective management of the care continuum.

Source:  Mirena Bagur, ReviveHealth
Poster presented at the Interconnected Health 2012

From Web-Enabled Care …
Many startups are exploring the use of Web applications and technology solutions for care management, coordination, collaboration and wellness among the care team as well as patients.  For example, in the care management area, Intel-GE Care Innovations™ provides solutions for clinicians and caregivers to remotely manage care for people with chronic conditions.  You can also take a look at how care coordination can bring business and health value to a whole new level.  A start-up company in the backyard of our Nashville office – InVivoLink – makes implant procedures (hip, knee, shoulder, spine, CRM) safer, simpler and more affordable while supporting the alignment of payments with quality and appropriateness.

… to Web-Enabled Communications
Despite the early success of many technology innovators, Web-based technology solutions are not yet widely adopted across provider settings.  Communicating the business benefits would certainly make it easier to deploy due to its clear impact on the success of engaging patients.  So, what are providers to communicate and how?  Enter ReviveHealth.

To help manage their community’s health, health system organizations need to engage their clinicians to accept Web-enabled tools as a way to interactively communicate with their patients.   We’ve conducted multiple campaigns encouraging clinicians to participate in the business of care in new ways.  From explaining new payor rules to clinicians, to creating online and printed material for clinicians to empower their patients with appropriate and timely information regarding changes in their access to care, we’ve seen the results of clear and concise information – efficient execution of processes and better care for patients.  Contact us if your health organization needs to institute guidelines for Web communications by encouraging clinicians to see the benefits through the business lens.

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When the Stars Align: Social Networks, Social Media and Communications

Wednesday, May 9th, 2012

Mirena Bagur
Health Technology Practice Leader, Revive

Yesterday, Boston seemed to be the center of the universe for social networking stars.  Zuckerberg was busy raising money for Facebook’s IPO in Boston’s financial district, while across the river at the Activate Networks Summit in Harvard Square, thought leaders were sharing findings of their research on social networks and how they influence behavior.

While the social networking giant’s IPO is certainly the center of attention, it’s worth taking a look at what the Summit accomplished, as it brought together the biggest movers and shakers in the network sciences sector as well as nearly 150 health care research, product development, and marketing gurus.  Case studies were presented on topics ranging from the theory behind the connected world to finding the most valuable customers and leveraging their influence, including leveraging physician and patient networks to achieve better health outcomes, to analyzing customers’ networks to predict trends and buying behaviors.

The Social Networks Theory

The two keynote speakers, Nicholas Christakis, MD, PhD, MPH, and James Fowler, PhD, authors of the book Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives, explained how their pioneering research has uncovered why humans create these elaborate networks, no matter if it is personally or professionally. While the topics of their research vary from obesity to voting to prescribing therapy and exercise for patients, they came to the same conclusion that humans in real and social media networks behave the same way today, as they did 10,000 years ago in caves. One speaker applied these findings to health care organizations, as he shared how identifying leaders in organizations can impact the creation of high-performing health systems.  So, what does that have to do with the social media world of today?

The Social Media Analytics and Case Studies

The Summit’s participants focused on similar themes surrounding technologies and methodologies that optimize marketing strategies for products to be sold to the health care market.  Genentech’s David Moore described the use of social network analytics as it helps identify key influencers (prescribing physicians) for various pre-launch and launch activities. Steve Schlabs from WorkWise demonstrated what motivates people to implement new technology in health care organizations. And, Trapper Markelz of MeYou Health outlined the Daily Challenge intervention program where over 200,000 people participated in using social media to drive their well-being improvement.  Interestingly, their case studies all came to the same conclusion.

Communications with Key Influencers

The consistent conclusion was that communications with the top influencers and their followers is the key to success when bringing any product to market.  That’s where we come in.  Revive can take key influencer data (extracted from claims databases and analyzed by Activate Networks) to define the marketing communications mix with the best potential to reach influencers in the way they prefer.

Award-winning Revive is devoted to working with clients who develop technologies, provide health care and improve the well-being of people. By combining analytics with its own qualitative and quantitative research, Revive develops communication strategies spanning product launches, speaker programs, medical education, sales force alignment, industry analyst relations, as well as media relations and social media programs.

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Electrical Plugs at a Health Technology Conference?

Thursday, April 5th, 2012

Mirena Bagur
Health Technology Practice Leader, Revive

More than 100 technology gurus from leading health care organizations and technology vendors gathered this week at Interconnected Health 2012, a conference sponsored by OMG® (Object Management Group), Health Level Seven® International (HL7), and Healthcare Information and Management Systems Society (HIMSS). This year’s topic, Enabling Health Through High-Impact IT, focuses on approaches, challenges, and solutions affecting the ability to connect health organizations and systems.  At this point, you are probably asking, “Where do electrical plugs fit in?”

Richard Mark Soley, PhD, Chairman of OMG, described how various forms of electrical plugs around the world showcase an exemplary standardization effort. Instead of a global engineering community getting together and agreeing on protocols to standardize the global electric network (how realistic would that have been? debates Soley), an interesting thing happened as a result of market innovation.  The hardware manufacturers figured how to build transformers into all devices so that the power supply was not the issue. At that point, the only problem was the adapter. So, a package of a few dollars’ worth of small pieces of plastic and metal created an effective and inexpensive solution for travelers needing to charge their devices, no matter the country or the electrical plug.

This analogy rang true for many attendees. At a break I overheard a comment by an architect at Kaiser Permanente say, “We’d love to be visionary about how IT can create an impact on care, but we cannot today figure out exactly what the standard might be a few years from now. However, similar to the plugs, we could accomplish more by creating and using tools to develop software applications, rather than developing protocols to which software needs to comply with.”

So, what should a health system or a hospital do when dealing with various interoperability issues without an adopted standard?  Soley eloquently states “join OMG’s efforts to bring down the cost of adaptation, rather than bringing down innovation.”  I add, “Make sure your health organization is communicating its technology innovation role to its key audiences, be they consumers who want the best care possible, or investors who care about the operating efficiency of your organization.”

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When Failure Isn’t an Option: Communicate

Tuesday, March 27th, 2012

Kriste Goad
SVP, Revive

“The single biggest problem in communication is the illusion that it has taken place.”
- George Bernard Shaw

If failure isn’t an option, why do seven out of every 10 major change efforts within health systems fail?

That may not seem like a remarkable statistic by itself.  We know that change is hard, regardless of the industry, and that organizations are remarkably resistant to change. What is remarkable, however, is why major change efforts at health systems fail.

According to Objective Health’s Ed Stout, effective communication — or lack thereof — is the number one reason why new health system initiatives fail to hit their mark, 70% of the time.

“One thing we’ve learned the hard way is in any complex change, the lack of effective communication is the single most commonly cited cause of failure,” Stout says. “Because in a health system, we’re not just talking about minor adjustments, we’re usually talking about a change in behavior.  It’s crucial that everyone — from physicians to middle management to front line caregivers — really understand why the change is happening and what goal it supports. Health systems really need to take the time to develop a thoughtful, thorough communication plan and then commit to executing the plan.”

But don’t just take their word for it. As part of its change readiness assessment, Objective Health asks health system employees to name the most important thing for leaders to keep in mind when introducing major change as well as the greatest obstacle to that change. The consistent clear winner across multiple health system clients? Communication.

The good news is that there are plenty of examples of how the right communications plan, coupled with flawless execution, have helped usher in important changes and enable successful transitions in leadership, process and, ultimately, patient care.

Change is the only constant — in life and in health care — and those of us in health care are in the middle of one of the most transformative times in history. Failure isn’t an option. Don’t assume change will happen just because you’ve installed a new technology or engineered a new system. Explain what you’re doing and why you’re doing it. Get buy-in at every level. Change minds. Change behaviors. Succeed.

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Is It Too Late for Better Rates?

Thursday, March 22nd, 2012

Brandon Edwards
President, Revive

All the scuttlebutt right now is focused on rate compression from the private payors.  Health systems accustomed to 8% or 9% annual increases are being presented with 3% inflators with some quality based payments.  Health systems accustomed to 5% are receiving renewals with 1% or 2% inflators.  And those organizations that have secured market-leading rates as a result of aggressive negotiations, leverage, and market share are now being targeted by payors looking for rate reductions.

So the question is: is it too late for better rates?

In a recent survey on Linkedin’s Healthcare Executives Network group, the number one priority for health system CEOs is revenue growth, followed closely by cost cutting.  Putting aside the obvious tension between these priorities, how do you grow revenue in this environment?  Volumes are flat or down — especially commercial payor volumes — and payor mix is eroding for most health systems as Medicaid enrollment grows and payment rates are cut.  This puts the focus squarely on commercial rates.

The good news is, it’s not too late, but you cannot expect to approach negotiations the same way and tell the same story you’ve always told.  Payors know they have the wind at their backs, a poor economy as justification, and employer discontent as their primary rationale.  Health systems must take a different approach to achieve a different outcome, and that’s where Revive comes in.

Instead of hunkering down and hoping the payor won’t give you both barrels, take the initiative.  Develop your story.  Engage physicians and internal audiences.  Prepare your board.  Preserving market-leading rates isn’t easy, and neither is securing inflators at-or- above medical inflation.

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“Insurers Face Extinction” – Possible Future or Wishful Thinking?

Tuesday, February 28th, 2012

Brandon Edwards
President, Revive

There are many physicians and hospital executives who have secretly prayed for health insurers to face extinction over the last 10 or 20 years. Well, maybe not extinction, but the tension between payors and providers has always created trust issues and difficult business relationships.

Since the Great Recession started in 2008, we’ve seen a fundamental change in the contracting environment and the relationships between payors and providers. United, for example, has been acquiring physician practices and HIT companies in earnest, creating a separate brand for Optum as well as agressively pushing into the provider and care coordination space.

Blue Cross plans, on the other hand, including Anthem, HCSC and independent Blues, have been much more aggressive with tiered and restrictive networks. They have also pushed hard on provider rate increases, pushing historical rate increases down from mid- to high single digits into the mid-single digits or even zero. News accounts are rife with stories of Blue Cross physician rates in Texas below Medicare rates, after five consecutive years of cuts. Or Anthem in California pushing for 15% to 20% rate cuts from a stand alone community hospital. Or countless other examples of harsh rate cuts and contracts with zero increases as Blue Cross profitability and reserves continue to grow and grow.

The recent article in Health Data Management News outlines Aetna’s vision for the future, as articulated by Aetna’s new CEO Mark Bertolini. “So what will the health insurers look like in the future? Bertolini offered a strong endorsement of the accountable health organization model, positing health insurers as uniquely suited to usher in an era of coordinated care. ‘We need to move the system from underwriting risk to managing populations,’ he said. ‘We want to have a different relationship with the providers, physicians and the hospitals we do business with.’”

On the surface, it’s easy to see how the focus on “coordinated care” is similar to United’s strategy. Yet Aetna also plans to bring substantial new product offerings in technology, including mobile apps. Bertolini sees Aetna “providing providers with the technical wherewithal to better serve patients and drive costs out of the system, likening the relationship to Intel’s strategy to support computer manufacturers rather than targeting consumers directly.” I’m not sure that I can see many hospitals advertising “Aetna Inside” to their physicians and patients, but maybe I’m being overly literal.

It remains to be seen whether these are messages crafted for Wall Street analysts and the press, or whether Aetna and other payors are truly committed to a “different relationship with providers.” So far, we see ample evidence that payors are committed to lower provider payment rates and higher margins for their own businesses. We see the payors’ business success coming at the direct expense of hospitals and physicians.

Understanding the payors’ stated priorities is an important step in preparing for your next negotiations. Make sure your negotiating position takes into account their stated priorities, and push them to make these new arrangements and payment models a priority. If hospitals and physicians allow payors to dictate the agenda – cutting rates, creating new narrow networks that they control, and connecting with employers and consumers through the web and mobile technologies – caregivers run the risk of losing the little control and influence they have left.

You must carefully craft and share your own value proposition and priorities. Explain your technology priorities, not just in lifesaving technologies, but the platforms and apps that better connect physicians, patients, hospitals, and other care sites. Health systems and physician groups need a clear vision for the future, and to connect with those stakeholders that will make all the difference in the future – employers, patients, and the broader consumer audience.

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“Second Generation” Clinical Integration

Wednesday, March 7th, 2012

Brandon Edwards
President, Revive

Most hospitals and health systems are embracing the cost cutting imperative, also known as the “Medicare profitability project.”  It’s becoming conventional wisdom that substantial cost cutting and process re-engineering will be required for hospitals to remain profitable in the future, and that hospitals will have to make money at Medicare rates in order to make money at all.  That means lowering costs by 5% to 20%, depending on your assumptions about volume and the migration of private pay volume into the exchanges and Medicaid.

Yet every business leader knows that you can’t cut your way to prosperity.  Organizations must grow and change to be successful in the future, and for many hospitals and health systems, that growth and change can be captured under the headline “clinical integration.”  While the term has become so commonplace that it’s not always clear what people mean when they say it, one thing is clear – it means hospitals, physicians, and other health care organizations are working together to provide a more coordinated, better quality of care than ever before.

It’s become equally clear that effective internal communication strategies are necessary for clinical integration to be successful even in its simplest form.  In order to align incentives and goals, health systems must communicate clearly and consistently with employed and affiliated physicians alike, sharing the vision, the process and most importantly, the benefits.  But we also have to ask – what else is required for successful clinical integration besides clarity and vision?

The recent Future Scan 2012 chapter on clinical integration was authored by Modern Healthcare Hall of Fame consultant Nathan Kaufman, a long-time friend and well-respected industry leader. Kaufman’s piece, titled “Deja Vu All Over Again,” says:

“To truly impact costs, provider networks must be committed to reducing utilization of high-end services and must possess ‘second generation’ clinical integration competencies that are essential to create a financially successful, sustainable provider network.  These competencies include:

- A common electronic health record (EHR) with point-of-care protocols
- Sufficient primary care capacity
- Engaged physician champions
- Evidence-based inpatient and outpatient care plans
- Proactive programmatic approaches to chronic disease
- Dedicated, sophisticated, mature infrastructure
- Performance based rewards and consequences
- Pilot-testing network performance with health system employees and their beneficiaries

Take a moment to read this piece, and consider the implications for your organization.  In the coming weeks, we will explore the PR and employee engagement implications for several of these areas, including physician champions, infrastructure, and the all-important pilot testing with your own employees.

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Cost Cutting: Tomorrow’s Challenge is Different from Yesterday’s

Tuesday, March 13th, 2012

Brandon Edwards
President, Revive

Today, nearly every hospital and health system in the U.S. is looking to their next round of cost cutting in order to deal with problems such as declining inpatient volumes, lower Medicaid payments, and a difficult pricing environment with private payors. Despite these issues, smart provider organizations are moving beyond the supply chain and considering other, more innovative cost-cutting initiatives.

As health systems identify improvement opportunities, they recognize the need to engage their directors, managers, employees, and physicians in order to make the initiative successful. The stakes are too high to allow misunderstanding, rumor, or ill-informed opposition stand in the way.

Any major cost cutting and performance improvement effort should be presented as a proactive and strategic approach to a period of unprecedented change in health care, as well as an effort that is closely aligned with your organization’s mission. While governmental and marketplace impacts are still unfolding, there exists a need to make sustainable changes within your organization today to position you for success in the future.

In a world of declining acute-care volumes, as well as decreasing payment per patient, your health system will need to think and act differently to deliver the highest level of care to your communities. By leveraging your existing infrastructure and sharing the best ideas from across the organization, you can rethink the way care is provided in order to achieve the highest quality for your patients in the most efficient way. The story you tell, along with the messages and tone, should be honest, confident, and respectful in keeping with your organization’s mission and core values.

It is important to balance the critical nature of any cost cutting and performance improvement with the other important initiatives and priorities within your organization. In addition, it is critical that you communicate that this effort extends beyond expense reduction to include opportunities for strategic growth and revenue capture. Performance improvement needs to be a “big tent.”

So how is this different from yesterday’s supply chain management initiative or revenue cycle reengineering? First, it’s not the sole approach to cut costs as a result of a high-cost area or a one-time Medicaid cut. Second, it’s a recognition that the health care world has changed – not as a result of health reform, but as a result of the fundamental demographic and financial trends that are finally converging after 25 years of warning signs.

By approaching any major cost cutting and performance improvement initiative with the right mindset and devotion to tightly managed communication, you can create a unified communication platform that can be used after the initial review, as well as after analysis is complete, and as you carry out the vision. Smart, strategic communication can improve staff awareness of specific issues and solutions in a way that will support and facilitate future health system initiatives identified through the cost-cutting initiative.

A strategic communication approach should be built around the following:

Focus on vision – pivot off of the inherently negative “cost cutting” storyline and make this about the future of healthcare in the region and within your health system.
Reinforce the purpose and importance of the cost cutting and performance improvement effort, as well as any planned initiatives using easy-to-understand key messages.
Minimize the spread of misinformation and rumors by:

-Making it easy for people to get accurate answers to their questions
-Establishing clear expectations so physicians and employees know how often and through what channels they will be updated
-Engaging in two-way communication
-Staying on message, through every channel and with every tactic

Avoid limiting your future options at all costs by sticking to the truth. Proactively address difficult questions, realities, and possibilities. And when needed, acknowledge that you don’t know – yet.

Cost cutting and performance improvement are a high priority strategy for every smart health system, and strategic communication can make the complex and difficult issues easier to understand and achievable. Is it really necessary?

The January 2012 edition of Healthcare Financial Management featured an article titled, ‘A Patient Focused Model for Cost Reduction’:

“Changing the healthcare payment system to account for outcome measurements and low-cost providers will drive needed change in cost and quality. The pressure on insurance companies to reduce premiums will drive lower payments to providers, and the budget issues at the federal and state levels will drive reductions in Medicare and Medicaid payments. In fact, some expect the Medicare payment rate to become the standard in the future. Such a change could result in a “one-payment” system rather than a “one-payor” system.”

As your organization prepares for needed changes, think about the story that’s being told. You will need to develop the right plan with the right changes – communication can make all the difference between the success and failure of the plan’s implementation.

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Technology, Transitions and Thoughts – Oh, my!

Wednesday, March 14th, 2012

Mirena Bagur
Health Technology Practice Leader, Revive

On the road to a healthier nation and a more cost-effective health care system, health systems and physicians in the U.S. are about to face a mandate for coordinated care with patients. And there will be penalties and payment cuts if the transition from bedside to home is not carefully managed. This seems like a logical path as hospitals work to reduce readmissions. In many other industries, technology implementation has proven to increase efficiency, effectiveness, and quality. Unfortunately, this has not been the case when it comes to health care, even as it relates to follow-up with patients as they leave acute care settings. So what are providers supposed to do?

Rather than being overwhelmed with many unknown challenges, physicians and health systems can adopt a rhythm according to which they can evaluate emerging technologies, support transitions of care, and empower patients to participate in their own follow-up care and managing their health conditions.

Questions to Address Come from the Leading Providers
In conversations with many of Revive’s clients, we recognize that each organization needs to write its own music and arrange its own tune. Leading organizations are creating multi-stakeholder teams to evaluate how to best address the transitions of care from hospital to home, and the first step is to ask a few fundamental questions:

- What is the current workflow for the way we transition patients to their homes?
- How can we address the shortage of skilled clinicians to support transition and provide education to patients and their home caregivers?
- Do we have a “navigator” or a “mobility expert” that helps patients leave the hospital with confidence?
- What processes or methodologies can we automate?
- Have we looked at emerging technologies that can support transitions and shape post-acute care delivery?

Patient Power
Health Technology entrepreneurs and innovative researchers in the medical field are exploring how to enable providers to give patients better care. Communication is the key. From motivational tools, self-care, population health, mHealth, and consumerism of health care information, entrepreneurs are pioneering approaches to care coordination that also empower patients to make thoughtful decisions about ways to impact their own health.

Revive is helping those entrepreneurs, along with health systems, physician groups, and health services companies of all stripes, forge the way, leveraging marketing and PR to engage people and organizations all along the health care continuum. Together, we’ve discovered not only the power of effective communications, but the power of working with leaders and entrepreneurs who are as passionate about health care as we are.

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