All Posts By

Daniel McLaughlin

Uncategorized

Trump Care 8 minute videos

The Opus College of Business health care programs is tracking the current activities of Congress and President Trump to “Repeal and Replace” the Affordable Care Act.  OCB faculty and community experts provide a short video discussion about pending issues and progress every few weeks.  The most current videos are provided below:

Week 1

Week 2

Week 3 

 

Health Policy

Medicare Payment for Physicians Comes of Age

Copyright Health Administration Press Jan/Feb 2016, Used with Permission

Financing, Health Policy, Leadership, Operations Improvement

Optum’s strategy for ACO development

docsMinnesota is proud to be the home town of UnitedHealth Group (UHG), the largest health insurance and health services company in the United States. UHG provides services to over 97 million Americans.

On January 31, 2013, Chris Pricco, senior vice president of accountable care solutions at Optum, presented the UHG perspective on accountable care organization (ACO) development over the next 5 years. This event was co-sponsored by the Minnesota Chapter of the American College of Healthcare Executives.

If you were to attend one event that would encapsulate the future of the American health care system – this was the event. Here are some key points from Mr. Pricco’s presentation.

The most important trends in health care delivery today:

  • Providers are under market share, profitability and consolidations pressures
  • Cost shifting is rising to unsustainable levels
  • CMS is radically revising its payment methodologies
  • Commercial providers are implementing aggressive pay for performance systems
  • Providers are beginning to take and manage risk

As providers move into the ACO and quality payment environment, several key strategies must be effectively executed:

  • Redesign the organization’s care delivery model to be attractive to the market
  • Develop methods to manage risk
  • Optimize contracts with payers and providers in the system
  • Effectively integrate all providers into the system
  • Measure and improved consumer engagement
  • Increase effective branding and marketing at the retail level

The need to move from a fee-for-service environment to a value-based payment system is challenging for most delivery systems. However, Optum’s experience is that this shift is happening to all systems today.  Continue Reading

Uncategorized

The Challenge and Opportunity with Big Data in Health Care

By: Daniel McLaughlin, M.H.A.

The expansion of Electronic Health Records is presenting an unprecedented opportunity to make significant improvements in the American health care system. However, for this opportunity to be realized, new methods of data management and analysis that are uncommon in health care will need to be deployed.

Organizations that have mature electronic health records have conquered the challenge of moving data from operating systems into data warehouses and are using them for substantial improvements. For example, a question that had challenged researchers for many years was whether traditional low-priced blood pressure control was as effective as newer, more expensive drugs. To answer this question, NIH conducted an extensive trial that took eight years and cost $120 million. The results indicated that: the oldest and cheapest of the drugs, known as thiazide-type diuretics, were more effective at reducing hypertension than the newer, more expensive ones.

However, some patients did not respond to these drugs and needed to use the newer drugs – but which ones? Unfortunately, NIH did not have the funds to conduct a follow up study. By the time the NIH study was complete, however, Kaiser Permanente had an extensive electronic health record and data warehouse. By using real patient data in their warehouse and traditional statistical methods, the researchers had the answer in 18 months for $200,000.

Although traditional scientific methods and statistical tools work well for some health care questions, they cannot be easily applied to many interesting questions such as:

 

  • Which doctors have the most cost effective risk adjusted care patterns based on actual cost of care – not charges?
  • What are the characteristics of patients that can predict the level of non-compliance with discharge orders and the probability of re-admissions?

The challenge of answering these questions is best illustrated by the complexity of the data bases. A standard electronic health record for a patient will have over 2,700 fields. A charge master for a hospital can easily contain 20,000 separate services and prices. Traditional statistical methods flounder in this environment.

Fortunately, data mining professionals (particularly in retail) have developed new tools such as market basket analysis, classification algorithms, association rules, cluster analysis and neural networks to understand these massive data bases. Hopefully, these techniques will soon migrate to health care to support substantial improvements in care delivery.

To learn more about how the new tools of data mining and other technologies are changing the business of health care, attend the UST Executive Conference on the Future of Health Care on Friday, November 9, 2012 at the University of St. Thomas Minneapolis campus.

Financing, Health Policy, Leadership, Operations Improvement

The Health Care Execution Challenge

This article was originally published in the spring 2012 issue of B. Magazine.

Health care organizations lag behind most successful businesses in executing high-quality business plans

In 2001, the Institute of Medicine published Crossing the Quality Chasm, a seminal work identifying the chasm between what is known about providing high-quality health care and what actually is being delivered. Ten years later, this chasm still exists and was a key factor leading to the publication of Make It Happen: Effective Execution in Healthcare Leadership, a book published by Health Administration Press, a division of the Foundation of the American College of Healthcare Executives.

As director of the Center for Health and Medical Affairs at the Opus College of Business, I long have been engaged in the health care delivery system throughout the Midwest and the nation. The focus of the center is to “support improvements in the leadership and management of health care systems through research, community outreach and the collaborative development of innovative professional and executive education programs.” Conducting research for and writing this book not only furthered the goals of the center but can, as a member of HAP’s editorial board notes, “advance health care leaders from developing a plan and letting it sit on the shelf to full and robust execution.”

The Challenge

The failure to execute is a common problem in many organizations but more so in health care. Barriers include an incredibly complex system, splintered leadership, strategies that vacillate between financial goals and patient care, and no external pressure strong enough to force change.

Effective execution, however, is the key to high performance for most of America’s successful corporations. Executing strategies effectively and quickly is well-known in the general business world, but it appears not to have crossed the chasm into the health care field. One way to bridge this gulf is to provide more effective education and training to health care leaders nationwide in the area of practical and efficient execution.

In 2009, during the Health Care UST MBA Washington, D.C., seminar, I had the opportunity to meet Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality. A primary goal of AHRQ is to improve the processes needed to effectively move major clinical research findings from scientific literature to widespread use by the clinician.

AHRQ agreed to provide funding to the Opus College of Business to develop a new, effective execution curriculum for health care leaders and managers. For more than a year, I consulted with OCB faculty members on best business practices outside of health care and also visited some of the leading health care delivery organizations in the Midwest, including HealthPartners, Essential Health – Duluth, Marshfield Clinic in Marshfield, Wis., and Twin Cities Orthopedics to examine their systems for execution.  Continue Reading

Financing, Health Policy

How much will my health insurance cost?

With the Supreme Court ruling the Affordable Care Act constitutional, attention is now shifting to the details of the law – especially how the individual market will function in the insurance exchanges.

I had the opportunity to work on the Clinton health reform plan in 1992–1993. As part of this work, the White House sent us to various groups to present the proposed plan. I usually spoke to provider groups. At the beginning of the presentation, I always asked the audience to “Please raise your hand if you know someone who is uninsured or who has difficulty getting health insurance.” Almost all the hands in the room were raised.

My guess is that this question would yield similar results today. Although it’s likely that many health professionals are already working on implementing sections of the ACA (such as ACOs, medical homes, reducing re-admissions, etc.), they may not have paid a lot of attention to the individual market insurance details. Here are some basics to remind us of the details and some resources to share with any friends who are uninsured.  Continue Reading

Leadership

Catholic Health Care Leadership

32139066_smBuilding on more than 20 years of graduate and professional education for health care leaders, the University of St. Thomas is pleased to announce a new program in Catholic Health Care Leadership. The program is designed to increase the mission alignment within executive teams who are dealing with profoundly complex leadership issues while caring for patients as an expression of the healing ministry of Jesus.

“One of the needs for a program like this is that Catholic health care organizations competing in today’s marketplace need to be distinctive,” stated the program’s lead faculty, Michael Naughton, Ph.D. “What is crucial to the distinctiveness of Catholic health care is to have leaders who have a deep sense of what it means to be leading a Catholic health care system.”

The program’s admissions advisor, Marlin Meendering, M.Div., has spoken with leaders of more than sixty Catholic health care organizations across the U.S.  Reflecting on those conversations, Marlin stated, “Most Catholic health care systems are already heavily invested in ministry formation or mission integration programs. Our program will complement their efforts because our focus is on leadership formation, especially for physicians. How do a physician and his/her team effectively lead within the context of Catholic health care? Because of our experience in leadership formation, we are confident that the program will refine critical leadership skills, deepen understanding, strengthen team effectiveness, and increase personal career satisfaction.”

This leadership program integrates the important requirements for executive development with the unique dimensions of formation in Catholic health care. The program will include four quarterly modules of four days each and has these distinctive features:  Continue Reading

Leadership

Leadership at the Marshfield Clinic

Dr. Laura Nelson, Chief Medical Officer, Marshfield Clinic

Dr. Laura Nelson, Chief Medical Officer, Marshfield Clinic

On December 2, 2011, the University of St. Thomas held its graduation ceremony for its 17th cohort of the Health Care UST MBA. The commencement speaker was Dr. Laura Nelson who is the Chief Medical Officer of the Marshfield Clinic and a 2001 graduate of the Health Care UST MBA program.  

She spoke about the challenges of leadership in today’s chaotic environment and presented a list of key “leadership survival” insights that she has learned thus far. The Marshfield Clinic is one of the best delivery systems in the country and much of their success is due to leaders such as Dr. Nelson.

She shared with the graduating class some of her observations on what it takes to be a successful leader:  Continue Reading

Financing, Health Policy, Leadership, Operations Improvement

Industry Insight: The future of coverage and care delivery

37878562This post is part of the Industry Insight series which is designed to highlight the most significant new reports on health care management or policy–ranging from government reports to health care business studies.

We will highlight and briefly analyze reports that may be useful to the thoughtful and busy health care leader. Our health care programs at the Opus College of Business emphasize leadership, organizational transformation, and operational excellence. The reports we select will reflect these themes and can be helpful in strategy formulation, operations improvement and leadership activities. 

This series will show you at a glance what you need to know about current developments in health care management and policy.

This edition features:

  • The Oregon Health Insurance Experiment. Does having health insurance improve health?
  • Modernizing Rural Health Care: Coverage, Quality and Innovation. What is the state of rural health care in America and where is it going?
  • Large Employers’ 2012 Health Plan Design Changes. What is the future of employment-based insurance?

Continue Reading

Financing, Health Policy, Leadership, Operations Improvement, Uncategorized

Essential benefits and the battles to come

A key part of the Affordable Care Act (ACA) is the creation of state-based Health Insurance Exchanges to offer individuals and small business a standardized health insurance product. These policies will resemble benefit packages of small employers. Each of these health plans in the Exchange must provide an “essential benefit set” of services. But what does that mean?

In 1993 President Clinton’s task force on health care reform decided to define the essential benefit set as part of his health care reform proposal. A significant amount of the opposition to his plan was from provider groups that were excluded.

In 2010 the architects of the Affordable Care Act took this lesson to heart and developed a multi-step process which would define the essential benefit set of services over a number of years. First, the Institute of Medicine was asked to develop a process and guidelines for the initial development of and long-term updates to the benefit set. Their report was recently released and can be found here.

The second step is to define the essential benefit set; this will be done by HHS staff and their recommendations will be available in May, 2012. HHS has had a reasonably good track record of resisting pressure from provider groups to expand the Medicare benefit set significantly, so this initial set should meet the cost goals of the ACA.

A third component of the process allows state exchanges to modify the essential benefit set if the results are actuarially equivalent in cost. Here is where the challenge begins and the states’ history regarding benefits is not encouraging.

Most states currently have “mandated benefits” for fully insured products within the state. Over the years various provider groups have lobbied for the inclusion of their services into the mandated benefits which have made this type of insurance very expensive. Most reasonably sized companies have become “self-insured” to escape these mandates. For example:

chart10192011

Source: Perspectives on Essential Benefits — Workshop Report — Institute of Medicine

Because of this history, look for intense state legislative battles in the coming years among providers as they lobby to ensure their services are included as essential benefits. The actuarially equivalent definition will undoubtedly be stretched and vigorously debated. Some of the benefits that have been controversial in the past include:

  • Cosmetic surgery
  • Chiropractic care
  • Dental care
  • Care that is supportive but not clinical
  • In vitro fertilization
  • Experimental services, particularly drugs
  • And many more . . . .

Each state will face this challenge as they create their Health Insurance Exchange and they will struggle to keep the cost of health insurance affordable — which is, of course, the name of the law.

See how Minnesota is facing this challenge and others related to the implementation of health care reform at the UST Executive Conference on the Future of Health Care on Friday, October 28 in Minneapolis, MN.

This post was originally published October 19th on MedCity News.