Tropical Storm Irene Disaster Planning and Response
August 28, 2011
Posted by chcablogadmin in : Community Benefit
CHCA and Premier have teamed up for disaster planning and response efforts along the East Coast due to Tropical Storm Irene. CHCA staff have been participating in daily calls with Premier throughout the course of the storm (including this weekend) to identify and troubleshoot any supply-related issues that may arise for our Owner Hospitals in the path of the storm. Jennifer Gedney, Vice President, Supply Chain Improvement, and Arvil Minor, Premier Regional Director, have connected with Supply Chain Directors at Owner Hospitals to offer support.
Any CHCA Owner Hospital can access supply chain help in regardless of whether they are a Premier member. The Premier team has been busy shoring up resources and checking in with suppliers. Specfic disaster readiness and supply and service access plans have been shared with Supply Chain Directors from AmerisourceBergen Pharmaceutical, Cardinal Pharmaceutical, McKesson, MedLine, U.S. Foods (including sourcing emergency supplies, e.g. bottled water), Owens and Minor, and Clean Harbors disaster and emergency response products and services. Standard disaster plans and other useful links are located on Premier’s web site.
CHCA is also available to help your hospital with other types of support. In the aftermath of Hurricane Katrina, we helped Children’s Hospital in New Orleans by hiring a security force to secure their hospital, evacuating patients to other CHCA hospitals, and setting up temporary facilities after the storm. It is our greatest hope the devastation and impact of this storm will be minimal but we are available if you need us.
Please reach out to Jennifer or Arvil if the need arises during or post storm.
Jennifer: jennifer.gedney@chca.com or 913-226-9369 (cell)
Arvil: arvil.minor@chca.com or 816-769-0899 (cell)
Gray Marketers Taking Advantage of Drug Shortages
August 28, 2011
Posted by chcablogadmin in : Group Purchasing, Industry Trends
by John VanEeckhout, Pharm.D., Vice President, Clinical Services, CHCA
Editor’s Note: See the previous blog entry on drug shortages.
The current drug shortage situation — the highest in a decade — is a case study of supply and demand principles. Costs are rising exponentially as the drugs become harder to attain. There is also a growing trend of price gouging by “gray market” vendors. Also known as parallel market, “gray market” refers to the trade of a commodity through distribution channels which, while legal, are unofficial, unauthorized, or unintended by the original manufacturer.
A few weeks ago, Premier publicly released recommendations as a part of analysis which shows the average markup on many drugs in short supply is 650 percent. Even higher markups were seen in certain critical care areas including cardiology and oncology; so the sickest patients are most at risk.
In addition to the astronomical costs, the quality of the drugs cannot be assured since you don’t know how the “gray market” vendor gained access to the product. The drugs could be counterfeit and since pedigrees aren’t officially documented and tracked, you assume a huge liability risk when dealing with these distributors.
CHCA and Premier both recommend using recognized distributors who have a documented chain of custody, and we’ve been in close contact with your pharmacy directors.
We are working on multiple fronts to counter drug shortage issues including legislative efforts, advance warnings and connecting available supplies to organizations in high demand. I’ve been asked to participate as a panel member at an upcoming Drug Shortage Workshop presented by the FDA Center for Drug Evaluation and Research on Sept. 26. The workshop will focus on the causes and impact of drug shortages and strategies for addressing shortage issues. I will report back to you the outcomes of the workshop.
We are working in close partnership with your pharmacy directors to address drug shortages in all Owner Hospitals. In addition to your pharmacy team, you may contact me (johnvaneeckhout@chca.com) or Ben Lizak (ben.lizak@chca.com) with an urgent drug shortage issue, and we will do our very best to help you attain the necessary drugs without disruption of care.
ACO Update: Issue #7
August 28, 2011
Posted by chcablogadmin in : Financial Viability, Healthcare Reform, Leadership
In this edition of ACO Update we talk with Peggy Troy, President and CEO, Children’s Hospital of Wisconsin. Peggy shares their vision and market strategy as well as posing some thoughtful questions about long-term sustainability of children’s hospitals.
In the accountable care arena, Colorado has been very progressive. On the July ACO call, Bruce A. Harma, FACHE, Director, Managed Care, Children’s Hospital Colorado, provided an overview of the state’s Medicaid accountable care collaborative as well as his hospital’s accountable care initiatives for the commercial sector. Additionally, he profiled several quasi-governmental agencies working on reform initiatives in Colorado.
I welcome your comments and suggestions as well as your questions. Please feel free to contact me directly.
Jacqueline Kueser, Vice President, CHCA
Jacqueline.kueser@chca.com
CEO Interview Series: Poised for Change
August 28, 2011
Posted by chcablogadmin in : ACO Update, Healthcare Reform, Leadership
The following interview with Peggy Troy, President and CEO, Children’s Hospital of Wisconsin, is another in the series of CEO interviews with Jacqueline Kueser, CHCA Vice President, regarding children’s hospitals’ responses to the current and envisioned health care environment. Peggy candidly shares their post reform strategy, market position strengths and pursuits. – JR
Peggy Troy
Our Vision
Our organization does not intend to merge with an adult ACO, and we are not staying the same. We cannot be successful in the future in our current structure.
We have a vision that the children of Wisconsin are the healthiest in the nation. Our goals for the post-reform environment include:
- Regional independence;
- Meaningful relationships across the state to create necessary infrastructure and reduce costs, and
- An understanding of the implications of leveraging our health plan knowledge to expand our medical risk-taking beyond the Medicaid population.
Benefiting from Reform
The good news: The post reform policies of “no lifetime limits” and not excluding pre-existing conditions have resulted in additional annual revenues for our organization.
The challenges: To focus our efforts in this complex environment, we recently hired a new Advisor on Health Reform. We consider ourselves well positioned to pilot payment reform projects with 44,000 Medicaid HMO lives, 67 primary care physicians, distributed urgent care centers and hospital relationships and a foster care/ adoption program with 3,000 lives. In addition to focusing on payment reform, we are looking at what it takes to become a medical home. We also plan to transition from serving as an episodic and acute care center to a system of integrated care delivery with a high degree of accountability.
In terms of wellness and prevention, we continue our aggressive work in asthma care. Asthma represents 9.5 percent of our admissions, and we’d like to never admit another kid with asthma. We’re working on this through medical homes, case managers and our region’s school systems.
In terms of a payment model, we are working with the new Wisconsin Secretary of Health on ideas for proving a medical home for populations such as foster care children, of which there are 2,000 in Milwaukee County and 6,500 in the state. We’re also evaluating opportunities to expand our program for medical homes for children with special health care needs.
We’re developing an asthma pilot with an insurer in our market, which will share the expenses of a dedicated asthma case manager and share in savings from avoiding unnecessary hospitalization and ED utilization. I’d like to build on this idea and five years from now have different payor relationships and reimbursement structures than today.
This being said, we still must perform heart transplants and we need financial resources for these highly specialized services.
Adult Market Activity and Competition
In terms of pediatrics, I’m messaging to our large adult systems that our organization plans to remain a “Switzerland” among regional health care providers. We’re collaborating with several adult systems and making moves such as agreeing to put our neonatologists and nurse practitioners into adult hospitals. This makes good business sense when close in geography.
Health Plan and Positioning with Payers
We currently have a medical health plan covering pregnant women, children and families. We are evaluating the implications of the reform legislation for expansion particularly in light of the coming 2014 health insurance exchanges. We are gathering information to help us understand the implications of developing a broader insurance product for children. For example, we are reviewing regulations defining pediatric specialists and how they get paid particularly for multi-system conditions. We are concerned about the possibility of Medicaid moving to a block grant which, if not done carefully, could cause real erosion in coverage for children.
Market Positioning into the Future
No road map exists; we are working as an architect in an uncertain world. We need to start thinking differently than bigger is better. We need to adopt new capabilities in care management across settings. We need to switch from episode-centric care–and somehow protect ourselves in the transition–to managing a child’s health needs throughout childhood.
We are studying pediatric data to evaluate why kids come to our hospital. We need to understand our costs and efforts in complex care, secondary care and primary care to better position ourselves with adult providers and employers. We will need to be cognizant of the path as a high-end tertiary provider with a reimbursement base that erodes our ability to fund research and education.
One option for children’s hospitals in general may be to regionalize services to get to the required scale to compete. Only five percent of children need high-end services. This begs the question of how many high-end programs are needed across the country particularly with the shrinking talent pool and the costly infrastructure of these programs. Is regional alignment an option? This could be a great advantage to achieve the necessary scale. In this model, would we be able to create a superstructure that would benefit research, provide for concentration of high-end services, decrease costs and attract talent?
