School at Work®
Vision, Mission, Values
Careers at Catalyst Learning
School at Work®
Vision, Mission, Values
Careers at Catalyst Learning
Catalyst Learning Blog
Articles, case studies, and success stories to guide and inspire healthcare HR, Organizational Development, and Clinical professionals.
Pomp and Circumstance at Cleveland Clinic
On July 15, 2013 in
Catalyst Learning’s Lynn Fischer recently had the honor of addressing over 50 Cleveland Clinic School at Work graduates. It was an opportunity to reflect on Cleveland Clinic’s incredible commitment to School at Work; since 2005, the organization has had over 200 graduates! As Catalyst Learning gears up for its 20th anniversary, it was also a time to be thankful for the many organizations like Cleveland Clinic that have helped us provide career development to over 14,000 employees.
Click here to read full transcript
and the five pieces of advice Lynn offered graduates as they move into a new chapter.
Congratulations Cleveland Clinic School at Work Graduates
CLC Congratulates Award-Winning Customers
Catalyst Learning Company (CLC) works with the most progressive healthcare employers in the country to provide employee development solutions that raise the bar on engagement. Recently, several of CLC’s active customers have been recognized as national leaders in several categories that include “Best Place to Work” and diversity. CLC applauds these organizations and thanks
customers for the opportunity to contribute to their culture of growth, development and high-performance.
ASTD Best Award
University Health System, San Antonio, TX
Working Mothers Magazine “Best Company for Hourly Workers”
Bon Secours Richmond Health System, Richmond, VA University of Wisconsin Health System, Madison, WI
Diversity Inc’s Top Five Hospital Systems
Brigham and Women’s, Boston, MA Cleveland Clinic, Cleveland, OH
Becker's Hospital Review "100 Best Places to Work in Healthcare”
Advocate Health Care, Chicago, IL AtlantiCare, Egg Harbor Township, NJ Baptist Health South Florida, Miami, FL Brigham and Women’s Hospital, Boston, MA Catholic Healthcare West, San Francisco, CA Cedars-Sinai Medical Center, Los Angeles, LA Children’s Healthcare of Atlanta, Atlanta, GA Christiana Care Health System, Wilmington, DE Christus St. Michael Health System, Texarkana, TX Cleveland Clinic Foundation, Cleveland, OH Rush University Medical Center, Chicago, IL University of Chicago Medical Center, Chicago, IL Yale-New Haven Hospital, New Haven, CT
ACO Staffing Strategies: Redesign the Case Manager Role to Cut Readmissions
Operating a successful ACO requires a paradigm shift. Since readmissions will directly affect Medicare reimbursements, hospitals must work to keep patients out, rather than in. Most healthcare organizations know how to manage care within the facility, but what happens when the patient leaves the building? Since 2002, Catalyst Learning customer, University of Wisconsin Hospital and Clinics (UWHC) has dedicated significant resources to answer that question. Challenged by capacity management and throughput issues, the UWHC recognized the need for a more aggressive approach to case management. Barbara Liegel, RN MS, serves as Director Coordinated Care and Home Care Programs at UWHC. She explains that the traditional case management model blurred roles at UWHC. Staff within the hospital was not always clear on the agendas of the clinical case managers and social workers, and this lack of clarity caused overlaps in care. The subsequent redesign pushed the organization to eliminate duplication in roles. UWHC established an offsite case management facility, the Resource Center, staffed with payer specialists, referral specialists, data analysts, and clerical support. This team manages non-patient care aspects of the patient’s experience, things like discharge planning, communication with insurance companies and coordination with offsite treatment facilities such as physical therapy centers. As a result, the clinical team is freed from non-care related tasks. “The Resource Center’s team helps the wheels continue to turn by picking up much of the ‘busy work’. As we’ve evolved in the last decade, we’ve been able to enlarge it and cover outpatient requests. It helped us become more efficient, even before there was such a thing as an ACO.” As part of the initiative, UWHC introduced a web-based system for creating and monitoring patient care plans helps streamline the process. “We have made this online system the primary vehicle for communication between providers, both inpatient and outpatient,” Liegel says. “Embedded in the software are tools to assess the fit between patients’ needs and hospital services and to monitor trends in admissions and discharges.” UWHC still operates with the same number of staff, but with very clear and well-defined roles. The new model has eliminated the overlap in care and holds everyone accountable for his or her actions. Licensed clinical staff now has more time at the bedside. They are available to push their clinical colleagues, to look at medical necessity criteria and question if the patients even need to be in the hospital or transitioned to outpatient. Liegel credits her forward-thinking colleagues with driving the change forward. “The support from senior management and having a staff that was willing to analyze and improve their processes was instrumental. A change this big is not something that happens overnight. We are still trying to perfect our processes and will continue to do so.”
ACO Terms to Know
Earlier this year, the Obama administration released its long-anticipated proposed rules governing accountable care organizations, a mechanism that will pay providers a share of savings based on their ability to lower costs while meeting quality metrics. Navigating these new rules requires the mastery of key terms. The following glossary of ACO terms was extracted from
Health Leaders Media Impact Analysis
. Click here to access the full
The Paperwork Reduction Act of 1980
The proposed ACO rules specifically say that the PRA, which strives to minimize the paperwork burden resulting from the collection of information by or for the federal government, would not apply to ACOs.
Think safe harbor. This is the promise that federal antitrust agencies, “absent extraordinary circumstances” will not challenge the eligibility of an entity that meets other ACO criteria if its provider participants fall into this safety zone. To do so, they must have a combined share of 30% or less of each common service in an ACO participant’s primary service area. The zone is extended for ACO participants who have between 31% to 50% share of a common service area, “if it avoids specified conduct.” A greater than 50% share, however, constitutes “a valuable indication of an ACO’s potential for competitive harm.” There are exceptions for providers in Rural Service Areas.
Primary Service Area
This is defined as the lowest number of contiguous postal ZIP codes from which the ACO participant draws at least 75% of its patients for that service.
To eliminate the possibility that an ACO would pick the healthiest, easiest-to-manage patients, groups of 5,000 beneficiaries would be retrospectively assigned to each ACO by CMS. Here’s CMS’ explanation from page 114 of the regulations:
“One reason for this is that we believe that the ACO should be evaluated on the quality and cost of care
furnished to those beneficiaries who actually choose to receive care from ACO participants during the
course of each performance year. Another reason for retrospective assignment is to encourage the ACO
to redesign its care processes for all Medicare FFS beneficiaries, not just for the subset of beneficiaries
upon whom the ACO is being evaluated.”
ACOs that are procompetitive are likely to be approved and not endure any further scrutiny from the DoJ or the FTC. Likewise, anticompetitive ACOs will not be approved, or will subsequently face review.
Rule of Reason
This refers to the guidelines that the DoJ and the FTC will use to ensure procompetitiveness. In its statement of antitrust enforcement policy, they explain that “antitrust laws treat naked price-fixing and market-allocation agreements among competitors as per se illegal. Joint price agreements among competing health care providers are evaluated under the rule of reason, however, if the providers are financially or clinically integrated and the agreement is reasonably necessary to accomplish the procompetitive benefits of the integration.”
Each ACO will have to have a Taxpayer Identification Number, as that number signifies who would be paid shared savings.
Dominant Provider Limitation
The FTC and DoJ would apply this limitation “to any ACO that includes a participant with a greater than 50% share in its PSA of any service that no other ACO participant provides to patients in that PSA. Under these conditions, the ACO participant (a “dominant provider”) must be non-exclusive to the ACO to fall within the safety zone. In addition, to fall within the safety zone, an ACO with a dominant provider cannot require a commercial payer to contract exclusively with the ACO or otherwise restrict a commercial payer’s ability to contract or deal with other ACOs or provider networks.”
Mandatory Antitrust Review
An ACO that does not qualify for the rural exception is subjected to a mandatory federal scrutiny if its share exceeds 50% for any common service that two or more independent ACO participants provide to patients in the same PSA. One exception to mandatory antitrust review could be employed if the ACO can supply CMS with a letter from either the DoJ or the FTC “stating that the reviewing Agency has no present intention to challenge or recommend challenging the ACO under the antitrust laws.”
Group Practice Reporting Option
The GPRO is the method by which CMS proposes to calculate results for the first year of the program. The GPRO is similar to the Physician Quality Reporting System. CMS says the GPRO tool is a mechanism by which beneficiaries’ lab results and other clinical information can be reported to CMS for determining shared savings. Measures reported under the GPRO must consist of at least 411 assigned beneficiaries per measure set/domain, and if the pool of eligible beneficiaries is less than 411 for any measure set or domain, then the ACO will have to report on 100% of all assigned beneficiaries.
This is how CMS categorizes the 65 quality metrics whose scores will be basis for determining shared savings of up to 60%, or 65% if the ACO includes federally qualified health centers or rural health centers. There are five domains: 1 Patient or caregiver experience includes seven measures. 2 Care coordination includes 16 measures. 3 Patient safety includes two measures. 4 Preventive health includes nine measures. 5 At-risk population/frail elderly health includes 31 measures. This domain focuses on six categories of health conditions or status: diabetes, heart failure, coronary artery disease, hypertension, chronic obstructive pulmonary disorder, and frail elderly.
This is a physician or osteopath, physician assistant, nurse practitioner, or clinical nurse specialist and not limited to those dedicated to primary care.
The proposed rule says that the following groups are eligible to participate in an ACO: • ACO professionals in group practice arrangements • Networks of individual practices of ACO professionals • Partnerships or joint venture arrangements between hospitals and ACO professionals • Hospitals employing ACO professionals • Other groups of providers determined to be appropriate by the Secretary of Health and Human Services.
Healthcare Payment Reform Driving Innovative Staffing Models
Healthcare consultant and author, Deborah Walker Keegan, PhD, FACMPE, recently addressed a small group of Catalyst Learning customers grappling with healthcare reform’s impact on workforce development. Dr. Keegan spoke to the need for new staffing models in this era of industry transformation. There’s one thing most can agree on: payment reform is at the center of the issue. Dr. Keegan pointed out that payment reform is driving structural reform, which in turn is driving the delivery system reform. To remain competitive, hospitals are seeking higher levels of integration both horizontally within their own systems and with other hospitals while simultaneously acquiring physician practices. The resulting environment is one that’s ripe for tighter hospital-physician collaboration. Dr. Keegan spoke to the need for new staffing models in this era of industry transformation. She shared an innovative medical practice model that includes a core team of “super-trained associates”. These employees possess the skills needed to be successful in a variety of roles in a medical practice. This provides the ability to reassign roles without impacting care. “There is a real change in terms of the clinical support model in the medical practice setting. The staff is doing synchronous work, and these employees own it instead of simply waiting for work to be delegated… in a physician practice applying this model, the medical assistant can be responsible for care transition; LPNs can coach patients; RNs can treat complex illness—each with a vital role to play in patient health and wellness,” Keegan explains. The physician role then becomes one of oversight of the care delivery process as well as providing care where appropriate. This makes willingness to collaborate and flexibility a priority. In terms of the skill needs, clinical employees and nurses must have the ability to wear many hats. They must possess strong critical thinking skills and know how to evaluate the whole body/person, not just the symptoms. Practices must place more emphasis on patient education, prevention, and health coaching support. Many roles are changing, such as case managers, which Keegan explains can be filled virtually, in some circumstances. “If they are onsite, definitely integrate them into the practice,” Keegan says. “If virtual however, case managers can operate on the periphery. Of course, telephone and internet nursing takes a different kind of skill, it requires more critical thinking and diagnostic acumen. These associates should also be very integrated to electronic health records so the physician can evaluate the advice and triage provided to patients, with the case manager playing an integral role in managing chronic care and high risk patients.” An evolving workforce commands the development of new curricula based on new roles. Healthcare leaders must identify, and overcome, specific skills and curriculum gaps. The challenges are great, but an industry in profound transition also equals an industry with new opportunities. Due to these changes hospitals will see a 1.1% projected annual growth rate, between now and 2018. Ambulatory services will see a projected 3.1% annual growth rate in the same time frame. This growth rate will yield thousands of new positions in home health aide, registered nursing and medical case manager positions.
Early Staffing Strategies for Accountable Care
Deploy a Dedicated Project Manager
The transition to ACO is transformational, and-- in the face of competing priorities, uncertainty and communication gaps-- daunting. As a starting point, the Advisory Board Company, who recently shared a report on ACO Early Staffing Strategies at ASHHRA 2011, recommends deploying a dedicated Project Manager to guide the transition. An effective ACO Project Manager must have project management and clinical experience. Another key characteristic is comfort with ambiguity since much of the ACO journey covers uncharted territory. At AtlantiCare, a Baldrige recognized regional healthcare system located in southeast New Jersey, ACO Project Director Paige Younkin was appointed in October 2010. Ms. Younkin, a nurse who specializes in critical care, initially joined the AtlaniCare team to help develop the organization’s open-heart surgery program. From there, her role morphed into clinical development before she assumed her current title. She stresses that for an ACO Manager to be effective, one must also have the ability to connect people who need to work together to achieve clinical integration. “A key part of my role is making the right connections. At AtlantiCare, many parts of the system that previously did not work together now link to create a structure based on ACO law and its different components,” she says. For example, the organization now applies a system-wide approach to developing care models that connect the patient across the continuum. The Case Manager title has shifted to Care Manager, and the role has been redesigned to allow more for a more “front and center” approach as opposed to working behind the scenes. Specialized professionals like heart-failure coordinators have been responsible for developing care a model that extends beyond their function and applies more “big picture” thinking. “If one is looking at redesigning how care is delivered, then any employees who deal with disease issues and planning must look at things in a different way,” says Younkin. Younkin suggests that after appointing an ACO leader, organizations identify and study the population for which they will be accountable. At AtlantiCare, the focus is on the local commercial market. Based on that population, the organization is in the process of examining needs and analyzing internal infrastructure to identify quick wins, like changing internal employee benefit design to provide local employers with an example of how to lower costs and improve health outcomes. Considering the massive resources and knowledge needed to create an ACO, a temptation surely exists for some healthcare organizations to do nothing, hoping to be left alone. Choosing that approach could irreparably damage a hospital’s competitive edge, resulting in competitors pursuing an ACO and retaining (or attracting) more cases from current primary care physicians. “The ACO transition is transformational work that involves risk, but is necessary. The paradigm has shifted, and many practices that have been successful in the past may not be conducive to the same results in the future. ” Younkin says.
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