Redefining the H

Redefining the H / en Sat, 26 Apr 2025 05:09:45 -0500 Mon, 30 Nov 20 11:52:38 -0600 The Ameriplan Report to Restructure Health Care Delivery and Financing /guidesreports/2020-11-30-ameriplan-report-restructure-health-care-delivery-and-financing For decades, the AHA's Ameriplan Report&nbsp;served as a blueprint for a number of proposals on national health insurance and health care reform. Mon, 30 Nov 2020 11:52:38 -0600 Redefining the H Preview: Spotlight Health 2018 /news/insights-and-analysis/2018-06-21-preview-spotlight-health-2018 <a href="https://www.aspenideas.org/content/spotlight-health-conference-aspen-ideas-festival">Spotlight Health</a> – the health care-focused opening segment of the annual Aspen Ideas Festival – kicks off today in Colorado. The three-day event features a diverse mix of sessions, with more than 125 presenters, 80 sessions spread over five tracks – The Cutting Edge of Medicine and Science; Disrupting Health Systems; Healthy Communities; Our Planet, Our Health and Viewpoints. The AHA has joined the roster of sponsors and are coordinating several sessions spotlighting hospitals and health systems and how they are redefining the “H,” addressing affordability and managing disruption: <ul> <li>Former AHA Chair Jonathan Perlin, M.D., president, clinical services and chief medical officer, HCA Healthcare, and Ken Davis, M.D., president and CEO, Mount Sinai Health System, will participate on a panel to discuss Health Systems of the Future;</li> <li>I will review the association’s Path Forward and speak about the <a href="/value-initiative">AHA’s Value Initiative</a> and health care innovation ahead of a panel on improving accessibility and affordability featuring Lou Fierens, senior vice president of Supply Chain, Fixed Asset Management, Laboratory Services, and Philanthropy, at Trinity Health, and Dan Liljenquist, vice president, Enterprise Initiative Office, at Intermountain Healthcare, who will discuss how they have banded together to form a not-for-profit generic drug company to ensure a steady supply of certain medicines at an affordable price during an AHA-sponsored panel; and</li> <li>Ronald Paulus, M.D., president and CEO of Ashville, NC-based Mission Health, will discuss the National Taskforce for Humanity in Healthcare’s blueprint for rekindling joy among clinicians during an AHA-sponsored lunch roundtable. </li> </ul> In addition, AHA Chief Medical Officer Jay Bhatt, D.O., will facilitate an AHA-sponsored lunch discussion, Health Disparities: America’s Chronic Condition, and conduct a Facebook Live discussion with AHA Chair-elect Brian Gragnolati, president and CEO of Atlantic Health System, on Friday at 6 p.m. ET. Other keynote speakers include author Atul Gawande, M.D., Harvard T. H. Chan School of Public Health and Harvard Medical School professor, Brigham and Women’s Hospital surgeon;&nbsp;Lucy Kalanithi, M.D., clinical assistant professor of medicine at the Stanford University School of Medicine and widow of the late Dr. Paul Kalanithi, author of the best-selling memoir&nbsp;When Breath Becomes Air; and Bernard Tyson, chairman and CEO of Kaiser Permanente. The conference has been growing in importance over the past several years as an incubator and platform for new ideas in health care, and for the second year in a row, AHA is proud to be playing a role in helping to ensure the voices of hospitals and health systems are represented and heard as the conversation about moving our health system forward continues. Please watch for additional coverage in AHA Today from the conference next week. Wurth is executive vice president and chief operating officer of the AHA and president and CEO, Health Forum. Thu, 21 Jun 2018 09:52:27 -0500 Redefining the H 19th Annual Not-for-Profit Investor Conference Highlights How Hospitals are Redefining the ‘H’ /news/insights-and-analysis/2018-06-05-19th-annual-not-profit-investor-conference-highlights-how At the recent Not-for-Profit Health Care Investor Conference in New York City, more than 25 not-for-profit health systems had the opportunity to discuss with potential investors how they are redefining the “H” and working toward the goal of transforming health care. The conference, now in its 19th year, is sponsored by the �� Association, Citigroup and the Healthcare Financial Management Association. Major trends discussed included providing valuable health care services at a lower cost and higher quality, addressing the social determinants of health, engaging in transformative partnerships, and diversifying the scope of business during this time of health care disruption.&nbsp; A panel discussion moderated by Citigroup Managing Director Jim Molloy, titled “Taking the Plunge: Bold Transformational Strategies,” explored how some systems are positioning themselves for the future. Clint Matthews, president and CEO, Tower Health in Reading, PA; Ron Paulus, M.D., president and CEO, Mission Health in Asheville, NC; and Russell Cox, president and CEO, Norton Healthcare in Louisville, KY, described how they are working with their trustees to develop strategies to transform their organizations and ensure continued access in their communities.&nbsp; “We don’t necessarily know what the future will hold, but we do know that lower cost and higher quality is always better, and I believe that health informatics and data analytics will drive the future of health care,” said Paulus. Matthews stressed that though Tower Heath is changing, its mission has not, “We stayed true to our mission of advancing health and transforming lives.”&nbsp; All leaders agreed that hospitals and health systems must be nimble and honest about how partnerships will help fuel the future of their business strategies and ultimately work to deliver the best health care services for patients and families.&nbsp; “It is our incumbent responsibility to find that next transformation and for us it is all about leveraging innovative partnerships,” Cox said. As the field of health care changes, hospitals and health systems are rising up to the challenges they face to meet the needs of today and are constantly evolving to strategically plan for tomorrow. Regardless of their place in the journey, hospitals and health systems will always be there ready to care for the communities they are privileged to serve, the panelists stressed. Tue, 05 Jun 2018 11:14:58 -0500 Redefining the H Perspective: Accelerating Innovation /news/headline/2018-06-01-perspective-accelerating-innovation “If your only defense against invading armies is a moat, you will not last long. What matters is the pace of innovation. That is the fundamental determinant of competitiveness.” That’s a recent quote from Tesla co-founder Elon Musk referring to an economic theory that promotes buffers, or “moats,” around a company to help them maintain a competitive edge. &nbsp; While it’s true that many companies have succeeded and continue to succeed by building such moats, as Warren Buffet pointed out to Musk, it’s also true that technology is helping many companies seeking to disrupt the status quo figure out ways to get past those moats. And perhaps no field seems as ripe for these types of disruptions as health care. &nbsp; Health care is changing at a rapid pace, moving from a system that rewards volume to one that promotes and rewards value. At the same time, forces such as the rise of consumerism and the new digital economy are forcing even greater changes in the way health care is delivered and how providers interact with patients. We’ve been calling it redefining the “H.” These massive transformations make the field attractive to new entrants looking for different and perhaps novel ways to deliver services … and new services to deliver. It seems you can’t pick up a newspaper today without hearing about some company – many of them giants in their field like Amazon or Walmart – looking to make moves in health care. &nbsp; We believe it’s important for hospital and health system leaders to understand the trends and forces impacting the field, as well as the opportunities disruptive innovation may create. That’s why we’ve created a new home on <a href="/disruptive-innovation-opportunities-and-challenges">AHA.org</a> to track and analyze these trends. &nbsp; And like Elon Musk, we believe innovation – and accelerating the pace of innovation and transformation – is key to next-level transformation. No one knows health care like hospital and health system leaders, so it stands to reason that no one can innovate better ways to deliver health care and enhance value and the customer experience like hospital and health system leaders. To assist you, the AHA has created a suite of innovation-focused <a href="/disruptive-innovation-opportunities-and-challenges">educational offerings</a>. And there’s more in store. &nbsp; To transform health care, we need to disrupt ourselves. And the AHA is proud to be your partner in this journey. &nbsp; Fri, 01 Jun 2018 10:17:15 -0500 Redefining the H Perspective: Transforming to Better Serve Communities /news/perspective/2018-05-18-perspective-transforming-better-serve-communities Health care is changing as the march from volume to value moves forward. And hospitals and health systems are redefining the “H” to meet the demands of the moment, and of the future, in a way that is even more responsive to our patients and communities. &nbsp; As this movement continues, hospitals may look very different than they do today. But every hospital – regardless of how you define the “H” – has the opportunity to provide leadership, serving as an access point or anchor of services in their community. &nbsp; Recognizing the need for new models of care to fit these changing times, in 2016, the <a href="/guidesreports/2016-11-28-task-force-ensuring-access-vulnerable-communities-report">AHA Task Force on Ensuring Access in Vulnerable Communities</a> put forth nine emerging strategies for preserving health care services in these areas. &nbsp; One strategy – the Emergency Medical Center – would allow existing facilities in certain areas to continue providing emergency medical services without having to maintain inpatient beds or provide inpatient acute care services. This would allow hospitals that may be struggling, for a variety of reasons, to continue to meet the needs of the community for emergency and outpatient services. &nbsp; Last week, Reps. Lynn Jenkins (R-KS), Ron Kind (D-WI) and Terri Sewell (D-AL) <a href="/news/headline/2018-05-07-bill-would-designate-medicare-rural-emergency-medical-centers">introduced</a> AHA-supported&nbsp;legislation&nbsp;that would make this strategy a reality. The Rural Emergency Medical Center Act of 2018 (<a href="/2018-05-07-overview-rural-emergency-medical-center-act">H.R. 5678</a>) would create a new designation under the Medicare program allowing hospitals meeting certain criteria to transition to a 24/7 emergency medical center with enhanced reimbursement and transportation to higher-acuity facilities, as needed. &nbsp; The REMC Act is an important step in providing options for redefining the “H.” It would offer certain hospitals a new option to align services with community needs and remain a local access and anchor of services.&nbsp; &nbsp; Nearly 60 million Americans live in rural areas and depend on their hospital as an important – and often only – source of care in their communities. The AHA supports the REMC Act as an innovative approach to ensuring all Americans have access to the health care they need, no matter where they live.&nbsp; Fri, 18 May 2018 13:57:24 -0500 Redefining the H Perspective: Insights from the AHA Annual Meeting /news/headline/2018-05-11-perspective-insights-aha-annual-meeting This week we hosted yet another first rate AHA Annual Membership Meeting as more than 1,200 hospital and health system leaders from around the country converged on Washington, D.C. &nbsp; There, they heard from leaders in health policy such as Health and Human Services Secretary Alex Azar, who shared the administration’s priorities for creating a value-based health care delivery system, and Centers for Medicare &amp; Medicaid Services Administrator Seema Verma, who discussed a number of efforts underway at the agency, including many to reduce regulatory burdens on providers. &nbsp; A number of legislators – including Sen. Susan Collins (R-ME), House Ways &amp; Means Health Subcommittee Chairman Peter Roskam (R-IL) and House Democratic Caucus Chairman Joseph Crowley (D-NY) – also joined us to discuss important health issues such as the opioid crisis, regulatory reform, health coverage and ensuring an adequate pipeline of physicians. &nbsp; And throughout the meeting, attendees heard from leading political observers and media pundits who provided insights related to the mid-term elections to presidential leadership. &nbsp; This year’s theme was “Redefining the ‘H.’” And the special briefings showcased how hospitals and health systems in every part of the country are doing just that on issues ranging from value and affordability to advancing equity of care to post-acute care innovations and more. &nbsp; If you were unable to join us in Washington, or if there was a session you missed, you can view highlights at <a href="/2018-aha-annual-membership-meeting-video-highlights">www.aha.org</a>. And please watch AHA Today for continued coverage of the special briefings. &nbsp; We at the AHA are honored to represent America’s hospitals and health systems and are proud to be your partner on this journey. As <a href="/person-events/2018-04-23-national-hospital-week-may-6-12">National Hospital Week</a>&nbsp;draws to a close, thank you for all you do every day to advance health in America. Fri, 11 May 2018 11:11:05 -0500 Redefining the H Pollack Pledges AHA Support, Resources as Hospitals and Health Systems Redefine the ‘H’ /news/headline/2018-05-07-pollack-pledges-aha-support-resources-hospitals-and-health-systems <h2><a href="https://www.youtube.com/watch?v=bb5nx-WBhn8&amp;feature=youtu.be">Watch the video</a></h2> Health care is facing a period of unprecedented transformation as new entrants seek to disrupt the field and reduce friction for patients, providing an opportunity for hospitals and health systems to reimagine and redefine themselves for the future, AHA President and CEO Rick Pollack told attendees today as he kicked off the AHA Annual Membership Meeting’s Federal Forum. “Now is our time to redefine the ‘H’, not by compromising our values or whittling away at our obligation to care,” Pollack said. “We’re going to redefine the ‘H’ to meet the demands of the moment, in a way that is even more responsive to our patients and communities.”&nbsp; Pollack noted that many organizations might look very different than they do today, and that the change is already under way. Hospitals and health systems are moving beyond their four walls to deliver care in the community and make it more convenient for patients. They are investing in digital technology to coordinate care and harnessing the power of data to manage populations to keep people well and prevent illness. They are partnering with diverse community groups to address the social determinants of health and their community’s unique needs. And, they are converting facilities to “right-size” for the future, Pollack said. <h2>[For additional highlights from the AHA Annual Membership meeting, <a href="/2018-aha-annual-membership-meeting-video-highlights">click here.</a>]&nbsp;</h2> To help members as they redefine the “H,” AHA continues to advocate to protect and expand health coverage and to remove regulatory barriers and burdens that inhibit care coordination and drive up costs. In addition, AHA is urging the government “to find creative ways for how we fund the social determinants of care,” Pollack said, noting that means ensuring safe neighborhoods and schools; improving education and health literacy; ensuring access to healthy food and a clean environment; eliminating disparities and inequities in care; providing social support mechanisms; and ensuring economic stability and jobs. As the field transforms, AHA is transforming with it to better serve members, Pollack said, highlighting new resources on innovation, as well as new data offerings. In addition, AHA has established the Value Initiative to both frame and address the issue of reducing costs and increasing value. It also has invested in additional resources to confront new and emerging challenges such as cybersecurity. In addition, AHA is working to develop new public policy ideas that can help providers be successful in the future, Pollack said. “Our job at AHA is to provide an opportunity for every hospital – regardless of how you define the “H” – to continue to provide leadership in serving as an access point or anchor of services in their community,” Pollack said. “…Every generation has been called to redefine what a hospital is…from the advent of antibiotics to the sequencing of the human genome. While [hospitals’] core role may remain the same, we need to continue to adapt as the needs of our patients and communities change. But, what will never, ever, change is that they need you,” the women and men of America’s hospitals, he said. Mon, 07 May 2018 11:33:57 -0500 Redefining the H Redefining the ‘H’ /news/perspective/2018-03-09-redefining-h Health care is changing…and hospitals and health systems are transforming to meet the evolving needs of our patients and communities. As I <a href="/news/headline/2018-03-05-aha-hospitals-are-leading-transformation">wrote</a> this week in the New York Times, communities will always turn to their local hospital in times of disasters, outbreaks and tragedies. Whether it is the flu or instances of community violence, people will flock to their local hospitals for care. At the same time, hospitals will continue to perform sophisticated surgery, diagnostics and therapeutics at the cutting-edge of medical science. As hospitals meet the needs of today, they are looking to redefine themselves for tomorrow. Without a doubt, hospitals and health systems are leading the greatest transformation in medical history. They are working to provide coordinated and convenient care beyond their four walls; care that is more responsive to patient preferences and community needs than ever before, all with a focus on keeping people well so that they reach their highest potential for health. And they are doing the hard work of advancing affordability and enhancing value. Please join us at <a href="https://s6.goeshow.com/aha_dc/annual/2018/about_the_show.cfm#_ga=2.130067914.412085619.1520273643-314316529.1459371947">AHA’s upcoming Annual Meeting – “Redefining the H”</a> – May 6-9 in Washington, DC, to learn how hospital and health system leaders are using value-based strategies to make health care more affordable for patients and communities. Fri, 09 Mar 2018 12:20:43 -0600 Redefining the H AHA’s Charge is to Define the Future, says AHA Trustee Doug Cropper /news/insights-and-analysis/2018-02-21-ahas-charge-define-future-says-aha-trustee-doug-cropper Perhaps the biggest challenge facing the AHA board is to “define the future” for hospitals and health systems, says AHA board member Doug Cropper, president and CEO of Genesis Health System in Davenport, Iowa. Cropper notes that America’s hospitals are continually transforming to meet the changing needs of their patients and communities – a transformation that the AHA calls redefining the “H.” “It is one thing to redefine the H,” he says. “It is another thing to define a vision for the future. We all have to get on the same page as to what that future is likely to be.” Cropper serves on the board’s health care strategy and innovation committee, which he says is looking at a health care future centered on innovation and affordability. He suggests the committee’s work this year could pave the way for the board “to make a statement about our ability to take risk and drive down costs to the consumers.” He says the board needs to “agree on the basic concepts of the future, and then state that it is our intent to move to whatever that new model is. I think it is important to put a stake in the ground and say, ‘we are committed as a field to move here and develop a more affordable health care model in the U.S.’” &nbsp; &nbsp; While much is changing in the hospital world, what hasn’t is the AHA’s ability to serve as a strong national advocate and voice for the field, Cropper stresses.&nbsp; “Everybody values the advocacy piece, especially in a tough year like last year when we were trying to protect the Affordable Care Act, and I think we have succeeded in doing that,” he says. Cropper notes that the AHA board includes “for-profit and not-for-profit health systems. There are small, medium and large hospitals, and rural and urban hospitals. The AHA’s advocacy is what brings us all together.” Cropper began his health care career 37 years ago, starting out as a surgical orderly at St. Mark’s Hospital in Salt Lake City. He joined Genesis Health System in 2008. The health system provides health services to a 10-county region of Eastern Iowa and Western Illinois. It operates a hospital with two campuses in Davenport, hospitals in Silvis, Ill., DeWitt, Iowa, and Aledo, Ill. Genesis Health System also manages Jackson County Regional Health Center in Maquoketa, Iowa. Genesis Health System is the largest employer in Iowa’s Scott County, and the third largest in the Quad City area with about 5,000 employees, more than 800 physicians and 1,000 volunteers. The Quad City area encompasses five cities in northwest Illinois and southeastern Iowa. One way the health system is redefining the H is by expanding health services in its communities. Its Genesis HealthPlex facilities offer “one-stop” access to care in the Quad City area. HealthPlex “is a hospital without beds,” Cropper says. “It has urgent care, imaging, labs, therapies and it has doctors.” Key to the health system’s future success is “how well we are able to work with consumers or patients on an outpatient basis in their homes and connecting them to our primary care physician teams and coordinating their care,” Cropper says. “Working with people in the community to keep them out of the hospital.” Before joining Genesis Health System, Cropper served as an executive vice president with Falls Church, Va.-based Inova Health System, and was campus administrator for its Inova Fairfax Hospital. He previously was administrator of St. John’s and St. Joseph’s Hospital and vice president of HealthEast in St. Paul, Minn.&nbsp; In his Minnesota health care days, Cropper worked under Don Wegmiller, then-president and CEO of Health One Corporation, which later grew into Allina Health in Minneapolis. It was 1987 and Wegmiller served that year as the AHA’s chairman. Cropper names Wegmiller as a significant mentor in his life. “Don paved the way for me and now I have an opportunity [on the AHA board] to pave the way for others and leave a legacy of strong health care well into the future.” &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Wed, 21 Feb 2018 10:35:06 -0600 Redefining the H AHA board member Christina Campos: Policymakers need to ensure access to care in vulnerable communities /news/insights-and-analysis/2018-01-30-aha-board-member-christina-campos-policymakers-need-ensure Too many decision makers in Washington, D.C. don’t understand what it is like for a small rural or frontier hospital to provide care in a rurally isolated region of the country, says Christina Campos, the administrator of 10-bed Guadalupe County Hospital in tiny Santa Rosa, N.M. She says federal policymakers often overlook the unique challenges facing small rural health care providers when drafting health care legislation or regulations that cut hospital funding. “I don’t think [policymakers] realize that when they paint with a really wide brush, in terms of rule-making, it affects these rural micro hospitals differently, and these hospitals often don’t have the margins to survive the cuts,” says Campos, who joined the AHA board on Jan. 1. “The majority don’t have the reserves that will allow them to switch gears and change strategies for the future.” Campos brings to the AHA board more than 13 years of hospital leadership experience on the front lines of frontier care. She wants to share with her colleagues her views on what it will take for small rural hospitals to continue to meet their communities’ health needs as they grapple with lower Medicare and Medicaid reimbursements; difficulty in recruiting physicians; an inability to make infrastructure improvements; and an aging population, among other challenges.&nbsp; &nbsp; &nbsp;&nbsp; Campos’s Guadalupe County Hospital has the only emergency department between Albuquerque and Tucumcari – a 170-mile stretch of Interstate 40 that spans the lonely eastern half of New Mexico. Santa Rosa is home to less than 3,000 people, making it the largest town in a county with less than 5,000. More than a quarter of the population lives below the poverty line. The hospital is a health care safety net and economic anchor for its rurally isolated community. “But as a small guy out here it’s scary, especially in these times of constant change,” says Campos, who notes that many small rural hospitals are fighting to survive. &nbsp; “When a rural hospital closes, the danger to the economic health of the community is as significant as the risk to patients,” she says. “Hospital jobs are some of the better paying jobs in the community; those are the college educated jobs. Studies show that soon after hospitals close doctors leave and clinics close. In isolated or remote areas, most people don’t have the option to commute elsewhere for work. There is nothing else. So, you start seeing more and more people leaving town. Then schools and merchants suffer, and the community slides into a quicker decline.” Campos appreciates the support small rural hospital leaders receive from the AHA. Campos “wasn’t aware of the value of being an AHA member” when she took over the reins at the county hospital. “I thought [the AHA] was for the big corporate guys,” she says. “But I was encouraged to participate and get involved on [the Regional Policy Board] and was amazed at how much interest there was in my having input as a member.” &nbsp; Campos likens the AHA board’s leadership role to “walking a tight wire.” The association’s educational programming, tools and resources are helping the field navigate a rapidly changing and uncertain health care landscape. At the same time, the association must continue to advocate for legislative and regulatory policies that protect resources dedicated to quality care and ensure access to vital health care services in the now. “It is pretty dramatic that the AHA is telling the field that we have to redefine the H and that the hospital, as traditionally defined, is the not the way of the future,” she says. “We have the long-term view that points to the horizon, with a greater emphasis on value, population health and robust outpatient services. But on a day-to-day basis we need to protect ourselves in the current environment or we are not going to survive long enough to get to that horizon.” Campos chaired the New Mexico Hospital Association in 2010 and 2011. She also has served on the AHA’s Section for Small or Rural Hospitals Council and was a delegate to the AHA’s Regional Policy Board 8, which includes Arizona, Colorado, Idaho, Montana, New Mexico, Utah and Wyoming.&nbsp; In 2013, then Department of Health and Human Services Secretary Kathleen Sibelius appointed her to serve on the National Advisory Committee for Rural Health and Human Services.&nbsp; Campos also was a member of the AHA’s Task Force on Ensuring Access in Vulnerable Communities. The task force released a report last year that points to steps Congress and the administration can take to protect care in vulnerable rural and urban communities. It recommends nine strategies – or models – from which communities could choose to fit their unique circumstances and protect access to essential health care services. &nbsp;“Understanding and taking advantage of all the options is critical to overcoming the challenges facing small rural hospitals,” Campos says.&nbsp; As part of that effort, Guadalupe County Hospital and five other hospitals founded in 2014 the New Mexico Network, an initiative to improve cooperation among small hospitals across the state. The network has expanded to 10 hospital members. The hospitals share information, hire experts and offer support and advice. At quarterly “peer committee” meetings, staff doing the same job in different hospitals get together to talk shop and share best practices. The network is “incredibly beneficial because we are all small standalone hospitals, and this enables us to lean on each other,” she says. Guadalupe County Hospital also has harnessed the power of telehealth and virtual care services to provide better care to patients living in remote areas. And under Campos' leadership, the hospital became one of the smallest in the country to achieve HIMSS Analytics Stage 6 in the transition to electronic medical records. About one-third of hospitals have reached Stage 6, which represents the second-highest designation. But there is only so much small rural hospitals can do – on their own or by pooling resources – to shore up bottom lines and meet their communities’ needs. Campos returns to the theme that brought her to the AHA board: Ensuring access to care in struggling, rurally isolated communities requires fresh thinking and creative strategies from Washington’s policymakers. She has delivered that message at AHA-hosted briefings for legislators and their staff on Capitol Hill and at other advocacy events in Washington.&nbsp; “My role is to humanize what is going on” in America’s rural heartland, Campos says. “Even if you don’t live in a rural community, you will be affected if you travel through swaths of America that have no health care … no emergency care within that golden hour or that platinum 15 minutes that improves the chances of saving your life. Quality rural health care matters. &nbsp;Ensuring access to essential health care services in vulnerable communities matters.”&nbsp; &nbsp; Tue, 30 Jan 2018 09:24:34 -0600 Redefining the H