Future Perfect—AMC Success in Evolving Markets

At the Sg2 AMC Summit 2016, Sg2 and cohosts BJC HealthCare and St Louis Children’s Hospital welcomed 75 attendees, representing 30 organizations from across the US, to discuss the implications of changing market dynamics for the trifold mission of academic medical centers (AMCs). With the expertise of presenters representing 7 academic institutions and even 1 payer partner, Sg2 explored the 4 C’s of market evolution—consolidation, consumerism, cohesion and convergence.

BJC Campus Tour Highlights Innovation and Technology
Attendees toured a newly developed technology district, a neurosciences innovation unit and the world’s first single-room proton beam accelerator.

  • The Cortex Innovation Community, a 200-acre technology district centrally located near the BJC campus, is a growing innovation hub for health care and technology start-ups.
  • At the 15-bed neurosciences innovation unit, the group learned how the team is using technology, data tracking and patient engagement to ultimately redesign neurosciences care.
  • Finally, participants had a unique opportunity to “go behind the curtain” at the S Lee Kling Proton Therapy Center and see the equipment that delivers the proton beam, a particle accelerator that is mounted on a 100-ton rotating gantry.

AMCs Must Balance Mission With Their Fight for Market Relevance
Sg2 experts Steve Jenkins and Jay Prystowsky, MD, discussed the pressures on AMCs to stay relevant in a changing market. Market relevance does not just apply to one audience: AMCs must prove their relevance to insurers, consumers, employers, referring physicians and partners. Dr Prystowsky emphasized that AMCs of the future will need to balance their traditional academic missions with a new focus on value enhancement and patient-focused care. We took a pulse of the attendees “risk readiness” and found that most AMCs felt they were more ready for risk than their respective markets. Thirty-five percent of participants fell into the “Expand Your Footprint” quadrant, based on their organizations’ high levels of risk readiness vs their markets’ low levels.

Consolidation: Developing an Academic Medical System/Network
Steve Lipstein of BJC HealthCare addressed consolidation, specifically around BJC’s population health efforts. Population health is a particular challenge for AMCs, as the desire to attract medically complex patients often results in costly, resource-intensive care. This does not translate well to managing margins on a per-member per-month basis.

Lipstein believes that many institutions are not yet ready to take on population health on their own and should be evaluating their readiness based on financial and data requirements. Partnerships may be the best path forward for some AMCs: BJC has focused on improving population health and reducing costs through a shift to accountable care and the development of the BJC Collaborative. This group of 7 independent health systems covers Eastern Kansas, Missouri and Southern Illinois and has helped BJC achieve its population health goals. The Collaborative has succeeded in lowering costs through group purchasing, developing regional specialty care networks and building a population health infrastructure.

Consumerism: Innovating to Meet Patient Needs
Both Froedtert Health/Medical College of Wisconsin and Northwestern Memorial Hospital in Chicago discussed the innovative work they are doing to meet the needs of the health care consumer. David Olson from Froedtert Health showcased the new strategic partnerships they are developing to maximize patient access to care. These include partnerships with Meijer and CVS on retail clinics and collaborations with employers to offer on-site health clinics. In addition, Froedtert’s virtual clinic will offer on-demand 24/7 access to care, a lower-cost alternative to urgent care and ED visits, and a feeder channel into the larger Froedtert system. The ability to effectively comanage the population, which includes managing multiple and frequently different expectations and roles, will be essential for these initiatives to succeed.

Nick Wojciechowski from Northwestern emphasized the importance of the voice of the customer in designing your facilities, particularly for highly competitive ambulatory services. He described the visioning and execution process for a new ambulatory care center in downtown Chicago. Key elements include:

  • Understanding the patient, mapping the patient journey and redesigning care delivery processes to ensure seamless coordination
  • Ensuring the vision is reached by recruiting and engaging the right individuals at all levels, from housekeeping to surgeons
  • Continually measuring and monitoring performance

Cohesion: Clarity, Workforce and Vision
Sg2 considers cohesion the deliberate orientation towards value through the adoption of value-based models of care, staffing and technology. Key themes that arose around cohesion were the need to actively manage and prioritize your strategic portfolio and leverage the full talents of your workforce. Kate Reed of Beth Israel Deaconess Medical Center described the process of developing a strategic prioritization scorecard to help their leadership make strategic choices and allocate hospital time and resources among competing priorities. The resulting 4-quadrant plot scores each clinical program based on the market opportunity (growth potential and patient demand) and financial value (contribution margin).

Sheila Antrum and Min Zhu from the University of California, San Francisco (UCSF) spoke of building cohesion across the enterprise through 3 levels of workforce: governance, clinical practice and daily operations. UCSF sought to overcome a “mine, mine, mine” mentality and move from a “What do I do?” philosophy to a “What am I part of?” way of thinking. Sheila shared the need for cohesion at the senior level to set the direction for the organization and share accountability for operation and performance targets. Min provided examples of cohesion at the practice level, including development of a perioperative surgical home and gynecological oncology pathways. This approach has reduced pain, opiate use and length of stay after surgery and improved patient satisfaction. Finally, Min shared how UCSF employed a group effort to redesign daily surgical operations, resulting in tangible reductions in instrument use and cost savings.

Convergence: Partnering With Payers
We are seeing the blurring of lines between providers and payers that has resulted in providers offering health plans, payers acquiring providers, and unique partnerships between providers and payers to innovate, improve care quality, reduce costs of care and appropriately take on risk. The Summit featured 2 AMC providers that have developed insurance products.

Santiago Munoz from the University of California, Los Angeles (UCLA) and Beth Ginzinger from Anthem described a partnership between 7 hospitals and health systems in Southern California and Anthem to develop Vivity HMO. Potential provider benefits include an expanded geographic network and partners to work with to provide value-based care. Keys to success are developing a product that is specific for the Los Angeles market and ensuring respect and equality among all partners, since the risk is shared equally among them. The end result will be a clinically integrated network and an insurance product.

Finally, Sheryl Garland and Christine Patterson from Virginia Commonwealth University Health System (VCUHS) discussed its approach to support the complex needs of patients enrolled in the Medicare and Medicaid dual-eligible program through its Center for Advanced Health Management. Building on its experience with the Virginia Premier Health Plan, a VCUHS managed Medicaid product, and its clinical expertise in geriatric care coordination, VCUHS built a System of CARE to effectively manage the care coordination for this complex group of patients. Providing care for dual-eligible patients is linked to VCUHS’s mission of providing complex care to the sickest patients, conducting cutting-edge research and training the next generation of health professionals. Lessons learned from this undertaking also supported the advancement of VCUHS’ population health strategies.

Consider the 4 C’s to Succeed in Your Evolving Market
In the end, attendees of this year’s Summit explored strategies that AMCs are undertaking and initiatives they have developed around consolidation, consumerism, cohesion and convergence in response to the mounting pressure to provide innovative and cutting-edge care. Look for more coverage of the 4 C’s throughout the year, as we sharpen our focus to provide you the most relevant information to succeed in health care’s evolving market.

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