Children’s Hospital Boston Takes Information Exchange to the Next Level
April 3, 2011
Posted by chcablogadmin in : Innovation, Quality, Technology
More than ten years ago, leaders at Children’s Hospital Boston set out on a multi-pronged approach to information exchange to improve patient care. The leadership team focused on safety and doing a better job of sharing data both internally and externally on behalf of patients. Today, the hospital’s HIMSS Level 7 electronic medical record (EMR) system and data warehouse enable research, clinical and business decision support. A closed loop medication system creates a new dimension in quality and safety. Web-based portals for community physicians and families (www.mychildrens.org) allow for easy and secure access to patient information.
- Sandra Fenwick
We were pretty clear – from the Board to physician leadership to employees across the organization – IT was a critical tool to enabling the care and the innovation that would inform care. It was an institutional priority and would enable our clinical environment and systems to focus on safety, quality and the patient. The financial ROI was secondary to all the other benefits that this would get us. We said if we can’t find a quick solution, we will build it ourselves. That’s part of who we are in terms of innovation. The focus was all about patient care and safety and enabling those who deliver it… In terms of stakeholders, this position was crystal clear and critical. – Sandra Fenwick, President and Chief Operating Officer, Children’s Hospital Boston
The hospital actively engages with other providers and payers through a robust regional health information exchange. These endeavors now show promise for enabling alignment with the state of Massachusetts’ significant health reform activities.
The executive team from Children’s Hospital Boston shared how their data strategies are creating the next level of information exchange between providers, payers and patients.
Editor’s Note: You will receive a hard copy of this publication and supplemental materials. If you are interested in receiving additional copies for your leadership team, please contact Jacqueline Kueser (jacqueline.kueser@chca.com).
add a commentMarch ACO Call: Current Integration Efforts at Children’s Hospital Los Angeles
April 3, 2011
Posted by chcablogadmin in : ACO Update
Steven Peiser, Associate Vice President, Contracting, Children’s Hospital Los Angeles and Children’s Hospital Los Angeles Medical Group
Dave Anderson, BDC Advisors
CHCA hosts a monthly conference call series highlighting Owner Hospitals’ movements in the evolving post-reform and ACO marketplace. During this call, Steven Peiser, Associate Vice President, Contracting, Children’s Hospital Los Angeles and Children’s Hospital Los Angeles Medical Group, provided an update to last quarter’s profile on market movements. (See “What’s it Like in California?” posted Dec. 19, 2010 in CHCA’s ACO Update). Dave Anderson from BDC Advisors provided national context following Steven’s presentation. Attached are the handouts from this conference call and the audio recording.
Note: Our next call, April 21, 2011, 11:00 a.m. CST, features Driscoll Children’s Health Plan (DCHP) CEO, Mary Dale Peterson, M.D.
Overview
Steven Peiser
California is a microcosm of the ACO environment with large physician groups controlling much of the marketplace with strong emphasis on care management across the continuum. The medical groups in CA are mostly delegated by the payors to take on risk for Commercial and Medi-Cal managed care HMO membership. These medical groups through the years have effectively and efficiently evolved under risk based arrangements and developed their infrastructure to handle risk, control costs and coordinate care. Complicating the picture is a $20 billion state shortfall and a 25 percent uninsured population. The market continues to experience increases in capitation contracting but decreases in HMO enrollment. Super physician groups of 600,000+ members exist and some groups are moving to specialty capitation. Rapid consolidation between hospital and medical groups is occurring. Physician supply is a major issue with a significant lack of primary care physicians and an over abundance of specialty based physicians.
Emerging Payment Structures
Bundled payments in transplant and cardiac exist with specialty risk capitation emerging. Large health plans keep everyone on their toes regarding evidence based medicine. For Los Angeles Children’s Hospital, a paradigm shift in terms of the care delivery cultural mindset will be necessary. Incentives will shift to appropriate care, evidenced based care, remote care, case rates, shared risk, bundled payments and capitation.
Los Angeles Children’s Hospital Initiatives
Our goals include increasing the referral base, participation in accountable care organizations, and forming a regional strategy to participate in the state California Children’s Services (CCS) pilot. We are currently:
a) Reaching out to community hospitals for hospital within a hospital initiatives; CHLA has already developed a hospital within a hospital arrangement with a facility in the san Fernando Valley market of Los Angeles, which will encompass running a 24 bed general pediatrics and PICU unit under CHLA’s license. At present CHLA is awaiting approval of this arrangement from the state and federal regulators. CHLA is in discussion at present with another facility and its strategic goal is to achieve a total of 5 Hospital within a Hospital relationships in targeted geographic areas throughout Los Angeles.
b) Expanding multi-specialty centers; in collaboration with Children’s Hospital Los Angeles Medical Group (CHLAMG), CHLA just completed its initial strategic implementation of a multi-specialty center in the San Gabriel Valley area of Los Angeles. CHLA is in the process of moving forward on another site with the goal of having five multi-specialty center locations throughout Los Angeles.
c) CHLA is also focused on developing laboratory services outreach centers and currently runs three centers in Los Angeles and is looking to additional an additional three sites over the year.
d) Redesigning the patient placement center with an emphasis on access and providing referring physicians with a centralized and coordinated approach to assisting with admissions and outpatient scheduling;
e) Establishing physician satellite offices; currently CHLAMG has 23 satellite physician office locations throughout the Los Angeles market;
f) Increasing use of evidence-based protocols;
g) Increasing hospitalists use; and
h) Focusing on outcomes measures.
Our approach continues to evolve with multiple pilots and initiatives to prepare the organization for multiple potential marketplace demands.
Dave Anderson
National Perspective
As payment structures evolve and integrated delivery systems emerge, caution is still the word for taking on risk or moving forward in the marketplace without incentive alignment. Emerging payment structures may be a win-win for the health plan, not for the providers. Be wary of diminishing returns for providers and a “fast forward” to a lower cost basis. It is important to note the recent Rand study indicated bundled payments are the most capable for bending the cost curve overall.
Respecting our Past, Embracing our Future
April 3, 2011
Posted by chcablogadmin in : Innovation, Leadership
The future for CHCA, NACHRI and N.A.C.H. as an aligned organization is very exciting. Along with looking ahead, it is also important to acknowledge the successes of the past and those who have paved the way. As we close the celebration on CHCA’s 25th anniversary, we’d like to share this interactive timeline with you. You will see and hear from your CEO colleagues about the early days and how “A Shared Vision” between Owner Hospitals and CHCA evolved over a quarter of a century. You will also soon receive a special commemorative printed piece along with a copy of a video, “Voices of CHCA,” with comments from CEOs, staff and alumni of CHCA. — JR
