Maryland Association of Health Care Executives

November 30, 1999

President's Message

By Alan S. Weisman, FACHE

As I begin the second year of my 2-year term as your President, I wanted to thank the MAHCE Board of Directors for their commitment and hard work to make the past year a success and to our members for participating in our networking events. In the following months, MAHCE will host two educational/networking evening events, July 17 and November 13 (please note that the venue for these evening events has changed to Sheraton Columbia Town Center), which will afford our membership the opportunity to gain knowledge and information on various topics in healthcare, as well as networking with peers and others in the healthcare field. In addition, MAHCE will hold a joint all-day meeting with NCHE (3 Face to Face credits) on May 20 at University of Maryland University College in Largo, Md. Our all-day MAHCE Face-To-Face educational meeting, which is one of the highlights of the year, is scheduled for September 18, 2014 at Sheppard Pratt Conference Center in Towson. You will find that the quality of the programming for this event is extraordinary and it is always well-attended. In addition, we will sponsor a Board of Governors exam review course this year. Please watch for announcements of these programs. You can access our website at http://mahce.ache.org/

As a Board, we are hard at work identifying excellent educational opportunities for our members and focusing on increasing the quality and quantity of services we provide our membership. In addition, we continue to engage MAHCE corporate sponsors this year in our member events, and we remain dedicated to providing value to both our members and our corporate sponsors. We are always looking for volunteers for our various committees, which members find very rewarding. Please contact any of our Board members or myself if you are interested. We are very fortunate that MAHCE is one of the largest and most active chapters in the country. The participation of our members has continually grown over the past years and we are committed to serving you.

I hope to see you at our next program on March 20, 2014. Please do not hesitate to contact me with any questions or comments regarding our chapter activities. My email address is: weisala@aol.com

Best regards,

Alan

Leadership Corner

CAPT Bernie Poindexter, FACHE

Cynthia Kivland, in her column “Your Future Get Brighter with Emotional Intelligence” (January/February 2014 edition of HEALTHCARE EXECUTIVE), highlights the importance of EI for successful leadership. The fact is there’s no escaping our emotions; however, EI is the ability to recognize and understand emotions in oneself and others and the ability to use this awareness to manage one’s behavior and relationships. It’s also the ability to cope with setbacks, remain optimistic, elicit charisma and stay purposeful even when things are not going well. 

As a leader, emotional tone either attracts or distracts followership. Employees perform at higher levels with leaders who create a positive emotional climate. The evidence is now clear that people skills are far more important than IQ, and unlike IQ, EI can be developed through being mindfully aware of one’s thoughts, feelings and decisions in the present moment, nonjudgmentally. As aware human beings we can choose to respond rather than react to situations in our life and workplace, and become capable of an expanded consciousness that leads to personal responsibility for actions and behaviors. 

Pushing Mobile Apps to Reduce Acute Care Episodes

Sam Hopkins, Sr. Writer Johns Hopkins Carey Business School

Getting sick often happens suddenly. Getting better requires patience and a plan. As health care administrators look for more efficient ways to prevent relapses into illness and readmission to hospitals for acute cases, they are increasingly turning to mobile broadband technology.

The company Health Recovery Solutions was formed in response to the demand for easy-to-use information tools, with appropriate data-driven technology and a human element that makes everyone involved in patient recovery feel more informed and empowered.  Co-founder and CEO Jarrett Bauer worked as a health care industry consultant prior to completing the Global MBA program at the Johns Hopkins Carey Business School.  From his professional experience and education, he knew how to assess market opportunities and recommend strategies for growth to health care organizations, but it was a bout of illness suffered by his grandmother that clarified his entrepreneurial goals.

What Bauer’s grandmother and every other heart failure and COPD patient needed to avoid after hospitalization was passing through those emergency room doors again. Bauer spoke with CFOs of major health systems and hospitals to validate his hypothesis that readmission was a growing problem for them, too. Yes, they told him, the readmission rate is a problem, but they would tackle when penalties came into play.

That time has come, with the Affordable Care Act causing hospitals and accountable care organizations (ACOs) to take a closer look at ways to keep patients and their allies informed and proactive about preventive care that keeps them out of the ER or ICU.

Once Bauer saw the problem and validated the desire to solve it, he integrated a business launch into his second-year MBA curriculum. “I looked at it as a chance to learn as much as possible in the first semester,” he said, “then focus on the Johns Hopkins-wide business plan competition in the spring.” First, he recruited team members, and they prepared to compete. The competitions went well, so his team applied to several technology accelerators related to health care, landing at New York-based Blueprint Health.

The software that they built not only educates high-risk patients about their specific diseases in the hospital, but also serves as a guide to helping them manage when they are leave, reminding them to take medications on schedule, weigh themselves, monitor their blood pressure, and communicate with their medical teams.  The information collected on 4G tablets is then sent back to the discharging hospital and care givers. With key milestones to reach and quizzes testing comprehension, it’s like a class for elderly patients—one where passing or failing could mean the difference between health and illness.

After more than a year of conducting a 50-patient, randomized nurse-assisted study based at Hackensack University Medical Center and Holy Name Medical Center in New Jersey, researchers who examined the data found an 8% readmission rate among patients who went home with the Health Recovery Solutions platform. That contrasts with a 28% readmission rate for the control group of patients who received usual hospital care but did not receive the 4G tablets. 

Another health-related technology tool with a Johns Hopkins connection is the eMOCHA platform created by physicians and researchers at the university’s Center for Clinical Global Health Education. Entrepreneur Sebastian Seiguer licensed the mobile health platform from Johns Hopkins in August 2013 to meet the demand for mobile health solutions in clinical settings. Developed by Hopkins clinicians and researchers, 15 eMOCHA apps have been deployed in 10 countries.

Seiguer's new company, eMOCHA Solutions, builds mobile health products that will give healthcare providers mobile access to patient data, with a focus on easing communication between providers and remote patients. There are three practical settings for this technology: patient management for clinical trials, where patient engagement can bring attrition down from over 30% in some recent Phase II & III trials. In a clinical setting, eMHOCA lets care providers interact with patient data from their mobile devices. “Clinical care professionals simply do not have the sophisticated tools they need to manage the increasing volume of electronic data being produced,” Seiguer says. Finally, eMOCHA can aid researchers in quickly and efficiently testing patient pools and collecting data.

In a recently-agreed pilot program, health care workers in Baltimore will use eMOCHA to monitor tuberculosis patients remotely as they self-administer medication. Centers for Disease Control rules require direct observation of therapy (DOT), which is costly when done in-person, but recently video supervision has been tested in California. EMOCHA has teamed up with Dr. Maunank Shah, a tuberculosis expert, and the CCGHE, to develop and launch the Baltimore City Pilot. In addition to uploading video, the same software will schedule medication refills, changes to regimens, and capture assessments filled out by the patient after video upload.  

The intersection of mobile broadband technology and healthcare has attracted many entrepreneurs who recognize the potential for efficiency gains and cost savings when multiple health care stakeholders participate in patient-centric networks.

Clinical Integration: The Grand Vision for Succeeding Under Health Care Reform

Allan S. Field, Executive Consultant, Clinical Integration, Glenridge Healthcare Solutions

At the signing of the Declaration of Independence, Ben Franklin is said to have stated, “We must all hang together, or assuredly we shall all hang separately.” While Mr. Franklin and his fellow rebels from the English Crown literally had much more to lose by not hanging together figuratively – literally their very necks - their plight is not so much different from what physicians and hospitals face in this era of health care reform.  Physicians and hospitals who learn to “hang together” through viable and sustainable integration and engagement strategies stand much less of a chance of “hanging separately.” 

The Federal Trade Commission and the Department of Justice in their joint Statements of Antitrust Enforcement Policy in Health Care, August 1996, provided a legal basis for such a strategy – clinical integration. As an early pioneer in the clinical integration movement, I would like to share some lessons learned for ensuring the launch of a successful clinical integration strategy.

The objectives of such a high functioning organizational framework include:

  1. Alignment of stakeholder initiatives to improve: total cost of care; quality; outcomes; utilization; access; provider cost of care; and, stakeholder and patient satisfaction.
  2. Promotion of a high degree of cooperation, collaboration and mutual interdependence among the stakeholders.
  3. Development of alternative reimbursement methodologies that support a culture of continuous performance improvement.
  4. Identification of and financially rewarding those physician stakeholders who successfully engage in the program objectives and meet or exceed performance measures.

Regardless of the PO (provider organization) model selected, there are common threads that run through successful models:

  1. Successful POs create a culture of trust by actively listening to each other, provide timely and data-driven feedback, are willing to respectfully challenge assumptions, especially if the data support the challenge, and relentlessly focus on transparency in all interactions.
  2. Matching physician and hospital capital investments can give fraud and abuse protection while also giving physicians a financial and governance stake for a relatively low investment amount.
  3. Key decisions - such as clinical protocols or indicators to standardize care, quality and cost benchmarks to monitor and reflect change over time, the I/T platform to support data collection and reporting, product development, membership rules, credentialing, and policies and procedures to assure uniform compliance - are centralized.
  4. Competency-based physician governance representation versus specialty-based is recommended.  While specialty-based representation is more common, especially with physician-hospital organizations, focusing on specialty may not reveal otherwise unknown or hidden skill sets among various stakeholders.
  5. Physician-led POs with a high level of professional management are most likely to succeed, especially if the PO invests sufficient time and money in physician leadership development.
  6. Credible and trusted data that is collected frequently and is available as close to real time as possible and at the point of care is more likely to be utilized than data that is error-prone or “stale.”
  7. The temptation to “blind” physician quality, cost and utilization scores should be resisted. The POs most effective at moving the mean on these metrics share un-blinded peer comparisons.
  8. A uniform program for improvement that sets one standard across all payers and products, measures processes and outcomes uniformly, and allows physicians to focus on the delivery of high-quality care, is more likely to appeal to payers and stakeholders and lead to the desired results.
  9. Engagement in patient satisfaction initiatives by all stakeholders is a hallmark of successful POs.
  10. When the hospital is a corporate member of the PO, it will have a stake in ensuring success of PO payer negotiations on behalf of the physicians and provide assurance to the physicians that the hospital is not prospering at the physicians’ expense.
  11. A hospital partner also can make the PO more successful by providing access to hospital support services such as general accounting, information technology, communications, marketing and public relations expertise.

There are four basic tenets of clinical integration. Get these right and these tenets will serve as a platform from which to succeed in virtually all emerging models of care and reimbursement. 

  1. Develop and implement clinical practice and evidence-based medicine guidelines, establish monitoring and reporting systems, and focus on physician and patient compliance. 
  2. Develop care coordination functionality that provides such tools as patient registries, gaps in care reporting and alerts, clinical decision support, patient outreach, health coaching and wellness, and management of care transitions. 
  3. Focus on the nurturing, negotiation and management of payer relationships. 
  4. Provide an IT solution that supports data aggregation from disparate sources, creates a virtual longitudinal community record of care, and encompasses risk stratification, predictive modeling, and performance reporting.

It is said that, in the absence of a great vision, we default to self-interest. While the IHI’s Triple Aim – lower cost, better population health and improved patient experience – is a laudable vision, it does not speak to a sustainable business model necessary to assure its attainment. A solid clinical integration program will not only achieve the Triple Aim but also will serve as that great vision for the community served and protect the interests of all stakeholders.

Apply for a Tuition Waiver

To reduce the barriers to ACHE educational programming for ACHE members experiencing economic hardship, ACHE has established the Tuition Waiver Assistance Program.

ACHE makes available a limited number of tuition waivers to ACHE Members and Fellows whose organizations lack the resources to fund their tuition for education programs. Members and Fellows in career transition are also encouraged to apply. Tuition waivers are based on financial need and are available for the following ACHE education programs:

  • Congress on Healthcare Leadership
  • Cluster Seminars
  • Self-Study Programs
  • Online Education Programs
  • Online Tutorial (Board of Governors Exam preparation)
  • ACHE Board of Governors Exam Review Course

All requests are due no less than eight weeks before the program date, except for ACHE self-study courses; see quarterly application deadlines on the FAQ page of the tuition waiver application. Incomplete applications and applications received after the deadline will not be considered. Recipients will be notified of the waiver review panel's decision not less than six weeks before the program date. For ACHE self-study courses, applicants will be notified three weeks after the quarterly application deadline.

If you have questions about the program, please contact Teri Somrak, associate director, Division of Professional Development, at (312) 424-9354 or tsomrak@ache.org. For more information, visit ache.org/TuitionWaiver.

Access Complimentary Resources for the Board of Governors Exam

For Members starting on the journey to attain board certification and the FACHE® credential, ACHE offers complimentary resources to help them succeed so they can be formally recognized for their competency, professionalism, ethical decision making and commitment to lifelong learning. These resources, which include the Exam Online Community, the Board of Governors Examination in Healthcare Management Reference Manual and quarterly Advancement Information webinars, are designed to be supplements to other available Board of Governors Exam study resources, such as the Board of Governors Review Course and Online Tutorial.

  • The Exam Online Community is an interactive platform to learn and glean study tips from other Members taking the Exam. The Community was recently redesigned, and its new look and streamlined navigation features are intended to enhance the member experience in utilizing this study tool. Participants can discuss Exam topics with experts and have the option to participate in study groups. Interested Members may join the Exam Online Community at bogcommunity.ache.org.
  • The Reference Manual, found at ache.org/FACHE, includes a practice 230-question exam and answer key, a list of recommended readings, test-taker comments and study tips.
  • Fellow Advancement Information webinars provide a general overview of the advancement to Fellow process, including information about the Board of Governors Exam, and allow participants to ask questions about the advancement process. 

 

 

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Tom Webb, Director of Communications

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