Financing – High Performance Health Care
Browsing Category


Financing, Health Policy, Leadership, Operations Improvement

Improved Economic and Employee Health is Goal of Blue Zones Strategies

37740635By Stephanie Hegland, MBA

In this age of health care reform, corporations are looking to innovative care delivery models – such as accountable care organizations and patient-centered medical homes — to bend the proverbial cost curve by improving the health and well-being of their employees. Recently, Kare 11 News profiled a different approach to improving employee health by implementing Blue Zones principles.

Salo, Oberon and NumberWorks – three affiliated Minneapolis contract staffing companies – became the first organizations to seek a Blue Zones Certified designation. “Workplaces with greater well-being have fewer health care costs and are among the best places to work,” said Dan Buettner, founder of Blue Zones, when he introduced the six-month initiative last September. The Blue Zones Certified Workplace designation is his effort to systematically create an environment of health by focusing on four optimal behaviors: move naturally, have the right outlook, eat wisely, and connect with family and friends.

Collectively, Blue Zones principles represent what Buettner has discovered during his global research to identify communities where more people reach the age of 100 than anywhere else, communities which he termed Blue Zones. Continue Reading

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

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, Leadership, Operations Improvement

Initiatives for Responding to Health Care Reform

By Noi Oan, Full-time UST MBA class of 2013

On June 27, I was excited to leave work a little early to attend the “Initiatives for Responding to Health Care Reform” event at the University of St. Thomas. It was one day before hearing the decision from the Supreme Court regarding the future of the Affordable Care Act. Curiosity and anticipation of what going to happen next was the main driver for me to come to the event.

The panel included Jim Eppel, chief operating officer of Blue Cross Blue Shield of MN, Brian Rice, the vice president of Network and ACO Integration at Allina, and John Herman, the president of Fairview Northland Hospital and Maple Grove Medical Center. Dan McLaughlin, the director of the Center for Health and Medical Affairs, moderated the event.

Each panelist brought to the table a unique perspective about the current health care system and the necessary moves to a better future for their organization. However, one theme arose as the common ground for all panelists: the necessity of patient engagement to improve health quality and control total cost of care. 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

Financing, Leadership, Operations Improvement

A Focus on Women’s Health

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

Dr. Donna Block ’05 M.B.A. has opened two women-centered clinics that provide care to women, by women

By Lisa Guyott

Women’s health issues have traditionally been narrowly defined as those specific to the female anatomy and to issues surrounding reproductive health. As late as the early 20th century, a large portion of health concerns brought forward by women were attributed to the catch-all diagnosis of “hysteria,” an ailment which had more symptoms than the common cold and could potentially be cured by bed rest, bland food, seclusion and, most importantly, refraining from taxing tasks such as reading or writing. Laundry, housekeeping, child care and cooking were still permissible.

Today, a rapidly growing number of organizations and practitioners include in the definition of women’s health not only reproductive health, but social and emotional well-being. As defined by the World Health Organization, the topic of women’s health includes biological differences between men and women as well as the study of those illnesses unique to women, more common or serious in women, with distinct occurrences in women, or with different outcomes or treatments in women. Since the 1980s, research on gender differences in health and disease has influenced new treatment and prevention of serious illnesses, including heart disease, stroke, lung cancer and depression.

Clinic Sofia in Edina subscribes to this revised and expanded definition. Launched in 2004 by Dr. Donna Block ’05 M.B.A., the clinic’s mission is to “nurture a community of confident, healthy women,” a mission taken seriously not only by Block, but by the all-woman staff and the clinic’s clients.

The clinic’s name evokes Sophia, the Greek goddess of wisdom, fertility and nurturing. Its waiting room is the first and most visible sign of this mission. Bearing a greater resemblance to a 19th-century literary sálon than a medical office, it is furnished in comfortable couches and lounge chairs. A large bowl of chocolates sits on a side table and soft music issues from a portable CD player. The waiting room also is an exemplar of the clinic’s – and Block’s – approach to business: a carefully crafted, deliberate implementation of disciplined intuition.

Continue Reading

Financing, Leadership

What Would You Do? UCare’s Ethical Dilemma

This post is republished from the Opus Magnum blog. The story was originally published in the Business Ethics Exchange, the newsletter from the Center for Ethical Business Cultures. Let us know your opinion in the comments.

By Ron James

“No good deed goes unpunished.” That’s the message Nancy Feldman, president and CEO of UCare gave to the commissioner of Human Services for the State of Minnesota as her organization returned profits (surplus gains for a nonprofit) to the state. Speaking to a packed house at the 12th Annual Minnesota Business Ethics Awards co-sponsored by the Center for Ethical Business Cultures, Feldman provided insights into her organization’s ethical culture, an ethical dilemma UCare faced and the resulting aftermath following its decision to return $30 million of gains to the State of Minnesota.

UCare is a unique health plan serving 225,000 low-income families and children, and Medicare and Medicaid members in Minnesota. Of its $1.7 billion in revenue last year, 40 percent came from state government and 60 percent from the federal government, placing government in the dual role of regulator and purchaser of its services. As the leader of this mission-based nonprofit, Feldman personally meets with all new employees to plant the seeds of the UCare mission and values into their hearts and minds. Integrity is the first key value.

Earlier this year, the value of integrity was placed in the spotlight. Due to a number of factors, including better efficiencies, improving the health care of its members, healthier people coming into the plans because of the recession and decreases in health care utilization, UCare realized strong “earnings after expenses” gains. This resulted in $30 million beyond the “two months reserves” it normally sets aside. Stimulated by a board of directors discussion, UCare considered a range of options to utilize the additional gains. But given the State of Minnesota’s $5 billion budget shortfall, UCare ultimately decided to return it to the state’s treasury.

Despite UCare’s best intentions, many voices emerged with a variety of agendas attempting to use the contribution for a variety of purposes. Feldman explained that given their unique relationship with the state government as a funder, this was the right thing to do for UCare and that this may not be applicable to other situations. But once started, the events took on a life of their own.  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, Leadership, Operations Improvement

America’s Health Insurance Plans (AHIP) Summit on Shared Accountability

39169852By Tina Morey

Recently, America’s Health Insurance Plans (AHIP) gathered some of the nation’s most innovative plans and providers together to discuss their accountable care models with the expectation to share outcomes, successes and failures. The hope was to spur on creativity for possible duplication in other markets.

Among the models, several common themes emerged, including collaboration between the plans and providers, focus on the triple aim and creating long-term relationships.  Many of the groups discussed the change from a combative payer/provider relationship to one of a partnership in an effort to optimize each organizations bottom line. In fact, there were several groups represented whose pilot was multi-stakeholder — multiple plans, providers, employer groups, etc. Competition was put aside for the best interest of the community.

Continue Reading

Financing, Health Policy, Leadership, Operations Improvement, Uncategorized

Ask the health care expert!

19172737Do you have questions about health care leadership skills, management, physician leadership, operations improvement, business intelligence, or strategy; health care reform and the Affordable Care Act; education and careers in health care; or other industry topics?

Whether you’re a student, novice, or a seasoned health care professional, our experts are here to help! Send us your questions, no matter how simple or complex, and faculty from the UST health care programs will respond to your questions on the High Performance Health Care blog.

To submit a question, simply leave a comment below or tweet it to @USThealthcare. Ask a question anonymously or specifically about your business – it’s up to you. Take advantage of this opportunity to get practical advice from our business and health care experts!