2016 Press Ganey NCC Executive Panel: The Health Care Horizon

Added on Nov 17, 2016

2016 Press Ganey NCC Executive Panel: The Health Care Horizon
By Diana Mahoney
Industry Edge November 2016

Managing change, achieving transparency, improving access to behavioral health care and enhancing care coordination were among the top concerns voiced by health care executives who participated in a panel discussion at the 2016 Press Ganey National Client Conference in early November.

Chief Executive Officers Cynthia Hundofean of Allegheny Health Network (Pittsburgh), Dr. Howard Grant of Lahey Health (Burlington, MA) and Chris Van Gorder of Scripps Health (San Diego) joined Press Ganey CEO Patrick Ryan to discuss the priorities they have for their own organizations and the challenges the industry faces moving into 2017 and beyond.

Ready, Set, Change

Understanding, adapting to and preparing for the light-speed changes that continue to define the health care industry is essential for organizational success, the panelists agreed.

“Managing the speed and rate of change is our biggest challenge,” Van Gorder said. “The industry is now so regulated that we are all busy trying to comply with the regulations and at the same time retool [operations]. It’s like trying to fix the engine of an aircraft while it’s in flight.”

The key to meeting that challenge, Van Gorder stressed, is to build a stable of capable, empowered leaders. This is achieved at Scripps through the organization’s Leadership Academy, a yearlong monthly training program geared for middle managers who either have been promoted to that position or are new to the organization. “It’s really an in-depth orientation into how the organization works and what goes on behind closed doors to remove any veil of secrecy about strategic planning,” he said. “Middle managers are the closest to frontline staff; they are the most important thread to realizing the management style we’d like to weave throughout Scripps.”

Bringing the decision making to front-line employees through their managers “is the best way to spread best practices across the system quickly,” Van Gorder said. “That is what is going to get us to more efficient, lower-cost, high-quality care with full engagement of everyone in the organization.”

According to Lahey Health’s Dr. Grant, empowering middle managers in this way also enables senior leaders to focus on the bigger picture of how their organizations will fulfill regulatory requirements while also meeting the increasing demand for health care services and reducing the rising cost of those services.

“I started my career in operations, so I have to fight my natural inclination to get involved in day-to-day operations, but I’ve realized that it’s more important for senior leaders to create the context for [middle managers] and staff about what is going on externally and the imperatives the organization is facing,” Dr. Grant said. “The most important thing that I do is create the message for my leaders that if there is evidence to suggest that there’s a best way of doing something, the presumption of the organization is that it will be adopted across the organization. That’s the best way to accelerate change.”

Assembling a team of “really great leaders” can also speed up the process, Hundofean noted. “When I came to Allegheny earlier this year [from the Cleveland Clinic, where she served as chief administrative officer], I brought on people who had the vision to take us where we need to go.” She has also spent her first nine months “really trying to understand the organization and its history over the past few years, and talking and listening to our physicians and caregivers about what has and hasn’t worked in the past” to make sure there is understanding and alignment in terms of future objectives.

Such insight is essential to progress, Van Gorder stressed. “When we start talking about the issues in health care and what’s going on in the marketplace and what that means to our organization, we build trust among leaders, employees and medical staff.”

Pulling Back the Curtain

In addition to building trust among individuals involved in care delivery, hospitals and health systems have to earn the trust of the patients they care for in order to survive and thrive in today’s consumer-driven health care marketplace.

The ongoing shift from volume- to value-based care has brought transparency to the forefront of health care leaders’ thoughts, leading to the realization that pulling back the curtain and letting patients see the safety, quality and cost of care is a powerful and necessary driver of improved performance across all three.

“Patients are increasingly going to be shopping between systems, so they need to understand what they are going to get when they come to our system: what they can expect for outcomes and how much it’s going to cost,” Hundofean said. “Patients know what they want, and it’s a given that they are going to become more involved in the decisions about where they will seek care, so it’s imperative that we listen to them and give them the information they need.”

Importantly, true transparency should be proactive rather than reactive, Van Gorder said. “We, as an industry, are not there yet. In California, for example, a lot of the transparency that we see is mandated, such as public reporting of never events and fines levied by the state.” Being truly transparent with patients, he said, “requires being more transparent internally.”

One way internal transparency is advanced at Scripps is by bringing a patient and his or her doctor to each management meeting. “We start the meeting with that patient talking about his or her care and experience as a way to ground ourselves that the reason we are in business is for patient care,” Van Gorder explained. “If we can become more transparent about our flaws internally, we will become more comfortable sharing that information externally.”

In the same vein, Dr. Grant recognized that transparency without context won’t drive improvement. “I’m always taken aback when I walk down the hallways and see the postings of our hospital-acquired conditions and serious events, knowing full well that all of our patients are able to see the number of times we harm people,” he said. “Even though we have come light-years compared to the rates of harm 30 years ago, we have to continuously challenge ourselves to do better.”

To this end, Dr. Grant continued, “we remind leaders in our organization—even those in finance and other areas—that if they don’t talk about quality, safety and patient experience in every meeting, people are not going to recognize them as priorities. Leaders have to set the tone, create expectations and adhere to the same rules if they expect others to follow.”

Easing Access to Behavioral Health Care

While the focus on improving health care quality and value has led to many significant improvements in care delivery, behavioral health has yet to reap many of the benefits of new care delivery and payment models.

Access to behavioral health care “is the greatest unmet health care need in this country,” Van Gorder said. “We are inadequately addressing and completely underfunding behavioral health, and it’s creating a crisis in our emergency departments, compromising throughput and contributing to all sorts of social issues.”

The historical decision in the health care arena to finance and deliver behavioral health care to patients separately from physical health care has “resulted in a scenario in which an estimated 50% of the people in this country with a behavioral health diagnosis don’t get care from a qualified professional,” Dr. Grant said. “There’s been little incentive for capable professionals to move into that specialty,” and the annual costs of care for patients with a behavioral health diagnosis are orders of magnitude higher than those for patients without a behavioral health diagnosis, he explained.

“If you are talking about compassionate, empathetic care, you can’t achieve it unless you have comprehensive behavioral health services for the people in the country who carry that diagnosis,” said Dr. Grant. “Unfortunately, as long as the insurance component in the behavioral health arena continues to be carved out in the way that it is, where we as providers, doctors and hospitals don’t bear the responsibility, we are not going to make the investments that are necessary.”

Efforts to support clinical, structural and financial integration of behavioral services through alternative payment models, innovative care models and multistakeholder partnerships (commercial and public payers, health care providers and community agencies) are needed to move the needle on behavioral health care delivery toward value, the panelists agreed.

The Last Word: Care Coordination

“If you could snap your fingers today and do one thing to make it so that every person who walked into your organization was able to navigate their way through the care process seamlessly, what would that one thing be?”

This question, posed by Press Ganey CEO Pat Ryan to each of the panelists, elicited similar answers across the board: care coordination.

“I would have a care coordinator for every 100 to 200 patients—someone who is on-call 24-7 for questions or concerns about how or where to access care,” Hundofean said, noting that Allegheny recently “took the plunge” by hiring 200 care coordinators. “People say, ‘we don’t have the money to do that,’ but in reality, we don’t have the money not to do it,” she said. “This is an important and necessary investment. It’s just not fair to have patients running around trying to find care. There are probably 30% to 40% of patients in our country’s EDs who would have never arrived there if they had had someone to help them access care.”

Every patient should be able to call someone within the health care system to help them navigate the process, Van Gorder agreed. “And patients with complex clinical issues should have access to navigators with the higher-level skills and experience needed to help them get them the appointments they need.” One barrier to this is the fact that health care, despite being a 24-7 business, “still operates on a five-days-per-week schedule,” he said. “No one should end up in the ED because they don’t know where else to go. We need to develop fully integrated systems with services on evenings and weekends, perhaps including virtual technologies, to offer 24-7 resources.”

The return on investment for making such resources available can be substantial, according to Dr. Grant, who saw it firsthand in his previous role as executive vice president and chief medical officer at Geisinger Health System in Pennsylvania. “I had the privilege to work through all of the patients there and assign them a case manager to the tune of about one for every 125 to 150 patients in every one of our ambulatory sites.” As a result, he said, ED visits, hospitalization rates and readmission rates dropped significantly. “Importantly, when you make those resources available, you create security for patients and make it a much more gratifying environment for physicians and other caregivers to work in, knowing that the resources exist.”