/ en Fri, 25 Apr 2025 20:17:51 -0500 Tue, 16 Jan 24 12:04:30 -0600 /value-of-health-systems <div><div class="panel-heading"><h3><span>RESOURCES</span></h3></div><div class="row rowEqual_768"><div class="col-md-4"><div class="panel module-typeC"><div class="panel-body"><div class="row"><div class="col-md-12"><h4 class="text-align-center"><span>Featured</span></h4></div></div><p><a href="/costsofcaring"><span>AHA Report: Cost of Caring</span></a></p><p><a href="/guidesreports/2021-08-16-hospital-merger-benefits-econometric-analysis-revisited"><span>Charles River Associates Report: Hospital</span></a></p><p><a href="/guidesreports/2020-02-05-eight-myths-about-hospital-mergers-and-acquisitions"><span>Eight Myths About Hospital Mergers and Acquisitions</span></a></p><p><a href="/fact-sheets/2021-05-18-key-messages-consolidation"><span>AHA Members Only: Key Messages on Consolidation</span></a></p><p><a href="/standardsguidelines/2021-10-08-partnerships-mergers-and-acquisitions-can-provide-benefits-certain"><span>Partnerships, Mergers, and Acquisitions Can Provide Benefits to Certain Hospitals and Communities</span></a></p><div class="row"></div></div></div></div><div class="col-md-4"><div class="panel module-typeC"><div class="panel-body"><div class="row"><div class="col-md-12"><h4 class="text-align-center"><span>Related </span></h4></div></div><p><a href="/system/files/media/file/2021/11/advert-rpollack-WSJ-1121.pdf" target="_blank"><span>WSJ Advertorial: Fighting for Fair Health Insurance </span></a></p><p><a href="/guidesreports/2021-08-16-anticompetitive-conduct-commercial-health-insurance-companies"><span>Anticompetitive Conduct by Commercial Health Insurance Companies</span></a></p><p><a href="https://www.ama-assn.org/delivering-care/patient-support-advocacy/competition-health-insurance-research" target="_blank" rel="noopener nofollow"><span>Competition in Health Insurance, 2019 Update. American Medical Association</span></a></p><p><a href="/system/files/media/file/2021/05/advert-rpollack-WSJ-0521.pdf" target="_blank"><span>WSJ Advertorial: Value of Health Systems Shown Clearly During the Pandemic</span></a></p><div class="row"> </div></div></div></div><div class="col-md-4"><div class="panel module-typeC"><div class="panel-body"><div class="row"><div class="col-md-12"><h4 class="text-align-center"><span>The Value of Systems during COVID</span></h4></div></div><p><a href="/white-papers/2021-12-14-better-together-value-scale"><span>Better Together: The Value of Scale – Providence</span></a></p><p><a href="/infographics/2021-07-19-covid-19-response-resilient-integrated-network-protects-patients-employees"><span>Sutter Health COVID-19 Response: Resilient Integrated Network Protects Patients, Employees & Community</span></a></p><p><a href="/case-studies/2021-06-01-value-health-systems-during-covid-19-pandemic-spectrum-health-grand-rapids"><span>The Value of Health Systems During the COVID-19 Pandemic Case Study: Spectrum Health – Grand Rapids, Mich.</span></a></p><p><a href="/case-studies/2021-06-02-value-health-systems-during-covid-19-pandemic-advocate-aurora-health"><span>The Value of Health Systems During the COVID-19 Pandemic Case Study: Advocate Aurora Health – Milwaukee, Wisc.</span></a></p><p><a href="/case-studies/2021-06-02-value-health-systems-during-covid-19-pandemic-ohiohealth-columbus-ohio"><span>The Value of Health Systems During the COVID-19 Pandemic Case Study: OhioHealth – Columbus, Ohio</span></a></p><div class="row"> </div></div></div></div></div></div> Tue, 16 Jan 2024 12:04:30 -0600 Hospital Field Realignment /news/headline/2023-08-09-aha-letter-editor-report-hospital-mergers-omits-their-benefits <p>In a letter to the editor published by Modern Healthcare, AHA President and CEO Rick Pollack responds to a recent report on hospital consolidation from Elevance Health — the large, for-profit commercial insurer formerly known as Anthem that dominates many insurer markets and earned nearly $2 billion in net profit in the second quarter of this year alone. <strong><a href="https://www.modernhealthcare.com/opinion/hospital-mergers-benefits-american-hospital-association-rick-pollack" target="_blank">READ MORE</a></strong></p> Wed, 09 Aug 2023 14:45:43 -0500 Hospital Field Realignment /lettercomment/2023-08-01-ftc-urged-extend-comment-period-draft-merger-guidelines <p>August 1, 2023 </p> <p>April Tabor <br /> Secretary <br /> Federal Trade Commission <br /> 600 Pennsylvania Avenue NW Suite CC-5610 (Annex C) <br /> Washington, DC 20580 </p> <p><strong>Re: Request for Extension on Comments for Draft Merger Guidelines (FTC-2023-0043) </strong></p> <p>Dear Ms. Tabor: </p> <p>The undersigned organizations request that the Federal Trade Commission and the Department of Justice extend the comment period for the Draft Merger Guidelines for a minimum of an additional 60 days. Collectively our associations represent a wide range of members that report transactions that undergo merger review. </p> <p>An extension would serve the interests of both the public and the agencies by allowing adequate time for more fulsome responses to the proposed revisions to the merger guidelines, which are designed to reshape U.S. merger policy and capital markets. A typical year sees more than 2,000 mergers, whose aggregate value approaches $3 trillion. The draft merger guidelines have the potential to impact all of these transactions. </p> <p>As evidence of the importance and complexity of these issues, the agencies themselves took around fifteen months to complete the draft merger guidelines after the close of the previous comment period in March 2022. The length of time it has taken the agencies to produce this draft demonstrates that any urgency to the issue is outweighed by the importance of careful consideration of these complex issues. Further, the agencies have also proposed sweeping revisions to the HSR Rule, with a comment period that significantly overlaps the comment period to respond to the draft merger guidelines. </p> <p>The agencies are best served if they receive quality feedback. To allow sufficient time for detailed comments, we ask that you grant an extension of at least 60 days. </p> <p>Thank you for your consideration of this matter.</p> <p>Sincerely,</p> <p>American Coatings Association<br /> ���������� Association<br /> American Investment Council<br /> Alternative Investment Management Association<br /> Biotechnology Innovation Organization (BIO)<br /> Business Roundtable<br /> Consumer Technology Association (CTA)<br /> Consumer Brands Association<br /> Computer & Communications Industry Association<br /> Engine<br /> Federation of ����������s<br /> Information Technology Industry Council (ITI)<br /> NACS I Advancing Convenience & Fuel Retailing<br /> National Association of Manufacturers<br /> Metals Service Center Institute<br /> Pharmaceutical Research and Manufacturers of America (PhRMA)<br /> Retail Industry Leaders Association<br /> Software & Information Industry Association (SIIA)<br /> TechNet<br /> US Chamber of Commerce</p> Tue, 01 Aug 2023 13:42:53 -0500 Hospital Field Realignment /advancing-health-podcast/2022-05-24-special-edition-insurers-white-bagging-drug-policy-threatens <p>Increases in consolidation and alignment between commercial health plans and pharmacy benefit managers have resulted in a series of business practices designed to steer patients to insurer-affiliated pharmacies and away from patients’ longstanding providers to the detriment of patient care. Under new policies being implemented by a number of large commercial insurance companies, they steer patients to third-party specialty pharmacies – often owned by the same parent company as the insurer – to acquire medication necessary for clinician-administered treatments, such as chemo infusions. Commonly referred to as “white bagging,” this practice raises significant patient safety issues, results in frequent delays in care and shifts tremendous administrative burden to hospitals to reconcile these policies on behalf of their patients. To examine this concerning trend, we hear from Mark Howell, AHA’s director of policy and patient safety, and Michelle Millerick AHA’s senior associate director of health insurance coverage policy.</p> <hr /> <p></p> <div><a href="https://soundcloud.com/advancinghealth" target="_blank" title="Advancing Health">Advancing Health</a> · <a href="https://soundcloud.com/advancinghealth/special-edition-insurers-white-bagging-drug-policy-threatens-patient-safety" target="_blank" title="[Special Edition]: Insurers’ “white bagging” drug policy threatens patient safety">[Special Edition]: Insurers’ “white bagging” drug policy threatens patient safety</a></div> <p> </p> Tue, 24 May 2022 13:07:21 -0500 Hospital Field Realignment /advisory/2021-08-12-doj-and-ftc-investigations-employee-no-poach-agreements <h2>At A Glance</h2> <p>The Antitrust Division of the Department of Justice (DOJ) and the Federal Trade Commission (FTC) (together, the “Antitrust Agencies”) have dramatically increased their enforcement actions against “no-poach” agreements, where companies agree not to recruit or hire each other’s employees. DOJ is now bringing criminal prosecutions of no-poach agreements on a regular basis.</p> <p>The Antitrust Agencies’ reinvigorated enforcement of “no-poach” agreements is consistent with President Biden’s recent Executive Order (EO) on Competition in the American Economy. That order singled out non-compete and “other clauses or agreements that may unfairly limit worker mobility” for increased scrutiny.</p> <p>To help hospitals and health systems reduce their risks of prosecutions of no-poach agreements, the AHA enlisted the law firm of Wilson Sonsini for an in-depth analysis of the DOJ’s and FTC’s policies and insights on how the hospital sector should respond. This Legal Advisory is the latest in a series of resources that we will provide on this issue to ensure that AHA members are informed about important legal developments.</p> <h2>AHA Take</h2> <p>Hospitals and health care systems should expect the federal antitrust agencies to be even more aggressive in investigating and prosecuting ‘no-poach’ agreements. A good first step to avoid running afoul of the agencies would be to review any relevant agreements against the “Practices and Protocols to Reduce Risk” outlined in this advisory.</p> <h2>What You Can Do</h2> <p>Share this advisory with your human resources department, legal counsel, and others engaged in recruiting and/or setting employee compensation and benefits.</p> <ul> <li>Review the 2016 Antitrust Guidance for HR Professionals issued by the FTC and DOJ and consider its application to your organization and activities.</li> <li>Adopt an antitrust compliance program for your organization to lessen risk.</li> </ul> <p>Sign in to download the entire Legal Advisory. </p> Thu, 12 Aug 2021 11:47:59 -0500 Hospital Field Realignment /special-bulletin/2021-07-09-president-signs-executive-order-promote-economic-competition <p>President Biden today signed an <a href="https://www.whitehouse.gov/briefing-room/presidential-actions/2021/07/09/executive-order-on-promoting-competition-in-the-american-economy/">executive order</a> (EO) establishing a “whole-of-government” effort to promote competition in the American economy. The EO includes 72 initiatives by more than a dozen federal agencies to tackle competition issues across the economy, including in health care, financial services, technology and agriculture. It also establishes a White House Competition Council to coordinate, promote and advance federal efforts to improve competition in the American economy.</p> <p>The EO, which does not have the force of law or regulation and rather serves to provide direction to federal agencies, contains a number of provisions directed at drug manufacturers, hospitals and health insurers.</p> <p>Highlights of the EO that are important to hospitals and health systems, as well as AHA’s statement follow.</p> <h2><span><b>AHA Take</b></span></h2> <p>In a <a href="/press-releases/2021-07-09-statement-executive-order-competition">statement</a> shared with the media, AHA President and CEO Rick Pollack said, “Today’s executive order is expansive, establishing an all-of-government effort to promote competition across many sectors of the economy. With health care, the executive order targets drugs costs and commercial health insurance plans, and hospitals and health systems as well, among others.</p> <p>“In fact, with commercial health insurance plans, nearly three out of four markets were highly concentrated in 2019 and the top five largest insurers alone control nearly 50% of the market. Studies have found that when an <span>insurance market is highly concentrated, insurers reduce provider payments and do not pass savings along to the consumer. We urge federal agencies to focus on policies that address in a meaningful way competition among commercial health insurers.</span></p> <p>“However, today’s executive order falls short in several ways. For example, it does not recognize the exceptional value and essential services health systems provide to their patients and communities each day. This has been highlighted during the public health emergency of COVID-19. The pandemic challenged hospitals to transform their operations, which included rapidly expanding telemedicine services, overcoming shortages of equipment and drugs, retooling operations and reconfiguring space to provide life-saving care for patients and protect others from contracting the virus. Many  hospitals were also called upon to backstop an inadequate public health response by providing information, counseling and vaccinations as those became available. </p> <p>“Additionally, it is important to stress that hospital mergers and acquisitions undergo an enormous amount of rigorous scrutiny from the federal antitrust agencies and state attorneys general.</p> <p>“Finally, contrary to statements in the executive order, health systems can be a particularly important option for retaining access to hospital services in some rural communities. Mergers with larger hospital systems can also provide community hospitals the scale and resources needed to improve quality and decrease costs.”</p> <h2>Summary of Major Provisions in the Executive Order</h2> <h3>Hospitals</h3> <p>The EO encourages the Department of Justice (DOJ) and Federal Trade Commission (FTC) to review and revise their merger guidelines and directs the Department of Health and Human Services (HHS) to support existing hospital price transparency rules and to implement new price transparency provisions included in the No Surprises Act. The FTC has work underway to understand the effect of physician group and health care facility mergers, and HHS’ efforts to implement price transparency regulations have been ongoing. The EO suggests that consolidation among hospitals has led to high prices and inadequate access to health care services in rural communities.</p> <h3>Prescription Drugs</h3> <p>The EO aims to address high drug prices and lack of competition among drug manufacturers. It directs the Food and Drug Administration (FDA) to work with states and tribes to safely import prescription drugs from Canada, pursuant to the Medicare Modernization Act of 2003; directs HHS to increase support for generic and biosimilar drugs and instructs the department to issue a comprehensive plan within 45 days to combat high prescription drug prices and price gouging; and encourages the FTC to ban by rule “pay for delay” and similar agreements. It also reiterates the Administration’s support for legislative efforts to allow the Medicare program to negotiate drug prices, among other policies.</p> <h3>Health Insurers</h3> <p>The EO aims to address consolidation in the health insurance industry, which has led to many consumers having little choice when it comes to selecting insurers. Specifically, it directs HHS to standardize plan options in the federal Health Insurance Marketplace so people can comparison shop more easily.</p> <h3>Non-complete Clauses</h3> <p>The EO suggests that non-compete clauses and other types of contractual agreements limit workers’ ability to change jobs without making a specific reference to any industry, such as health care. The EO directs the FTC to use its rulemaking authority to curtail unfair use of such clauses.</p> <h3>Other Issues</h3> <p>Among other actions, the EO calls on the DOJ and FTC to enforce the antitrust laws vigorously and says that enforcement should focus on labor markets, agricultural markets, health care markets and the tech sector. The EO also recognizes that the law allows the agencies to challenge past mergers that previous Administrations did not challenge. The EO reiterates the Administration’s support for implementing a public health insurance option.</p> <h2>Further Questions</h2> <p>If you have questions, please contact AHA at 800-424-4301. </p> Fri, 09 Jul 2021 15:16:31 -0500 Hospital Field Realignment /case-studies/2021-06-02-yale-new-haven-hospital-saint-raphael-integration-progress-review <h2>Overview</h2> <p>On September 12, 2012, Yale New Haven Hospital (YNHH) acquired the assets of the former Hospital of Saint Raphael, located within blocks of each other in New Haven, Connecticut. The results achieved have exceeded expectations across all performance dimensions, including the efficient expansion of clinical programming at an otherwise underutilized campus, significant cost savings, and a stabilized workforce. The Saint Raphael Campus has become the growth engine for the medical center, and houses a number of key centers of excellence, such as musculoskeletal and specialty geriatric care.</p> <div class="row"> <div class="col-md-6"> <h2>Infrastructure Investments</h2> <p>To date, YNHH has invested over $240 million in the Saint Raphael Campus, making efficient use of a previously underutilized campus to increase access to local care. The investments include the implementation of Epic, replacement of chillers, generators, upgrade of interventional cardiac laboratories, creation of an ambulatory surgical center (McGivney Advanced Surgery Center) and renovation of five inpatient units (Sister Louise Anthony 3 and Verdi 4 North, Verdi 4 East, Verdi 4 West and Main 6).</p> </div> <div class="col-md-6"> <p><img alt="Saint Raphael Campus Verdi 4 North" data-entity-type="file" data-entity-uuid="b7b86a98-ca8c-44ff-a8a6-4b28f19266c2" src="/sites/default/files/inline-images/Yale-New-Haven-Saint-Raphael-Integration-Verdi-4-North.jpg" width="423" height="282" class="align-right"></p> <p><em>Verdi 4 North</em></p> </div> </div> <div class="row"> <div class="col-md-6"> <p><img alt="Saint Raphael Campus Verdi 4 West" data-entity-type="file" data-entity-uuid="eb4ea73d-70cd-40c3-8209-05d814ca0d3b" src="/sites/default/files/inline-images/Yale-New-Haven-Saint-Raphael-Integration-Verdi-4-West.jpg" width="390" height="254" class="align-left"></p> <p><em>Verdi 4 West</em></p> </div> <div class="col-md-6"> <p>To support the growth of musculoskeletal services, YNHH renovated two 17-bed units, Verdi 4 North and Verdi 4 East units. The units were designed specifically to meet all aspects of musculoskeletal patient care needs. YNHH also created the McGivney Advanced Surgery Center, which specializes in same-day hip and knee replacements. Patient comments regarding their experience at the Surgery Center have been very positive.</p> <p>Verdi 4 West underwent extensive renovations to become a 22-bed specialty geriatrics care unit. The unit was designed to establish a prototype of advanced safety and acute care for the elderly. It was designed by renowned architect Michael Graves, and includes innovative features for fall prevention and cognitive support.</p> </div> </div> <h2>Clinical Care</h2> <p>Consistent with the commitments made to the Federal Trade Commission and the Connecticut Office of Healthcare Access, a common core of medical, surgical and emergency services was created at both campuses. Cardiac surgery, pediatrics, obstetrics and major trauma services were consolidated to the York Street Campus. Bariatric services, specialty geriatric and adult non-trauma/oncology musculoskeletal services were consolidated to the Saint Raphael Campus. The consolidation of specialty services provided a growth path to provide specialized and targeted care for these patient populations, while putting to best use in an efficient way the infrastructure of the Saint Raphael campus as a destination for certain specialty care.</p> <div class="row"> <div class="col-md-6"> <p><img alt="Saint Raphael Campus Expansion Rendering" data-entity-type="file" data-entity-uuid="6dc5c014-2f60-4efe-9ac4-7069dffd739b" src="/sites/default/files/inline-images/Yale-New-Haven-Saint-Raphael-Integration-SRC-Expansion-Rendering.jpg" width="463" height="261" class="align-left"></p> <p><em>Saint Raphael Campus Expansion Rendering</em></p> </div> <div class="col-md-6"> <p>Most recently, the Saint Raphael Campus has allowed YNHH to successfully care for over 6,150 COVID patients across our medical center and achieve one of the lowest mortality rates for academic medical centers nationally (8.8%). Without the Saint Raphael Campus, YNHH would have been unable to care for these patients in a safe manner due to capacity constraints driven by COVID that were otherwise alleviated by the ability to coordinate and plan across two campuses in New Haven, Connecticut.</p> </div> </div> <p>At the time of its acquisition of the Hospital of Saint Raphael, YNHH faced capacity constraints due to growing demand for inpatient care. The Saint Raphael Campus provided a much needed solution to serve patients and meet growing demand while avoiding a capital intensive build of a new tower on a new site in New Haven. Instead, YNHH was able to grow services within the existing infrastructure and footprint at the Saint Raphael Campus. As inpatient volume continues to grow, YNHH will now utilize the same infrastructure and footprint to house a new patient tower (which would have been much more expensive if built on a new site in the city). As announced in 2019, an $800 million investment will be made at the Saint Raphael Campus in the coming years to enhance access and create a center of excellence in clinical neurosciences. The 505,000 square feet project will include inpatient beds, interventional laboratories, operating rooms and advanced radiology services. Planned clinical programs include epilepsy, neurovascular, brain tumor and neuro-restorative care, among others.</p> <h2>Workforce</h2> <div class="row"> <div class="col-md-6"> <p>In order to make sure that YNHH had a strong workforce to provide patient care, and consistent with our organizational values, YNHH preserved employment for most Hospital of Saint Raphael employees who have provided a high-quality workforce to support the efficient growth of YNHH at the Saint Raphael Campus. Ultimately, 3,497 employees successfully transitioned to Yale New Haven Hospital at their existing pay rates on September 12, 2012, without any gaps in pay or benefit coverage. YNHH built a strong partnership with the Teamsters union at the Saint Raphael Campus, and established the Catholic Heritage Committee to ensure that we continue to respect the tenets and legacy of the Sisters of Charity of Saint Elizabeth, the founding sponsors of the Hospital of Saint Raphael.</p> </div> <div class="col-md-6"> <p><img alt="Saint Raphael Campus Clinicians with Healthier Together T-shirts." data-entity-type="file" data-entity-uuid="7a790b40-57b7-4c07-85f9-364c6d1a34dc" src="/sites/default/files/inline-images/Yale-New-Haven-Saint-Raphael-Integration-Healthier-Together-T-Shirts.jpg" width="442" height="282" class="align-right"></p> <p><em>SRC Staff with Healthier Together T-shirts.</em></p> </div> </div> <p>Since the integration in 2012, 2,477 current employees at the Saint Raphael Campus have benefited from a wage-market adjustment and over 1,100 are taking part in career ladders to further advance their careers within the organization. In addition, since 2012, 700 employees have been added to the Saint Raphael Campus, predominantly in clinical care (43%) and non-clinical support services (24%) positions.</p> <h2>Conclusion</h2> <p>The integration of the Saint Raphael Campus into Yale New Haven Hospital has provided us with much needed inpatient capacity to grow our clinical programs in a cost-effective manner. As of end of fiscal year 2020, $638 million had been achieved in terms of cost savings, significantly exceeding our initial cost saving estimates.</p> Wed, 02 Jun 2021 15:23:17 -0500 Hospital Field Realignment /case-studies/2021-06-02-value-health-systems-during-covid-19-pandemic-scl-health-broomfield <p>Health systems often serve as the major employer in their communities and serve as conveners of key stakeholders to leverage new strategies. SCL Health is honored to share insights from its President and CEO, Lydia Jumonville, about how being part of a health care system improves access to care, the top priorities for SCL Health over the next five years, the organizational transformation experienced at the system as a result of the pandemic, changes coming to SCL Health, and lessons about leadership during a crisis.</p> <h2>The Value of Being Part of a Health Care System</h2> <p>SCL Health is a faith-based, nonprofit healthcare organization with a mission of improving the health of the people and communities we serve, especially those who are poor and vulnerable. Our health network provides comprehensive, coordinated care through eight hospitals, more than 150 physician clinics, home health, hospice, mental health, and safety-net services, primarily in Colorado and Montana.</p> <p>The size and scale of our system benefit our patients because having multiple hospitals in different regions allows us to share best practices, resources, and information. However, we are small enough to be agile and flexible to adapt to the rapidly evolving challenges quickly.</p> <p>During the pandemic, we have proven that we are innovative and nimble when a crisis hits. To avoid the problems created by idle capacity, we will continue to work closely with emergency planners to be ensure there are enough resources on hand to scale up when the next challenge unfolds.</p> <p>While the last year was undoubtedly challenging for all of us, both personally and professionally, we have seen exceptional resiliency and commitment from our associates and caregivers. What is also amazing is how the pandemic brought all of us together as a truly unified system.</p> <p>A great example of this unfolded in our Montana hospitals, which didn't see a significant first wave of COVID-19 until late summer/early fall of last year. The situation with COVID-19 had stabilized somewhat during that period in Colorado. As we started to see challenges with staffing in Montana related to the pandemic, we could dispatch nurses and other caregivers from our Colorado hospitals who volunteered to travel to Montana to support their sister hospitals.</p> <h2>Looking Forward – Top Priorities</h2> <p>Our top priorities through 2025 fall under four categories:</p> <ul> <li>Aligned and Empowered Organization</li> <li>Growth</li> <li>Aligned Clinician Network</li> <li>Clinical and Operational Transformation</li> </ul> <h3>Aligned & Empowered Organization</h3> <p>Our associates are at the heart of our success, so creating an aligned and empowered organization is foundational to our ability to execute any of our strategic initiatives. We empower our associates by building an inspiring, supportive culture that embraces our core values to ensure everyone who comes to work for SCL Health feels they can make a difference. We have accomplished this in part by creating a unified SCL Health brand and experience for our associates, providers, and patients. We have also focused a lot of effort on associate recruiting, engagement, and retention.</p> <h3>Growth</h3> <p>As an organization, our goal is to be an essential provider with strength in the right geographies, specialties, and services in every community we serve, ensuring the healthcare needs of each community are addressed. We do not seek growth for the sake of gain; our goal is to advance our mission and pursue opportunities that enhance services across the care continuum to meet the unique needs of individuals in the communities we serve.</p> <p>Examples of this include:</p> <ul> <li>Building out our Front Range acute services and seeking opportunities to improve access to care across the care continuum</li> <li>Expanding statewide in Montana, mainly through partnerships and other strategies that help ensure access to quality, affordable care</li> <li>Building solid relationships in Western Colorado, including support for and partnerships with rural healthcare providers in the region</li> <li>Building on our leadership in key service lines in each area to best serve the needs of patients</li> </ul> <h3>Aligned Clinician Network</h3> <p>At SCL Health, we continue to focus on building a robust and aligned network of providers, creating an outstanding experience for them, giving them tools to increase resiliency, reduce burnout, develop their leadership skills, and foster a strong connection to our culture and mission. Expanding our primary care base is critical. So too is increasing our base of employed providers in select specialties, consistent with our service line strategies to minimize our continuity of care gaps for our patients.</p> <h3>Clinical & Operational Transformation</h3> <p>The healthcare environment is constantly evolving and changing. This means we must think differently about how we deliver care to our patients and keep up with the ways healthcare is shifting.</p> <p>To achieve this goal, we are focused on advancing strategies to ensure an outstanding patient experience, implementing continuous improvements in quality and safety with all of our care sites aspiring for CMS 5 Star, and leveraging technology and innovation to redesign care delivery and create greater efficiencies.</p> <h2>Transformation Facilitated by the Pandemic</h2> <p>From the beginning, we knew COVID-19 was going to be bigger than just one system or state could handle on its own; we were going to have to join forces on a whole new level and focus on collaboration, communication, and taking care of our associates.</p> <h3>Collaboration</h3> <p>In the early days of the pandemic, I brought together my fellow CEOs from other systems to discuss how we could work together as we were all navigating uncharted waters. Our CEO group then charged our Chief Medical Officers (CMOs) to meet and track, compare and share learnings throughout the pandemic. This type of information sharing across our organizations was unprecedented. The CMOS met daily during the height of the pandemic, and they continue to meet weekly.</p> <p>We included members of our Governor's team in these weekly meetings. We learned early on that collaboration was critical for us to understand, pivot, and address the needs of our frontline associates and patients during the surges.</p> <p>In addition, there are two examples of where we stepped forward to partner because the communities we serve needed us. We recently partnered to build a free-standing rehabilitation hospital in Montana. We are currently working to finalize a joint venture for a free-standing behavioral health hospital in Colorado.</p> <h3>Communication</h3> <p>Along with collaboration, we changed and increased our communication; we learned how to communicate through various channels consistently and concisely. We learned that our communications were held as sources of truth, as there were so many competing headlines and miscommunications in our communities.</p> <h3>Taking Care of Associates</h3> <p>We also chose to invest and take care of our associates from the very beginning. We put them first; they were all being impacted in so many different ways, both professionally and personally. Our leadership team came together, and we focused on resources from HR, Mission, and Philanthropy to help support our associates.</p> <p>One example of this in action came in March 2020 when we created an Associate Relief Fund that granted associates struggling financially because of COVID-19 a $1,000 grant. Our foundations and our donors stepped up to fund the program, which ended up providing 4,007 grants to our associates totaling just over $3.4M.</p> <h2>Changes Due to COVID-19 That Will Occur in the Mid- to Longer-Term?</h2> <p>We will continue to leverage what we stood up at the onset of COVID-19 and what has now become our "new normal." For example, we extended the use of our transfer center, centralized staffing support, and developed a systemwide command center. We also moved to financial forecasting instead of using a fixed budget. And we are very focused on Health Equity. The pandemic has shined a light on health inequities in our communities, and it is helping facilitate a broader discussion and focus on how we as an industry can look more strategically at addressing the challenge and setting up both short and long-term plans.</p> <p>The acceptance and advancement of telehealth are positives coming out of the pandemic. In March 2020, we launched new virtual and telehealth options for our patients to continue to receive needed medical care safely and effectively. Immediately, we saw hundreds of virtual appointments in Colorado and Montana. We now see consistent demand for virtual care options that are likely to stay well into the future.</p> <p>For our providers, there is a realization that virtual care and video visits will be something that we need to continue to offer in addition to in-person care. While there are still some appointments that require a hands-on approach, the convenience of virtual care for low-acuity needs is something our patients now expect and must be maintained. Our challenge is to make our virtual care as comprehensive as an in-person appointment while retaining the ease of access.</p> <h2>Leadership in a Crisis</h2> <p>The most important characteristics of a leader, especially in a time of crisis, are:</p> <ol> <li>collaboration</li> <li>team</li> <li>communication and transparency</li> <li>flexibility</li> <li>empathy</li> </ol> <h3>Collaboration</h3> <p>Collaboration was and is going to be essential for all of us moving forward. COVID-19 taught us so much about the power of partnership. For example, bringing health systems together to collaborate was critical to successful crisis response and greatly benefited the patients and communities we serve.</p> <h3>Team</h3> <p>The power of the group is the only way to come through a crisis successfully. Empowering individuals who bring the right skills needed to address the challenge and bringing them together to each own their role ensures success. A crisis can make or break a team, and for us, the way our team stepped up and worked together allowed us to come through COVID-19 even stronger and more unified than ever.</p> <h3>Communication and Transparency</h3> <p>In a crisis, communicating confidently, frequently, and transparently can make all the difference. Fear and uncertainty are high, and misinformation from outside sources can amplify these fears. Being open and positive while also being honest and transparent when things are challenging builds trust and confidence.</p> <h3>Flexibility</h3> <p>Recognize that you don't have all of the answers. It is critical to build a culture that allows for practical decision-making by the people closest to the situation. If a leader were to wait for answers to become crystal clear or stick to a strict chain of command, they would miss out their team's creative thinking, and we may miss critical opportunities.</p> <h3>Empathy and Connection</h3> <p>Work and personal lives have collided in an unprecedented way over the past year. It was essential that we took care of our team so that they in turn could meet the needs of our patients and communities. We must continue to show empathy and keep them connected to the team and to the organization.</p> Wed, 02 Jun 2021 11:28:18 -0500 Hospital Field Realignment /case-studies/2021-06-02-value-health-systems-during-covid-19-pandemic-ohiohealth-columbus-ohio <h2>Responding to the Pandemic: Testing, Supply Chain and Staff Support</h2> <p>Early in the pandemic, COVID-19 tests were shipped out of state, which lead to delays in patients receiving their results. In late March 2020, <strong>the OhioHealth Laboratory Services team developed the capability to run COVID-19 tests from around the system in our labs. A year later, over 500,000 tests have been analyzed by our lab team.</strong> OhioHealth Laboratory Services is able to read up to 2,200 tests per day, with PCR test results now available to the patient in six hours. Rapid test results, used in urgent cares and free-standing emergency departments, take under an hour.</p> <p><strong>OhioHealth had a dedicated supply chain team focused solely on personal protective equipment procurement for the entire system</strong> that ensured our front-line workers were never asked to work without proper PPE, even during the early days of the pandemic when the international supply chain was disrupted. This included accepting community donations and partnering with the nonprofit Battelle. OhioHealth was one of the first systems nationwide to engage with Battelle’s “Critical Care Decontamination System” to safely sterilize N95 masks so they could be reused as needed. <a href="https://newsroom.ohiohealth.com/today-show-young-couple-creates-new-system-to-clean-and-reuse-n95-masks/" target="_blank">Find more information on N95 mask sterilization.</a></p> <p><strong>Operating at “scale” allows resources to be redistributed in rapid time to meet critical needs. During the COVID-19 public health emergency, OhioHealth redeployed 20% of the administrative staff up to the front lines in roles such as unit clerks and vaccination processing teams.</strong> When non-emergent surgeries were paused, those staff members were also redeployed to other areas. <a href="https://newsroom.ohiohealth.com/columbus-dispatch-making-redeployment-rewarding/" target="_blank">Read a redeployed associate’s story.</a> We did not have layoffs or pay cuts due to the pandemic. In fact, our associates received “pandemic” bonuses as a “thank you” for their commitment. We are proud that we are able to care for those who care for our community. Being part of a system and having cash on hand made potential challenges, like layoffs, avoidable, even when we lost revenue over the past year from unexpected challenges, such as the statewide postponement of non-emergent surgeries.</p> <p>Systems create the ability to support the community in clinically significant numbers. We have the capacity to vaccinate 5,000 people per day as a system – this number simply would not happen if we were operating as individual hospitals. <a href="https://newsroom.ohiohealth.com/abc6-accessing-the-vaccine/" target="_blank">Learn more about how we keep our vaccine clinics running smoothly</a> – such as pharmacists pre-filling syringes and efficient registration.</p> <h2>Prioritizing Community Health</h2> <p><strong>The communities we serve (in 47 of Ohio’s 88 counties) benefit from OhioHealth’s mission to improve health and wellness.</strong> One of the most tangible measures of OhioHealth’s value to communities is the amount of “community benefit” we provide annually. OhioHealth is proud to reinvest in the community to improve the quality of care for patients and their families.</p> <p><strong>In fiscal year 2020, OhioHealth provided $479.1 million in community benefit, including $122 million in charity care for people who lack insurance or the means to pay for care, and more than $284.5 million in Medicaid costs not reimbursed by the state or federal government.</strong> The total exceeds our fiscal year 2019 support by nearly $30 million. Over 27,000 hours of service were completed by our associates, and over 220 associate leaders serve on boards and commissions in their communities.</p> <p><strong>OhioHealth worked with other health systems in the area, as well as an individual system, on a variety of initiatives during the pandemic to serve the community and our partners,</strong> including:</p> <ul> <li>OhioHealth partnered with the community to collect needed PPE and medical supplies to help prevent shortages for medical professionals treating COVID-19 patients. More than 1.1 million items were donated, with nearly 90% of the items used to protect front-line workers. When we no longer had a need for donated PPE, we provided those supplies to community partners, donating 100,000 items to nonprofit agencies throughout our footprint, who then distributed them to people in need.</li> <li>OhioHealth worked with the YMCA and Dedicated Senior Medical Centers to distribute more than 4,000 OhioHealth COVID-19 care packages, including hand sanitizer, masks and gloves to families and seniors in need. <a href="https://newsroom.ohiohealth.com/ohiohealth-gives-back-portion-of-donated-covid-19-supplies/" target="_blank">See local media coverage of this give-back event.</a></li> <li>OhioHealth partnered with Columbus Public Health and two other adult health systems in central Ohio to bring free, drive-through COVID-19 testing to underserved communities. <a href="https://abc6onyourside.com/news/local/columbus-unveils-free-drive-thru-testing-for-covid-19" target="_blank">Learn more.</a></li> <li>OhioHealth partnered with the Community Shelter Board, as well as city and county health departments, other local hospital systems and addiction medicine partners, to provide screening and care for patients experiencing homelessness, as well as training for their staff members. <ul> <li>We noticed patients experiencing homelessness were staying at the hospital after being tested because they couldn’t return to a shelter until their COVID-19 tests were known. OhioHealth worked with the Community Shelter Board to procure two hotels to serve as a shelter location for those who needed to quarantine while awaiting test results.</li> <li>OhioHealth also provided area shelters and YMCAs with needed supplies, like thermometers and access to N95 mask sterilization through our partnership with Battelle.</li> <li>One of our physicians and her team helped staff at shelters with education around proper PPE use and other infectious control protocols.</li> </ul> </li> <li>OhioHealth partnered with United Way of Central Ohio to support the United for Kids Summer Drive. Our associate volunteers helped package and deliver 1,500 kits to help kids stay active, learn and be happy.</li> <li>As businesses and organizations began to reopen, we wanted to continue our efforts to help keep the community safe. OhioHealth reached out to our nonprofit partners, chambers of commerce and local schools to offer complimentary OhioHealth Safety Signage Kits. The kits reflected Centers for Disease Control and Prevention guidelines for social distancing, mask wearing and hand washing. Kits included floor, seat and mirror clings and clings about donning/doffing PPE, all offered in a variety of sizes to fit each organization’s needs.</li> <li>OhioHealth partnered with the Columbus Urban League for a pop-up clinic, where 240 people in a traditionally underserved neighborhood were vaccinated. A trusted health care provider partnering with a trusted community partner led to this event filling up quickly.</li> <li>We know our state is home to many non-English-speaking people. In order to make sure that they had the opportunity to learn about the COVID-19 vaccine and get scheduled, we had our website translated into the five most common languages spoken in our communities.</li> <li>Systemness provides a single point of contact for government, which allows for more efficient communication and networking. We’ve partnered with the state and local community governments to provide physician expertise behind the scenes and at press conferences. Our physicians have also been spotlighted in statewide commercials encouraging COVID-19 mitigation strategies and encouraging vaccination.</li> </ul> <h2>Increasing Operational Efficiencies</h2> <p><strong>Streamlining our COVID-19 work as a system was top priority.</strong> A system incident command center was established for COVID-19, which was able through online WebEx video calls to interact daily with incident command centers at each hospital. During daily briefings, each hospital heard system updates and shared with the group their obstacles and successes, support and guidance. There was also an incident command phone number and email address available for hospital incident commanders to call with questions, ideas or feedback.</p> <h2>Maintaining and Expand Access</h2> <p><strong>Due to being a large system of over 35,000 physicians, associates and volunteers, we have the staffing and system support to provide easy access to COVID-19 testing and vaccinations in the communities we serve.</strong> Our goal is to make services convenient to where patients live and work, and OhioHealth was able to expand access for testing to the communities we serve in central Ohio and in the region. OhioHealth currently has vaccination sites at 13 different clinics to reach patients in all areas of our footprint.</p> <h2>Fueling Innovation</h2> <p><strong>Being a system allows us to use our IT platform to reach a much larger number of patients. We used MyChart to contact patients for vaccination awareness (through push alerts) and scheduling.</strong> Patients who were not comfortable scheduling online were able to call a staffed phone bank to schedule appointments.</p> <h2>Improving Quality of Care</h2> <p><strong>Being part of a system creates the opportunity to standardize processes, management structures and tools/equipment, which is something that OhioHealth takes advantage of during and beyond a pandemic.</strong> COVID-19 has also helped health care evolve, reminding us we need to be flexible and nimble in how we provide patient care going forward, as well as continuing to care for our associates and their resiliency. Because of this, we’ve named a medical director of associate and provider well-being to keep this work top of mind and make sure our associates and providers have the resiliency resources they need.</p> Wed, 02 Jun 2021 08:10:11 -0500 Hospital Field Realignment /case-studies/2021-06-02-value-health-systems-during-covid-19-pandemic-advocate-aurora-health <h2>Responding to the Pandemic: Adapting for Patient Need, Supply Chain and Staff Support</h2> <p>Advocate Aurora Health’s scale has been a critical asset that has allowed us to successfully respond to the financial, operational and clinical challenges created by COVID-19. Below are examples:</p> <p><strong>Expert emergency management, supply chain and laboratory teams worked around-the-clock to ensure adequate supplies and equipment, rerouting gear where most needed.</strong> The team was given the funds needed to procure personal protective equipment and scoured the globe — not just the country — resulting in swift replenishment of critical equipment. We eventually invested in a domestic mask manufacturer, Prestige Ameritech, to ensure our PPE supply remains stable in the future. Scale has enabled us to have our own centralized laboratory company, which greatly facilitated our testing and distribution ability.</p> <p><strong>In response to unprecedented staffing challenges, our system leaders developed a flexible staffing strategy to address COVID-19 patient surges in hospital emergency departments, critical care, medical and surgical units.</strong> The strategy included standards and best practices that will become operating norms for Advocate Aurora Health, even after the pandemic ends. This includes informing the organization’s strategy for operational efficiency and cost-effective labor management, including the development of a system labor pool. Our system created and implemented education and training plans to support more than 5,000 clinical team role reassignments in direct response to staffing needs. This was accomplished via just-in-time learning modules that prepared nurses and others for supportive and assistive roles, including mobilization of team members to new clinical and screening areas. Virtual tools were developed to assist with efficiency, including an assessment for appropriate placement based on experience, skill evaluation and training. We matched nurses’ previous experience when reassigning; took advantage of more flexible licensing requirements at the state level to deploy nurses across Illinois and Wisconsin; and conducted twice-daily system calls to address immediate and anticipatory staffing needs.</p> <p><strong>Flexibility and innovation marked our response to the challenges presented by the pandemic.</strong> To serve our patients as lockdowns began, we rapidly expanded consumer-first offerings, including telemedicine, self-management tools and an AI-powered COVID-19 symptom checker that has been used more than 400,000 times since the pandemic began. We conducted nearly 1 million virtual visits in 2020, providing important care to patients in the comfort and safety of their own homes.</p> <p>As the vaccine arrived, we created a completely automated process to sign up where vaccine-eligible individuals schedule their first vaccine on Live Well. They complete their registration and use geo-location to automatically notify the clinic of arrival via the app. Second-dose scheduling is also completely automated. As the vaccinations expanded to patients, we created algorithms to prioritize access to the most vulnerable patients, partnering with community organizations to stand up tech-enabled mass sites. Non-tech outreach includes partnering with Federally Qualified Health Centers and expanding the call center function so we can reach those without internet capability.</p> <p><strong>Our in-house data experts created predictive models of test positivity and bed and ventilator utilization to guide resource allocation and purchasing in the face of COVID-19 surges.</strong> These forward-looking estimates of volumes guided planning and purchasing, resulting in more efficient and targeted spending — especially important given last year’s supply chain disruption and price increases. Because we knew our precise demand in each of our hospitals, we were able to move ventilators from site to site as need dictated, rather than buying new ones at extremely high prices.</p> <p><strong>We instituted robust system and site programs to support our team members.</strong> As smaller and less financially secure hospitals were forced to lay off or furlough workers without pay, we continued to pay our team members’ salaries, wages and benefits, including retirement plan contributions. We paid a special bonus to all team members, as well as additional crisis pay for front-line staff. We also provided lodging accommodations and childcare stipends, flexible paid time off, and mental health and wellness resources.</p> <h2>Prioritizing Community Health</h2> <p>We understand that we will never fully accomplish our purpose of helping people live well until health equity is achieved. That’s why we’ve created crystal-clear objectives and made our leaders’ compensation dependent on accomplishing them. <strong>As a member of the Healthcare Anchor Network, we have committed a $50 million investment to help address social determinants of health. We maintain specific action plans to ensure diversity in our workforce,</strong> including a leadership pipeline and mentorship program for nurses of color, veteran recruitment strategy, LGBTQ recruitment and inclusivity plan, and a program that explores how unconscious bias impacts medical residency selection. When it comes to our capital improvement and building projects, we’re increasing the amount of work we require our general contractors to award to minority- and women-owned subcontractors to 25% by next year.</p> <p><strong>We’ve expanded programs to address health disparities,</strong> including Circle of Care Program at Aurora Sinai Medical Center, South Asian Cardiovascular Center at Advocate Lutheran General Hospital, LGBTQ Health Program, Wisconsin’s first Spanish-language cancer clinic at Aurora St. Luke’s Medical Center, and instituted a diversity, equity and inclusion committee of the board.</p> <h2>Increasing Operational Efficiencies</h2> <p><strong>When Advocate Health Care and Aurora Health Care merged in April 2018, we operated more than 30 different systems for clinical, departmental and revenue cycle workflows. Since then, we have consolidated to a single patient record — a tremendous effort that will markedly improve efficiency and patient care going forward.</strong> Today, if a patient presents for care anywhere in our organization, caregivers have their complete medical record. The patient safety and patient experience of this single platform are foundational to our merged organization.</p> <p>As we streamlined and reorganized our merged organization, we: reviewed and standardized thousands of individual workflows, taking the best learnings from across the system; trained more 40,000 team members and more 10,000 providers; standardized operational metrics so sites can compare apples to apples; added bar code medication of specimens and blood administration to our medication administration processes to improve safety; added integration between the electronic medical record and the patient pump at the bedside for an additional safety check; and automated the patient flow process with a connection all the way from the central transfer center to the transporter carrying a smart phone, creating full transparency.</p> <p>Completion of these projects during COVID-19 created new challenges around remote training and support. Even with the unprecedented challenges, the project was completed on time and slightly under budget.</p> <h2>Maintaining and Expanding Access</h2> <p><strong>Advocate Aurora Health contributed $2.2 billion to community charitable care and services in 2019, which expands access to care and improves health outcomes by addressing social determinants of health.</strong> Free and discounted care is just one component in a broad array of community benefits we are proud to provide. In addition to providing free and subsidized care, we also sponsor programs and services that focus on expanding access and removing barriers to care, as well as preventing illness and addressing the social and behavioral factors that influence health. These programs include behavioral health and school-based care, wellness screenings, workforce development initiatives, community-building efforts and more.</p> <p>By shifting care from acute interventions to preventive and wellness-focused efforts, we are working to make a difference in our communities and improve people’s health while keeping them out of expensive emergency rooms.</p> <p><strong>During the worst of COVID-19, we remained committed to serving patients in their own communities. As patient surges affected our hospitals, we responded by shifting use of clinical space to expand capacity so as not to have to turn away sick patients.</strong> Because the Illinois Department of Public Health filed emergency rules, we were able to easily increase bed capacity and reallocate beds between clinical departments. Examples of these efforts include converting units into additional ICU beds and temporarily converting private patient rooms to double-occupancy rooms. Additionally, we managed our capacity expansion at a system level, coordinating our hospitals’ individual surge plans to bring equipment, supplies and staff to new locations as demand required. Because of regulatory flexibility and our own ability to coordinate capacity across our Illinois hospitals, we were able to serve our patients in their own communities during a period of extreme crisis without overwhelming our facilities.</p> <h2>Fueling Innovation</h2> <p><strong>Since our merger, we created a single patient portal (“LiveWell”) that unites patient communication with other wellness resources.</strong> Patients use LiveWell to message their providers, schedule care and execute a virtual visit while also accessing healthy recipes, guided meditation and more. LiveWell grew to 662,000 downloads in 18 months.</p> <p><strong>Scale enabled the development of Advocate Aurora Enterprises.</strong> We invested in health-related efforts and initiatives, including senior care, personal health and parenthood areas of focus.</p> <h2>Improving Quality of Care</h2> <p><strong>Increased scale allows us to continue to provide high-quality, safe care that more patients can feel good about choosing:</strong> Where there’s a national benchmark, we are exceeding it. We achieved top quartile health outcomes in 2018, coming close to top decile.</p> <p><strong>We’re making headway on eliminating a leading cause of patient death by sharing best practices.</strong> Sepsis bundle compliance has improved by 32% — a critical improvement, given that 1 in 3 inpatient deaths are caused by sepsis. Hospital mortality has decreased by 11%.</p> <p><strong>We’ve increased transparency and safety across the system by best practice sharing and a unified Culture of Safety.</strong> Safety event reporting has increased by 25%.</p> <p><strong>As a system, we can quickly mobilize resources, test innovations and roll out significant improvements to patient care that touch more patients as a result of our scale and scope.</strong> Our Multidisciplinary Surgical Team Approach to Advanced Recovery is changing pre- and post-surgical protocol to speed patients’ recovery, and we’re now rolling it out across all Advocate Aurora inpatient sites. Post-op pneumonia and elective colorectal surgery length of stay has decreased by nearly 30% through this program.</p> <p><strong>We scaled new clinical best practices to treat COVID-19 in our hospitals, including advancing new treatments such as the use of extracorporeal membrane oxygenation, or ECMO, machines on critically ill patients.</strong> Our system-wide collaboration played a significant role in meeting patient needs throughout this effort. In just one example, when as many as 30 patients at Advocate Christ Medical Center required ECMO at a single time, qualified staff from throughout the system were deployed to assist. <strong>Our Safe Care promise created new best practices that are now standard operating procedure at every site.</strong> These revamped protocols address masking, screening, social distancing, virtual check-in and enhanced cleaning to ensure patient safety, reduce the risk of contracting a communicable illness at a site of care, and increase trust and confidence among patients and team members alike.</p> Wed, 02 Jun 2021 07:38:55 -0500 Hospital Field Realignment