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https://www.marketplace.org/2017/02/16/world/ambulance-service-texas-delivers-home-care

For more than a decade, John Farris traveled through the streets of Fort Worth, Texas, working 911 calls. As a paramedic for MedStar, he would ask himself: Could he prevent these 911 calls in the first place?

It’s a question that went against the very business model of MedStar until recently — a question most emergency medical services companies don’t talk about, because the more trips to the hospital, the more money the company makes. But it still mattered to Farris. So, sometimes, after stabilizing a patient in the back of the ambulance, he’d try to squeeze in a conversation about nutrition or hydration.

“I’d be lucky if I got 10 minutes to talk with them,” he said.

Now, he gets a full hour with five patients each day.

Traditionally, ambulance crews arrive with sirens blaring, ready to rush someone to the hospital. In Fort Worth, some paramedics are doing the opposite: scheduling visits to treat patients in their homes.

This idea — what’s called mobile integrated health care — is gaining traction as a way for hospitals to save money.

Farris still works for MedStar. He still carries a bag with a CPR kit and gauze and gloves, but he rides in a four-door sedan, not an ambulance. Farris is what’s called a community paramedic.

It’s his job to see the trickiest patients, the so-called “frequent flyers” who keep landing back in the emergency room. Since the Affordable Care Act, the government penalizes hospitals for re-admissions. So these patients are costing hospitals across the country hundreds of millions of dollars. Farris is trying to figure out why they keep returning.

Today’s second stop is at Sandra Guevara’s apartment in Fort Worth. It’s dark, and the black curtains are closed. Guevara, who is in her early 30s, sits on her couch wrapped in a Dallas Cowboys blanket while she gets her blood pressure taken.

Last year, Guevara went to the emergency department more than 20 times, occasionally needing a ventilator to breathe.

“My asthma has been going on since I was 14 years old,” she said. “My anxiety triggers it when I go places, so I tend to shelter myself and stay home all the time.”

Guevara is on Medicaid, so she generally doesn’t have to pay the more than $1,000 each visit might cost. But those visits are something the government, hospitals and especially Guevara want to avoid.

“I don’t like going to the ER,” she said. “Especially when they put me in a little bitty room. I’ll start crying and shaking and everything. I can’t deal with it.”

Farris said from the perspective of the doctor in the emergency room, patients like Guevara can be labeled noncompliant. They’re sometimes seen as patients who won’t follow medical orders. But he said if you spend time getting to understand the situation, that’s not usually the case.

“The mental health needs that [Guevara] has, tied in with her asthma, tied in with her allergic asthma, tied in with her clotting factor, all of this stuff together, even her dehydration, all of it together is combining factors to make her worse.

And every time she was out of the hospital she was back in a couple of days,” Farris said.

He’s helped Guevara modify her diet, convinced her to drink more water and consistently take her medication. He also made sure her doctors know what’s going on and connected her to a psychiatrist. Next visit, they plan to tackle one of her fears and take a short walk outside.

Taking walks with patients, talking to them about their fears, setting up social services like Meals on Wheels, is a major shift in emergency medicine.

When MedStar started enrolling patients for its mobile integrated health care program in 2009, it was one of the first in the country. Today, there are more than 260 similar programs.

Dr. Darrin D’Agostino, associate dean of community medicine at UNT Health Science Center, said early studies show pairing frequent hospital users with community paramedics can save money by preventing re-admissions in the long run.

“Some programs are actually showing decreases of 80 to 90 percent re-admission because the services that are needed are things that are not necessary provided by the physician,” D’Agostino said.

That includes things like making sure a patient has the right medicine — and calling the electricity provider to pay a bill and keep the lights on.
MedStar reports saving $17,000 per patient over a three-year period. The challenge, D’Agostino said, is securing initial funding. Right now, most emergency services are paid for ferrying patients to the hospital.

Since MedStar’s community paramedicine program is paid for by hospitals and health providers trying to save costs, it’s not clear if it would be affected by changes to the Affordable Care Act. The company is counting on a continued focus on the quality of care — and cost-cutting — no matter what happens with the ACA. It just helped publish a textbook on how to provide home care that’s now available nationwide.

NIAGARA — A virtual treasure trove of new health-related data on Niagara residents across their lifespans is expected to play a crucial role in shaping programs and interventions to better combat everything from alarming levels of mental health problems among young people to soaring numbers of 911 medical calls that are straining finite paramedic services.

The massive examination of health data carried out by staff at the region’s public health department over the last 18 months involved scouring nearly 50,000 lines of data from multiple sources covering everything from what drives people to call an ambulance and visit a hospital emergency room, to infectious diseases, behaviour related to chronic disease, and the top things that kill Niagara residents.

Known as the ‘life course’ method of analyzing and visualizing Niagara’s top health issues, the approach marks a major shift in how public health looks at its key mandate of illness and injury prevention, Niagara medical officer of health Dr. Valerie Jaeger told regional politicians on Tuesday.

Rather than tailor programs based on assumptions or best guesses, the wealth of new data should allow the region and the Local Health Integration Network (LHIN) of which Niagara is part to make targeted investments aimed at key factors identified in the new analysis, said Jaeger.

“This is a different way of doing business for us,” she said. “(It’s) becoming more goal-focused. “

Jaeger said she was most interested in the actual health problems affecting Niagara residents at different ages and stages of their lives. “If we know what those are, we should then work backwards to see what programs would best influence them,” she said.

So she tasked her staff with the arduous process of collecting and analyzing the data that will now be presented to the local LHIN, the provincial agency that oversees decision-making on most health care expenditures in Niagara.

Among the more notable data uncovered was that being overweight/obese was the number one self-reported condition for every single age group from kids aged 12 and up to old adults, along with the fact that the top diagnosis for many older people being discharged from hospital is arthrosis — degenerative joint disease often requiring joint surgery or replacement, often the result of being inactive or overweight — highlighting the need to get kids and adults more active when 80 per cent of Niagara residents are sedentary, said Jaeger.

“Overall, it has a huge impact,” she said.

But mental health issues also emerged as a top priority to address. Psychiatric/behaviour problems were found to be among the top reasons for trips in ambulances for kids aged five up to adults aged 44; intentional self-harm was among the top five causes of death among teens aged 15 up to adults aged 44; and mood disorders such as bipolar disorder or depression and anxiety disorders were among the top five self-reported conditions in the 12- to 64-year-old age groups.

“The mental health piece comes up time and time again,” said Jaeger, who noted regional staff are already getting working on a mental health strategy across the age groups in Niagara.

The mental health data was jarring to Pelham Coun. Brian Baty, a former principal who spent his career working with young people.

“The thing that stood out to me is the early onset and prevalence of mental health issues in young people,” he said. “It was striking, but the facts don’t lie.”

Regional Chair Alan Caslin said the region could use the data as ammunition to convince the LHIN to invest in programs and interventions to target problem areas identified.

“You’ve done such a great job in presenting the data in a non-disputable way,” he said. “I think you’ve done all the right things to identify where the problems are. (It’s) remarkable.”

The fact the region has made improving Niagara’s economy a key priority is also important due to data showing people aged 45-64 have high rates of excessive alcohol or illicit drug use in Niagara, said Jaeger. Often, the basis for those problems are a weak economy, and the lack of self-esteem that can be attached to joblessness, she said.

The region has been forced to continue to add new ambulances and paramedic crews to its Emergency Medical Services department in recent years to try to keep 911 call response times at acceptable levels amid rapidly escalating call levels. A consultant hired to explore that issue told regional politicians last fall that massive new investments into the service will be needed in the next decade unless the region can somehow slow down those call increases.

But the new analysis now breaks down the top five reasons for ambulance rides by every age group, something which should help the region to begin bending the curve on EMS calls to hopefully slow the call volume growth by focusing on those factors that cause the most ambulance responses, said Jaeger.

Sinead McElhone, surveillance and evaluation manager at the region who took the lead on the new research, noted that acute upper respiratory infections associated with flu are among the top five diagnoses for everyone from infants up to adults aged 44 at hospital emergency rooms.

That should reinforce the need to double down on efforts to promote prevention strategies such as proper hand washing, she said.

“These are still preventable,” said McElhone. “They’re still the main reason young children are ending up in (emergency) departments.”

Jaeger said it’s believed Niagara’s public health department is the first in the province to be ready to present such detailed data by age group to the LHIN on how the health system is being utilized. Her department is in the midst of assessing what steps could be taken by public health, Niagara Health, which operates local hospitals, or the LHIN in light of the new data.

“We’re looking at transformative opportunities,” said Jaeger, noting there are critical ages in people’s lives when interventions can change health trajectories over the long term.

“If we get this right at a certain stage, we can reduce the impacts of these conditions,” she said.
Pelham Mayor Dave Augustyn joined other regional politicians in heaping praise on the work to collect and analyze the data.

“It will have uses we haven’t even dreamed of yet,” he said.

Jaeger said her staff is willing to present the findings to local town and city councils or service clubs if they’re interested.

Original article can be accessed here.

In January of 2015, the San Bernardino County Fire Department was chosen to conduct one of 13 pilot projects in California aimed at studying the value of community paramedicine.

Community paramedicine (CP) is an innovative model of care services that uses paramedics and emergency medical services (EMS) to treat local patients and meet their health care needs directly in their homes.

For this study, San Bernardino County Fire has partnered with Rialto Fire Department, San Bernardino County Department of Public Health, Arrowhead Regional Medical Center (ARMC), and the Inland Counties Emergency Medical Agency (ICEMA) to provide post-discharge follow-up visits to patients with congestive heart failure (CHF) in Fontana, Hesperia, and Victorville.

“Community paramedicine is the next innovation in healthcare,” said Fire Chief Mark Hartwig. “The goal of this program is to augment the patient’s current plan of care with resources currently established within the community which will provide the patient with the education and tools to maintain and improve wellness outside the hospital.”

The pilot project’s objective is to reach out to CHF patients within the first 48-72 hours of being released from ARMC and improve the quality of life for the patient by decreasing the rate of readmission to the hospital and reducing the need to access 911 for non-emergencies.

A statewide evaluation of the pilot project found that community paramedics identified 129 post-discharge patients (14 percent) who misunderstood how to take their medications or had duplicate medications and were at risk for adverse effects.

The evaluation also found that four of five post-discharge pilot projects achieve cost savings for payers, primarily Medicare and Medi-Cal due to reductions in inpatient readmissions within 30 days of discharge. Hospitals realized savings as well by lowering their risk of being penalized by Medicare for having excess readmissions.

The community paramedicine pilot projects also accumulated savings for parts of the health care system due to fewer ambulance transports, emergency department visits, and hospital readmissions.

Thus far the pilot project has shown that EMS and paramedics can facilitate more appropriate use of emergency care resources and/or enhance access to primary care for medically underserved populations when they function outside their customary role as an emergency transportation service.

In preparation for this project, San Bernardino County Fire specially trained 17 firefighter paramedics in CHF patient assessment, medication reconciliation, laboratory evaluations, and home safety inspections.

State officials have extended the project through November of this year.

San Bernardino County Fire has enrolled 179 post-discharge patients since 2015 and expects to enroll up to 300 before the end of the project.

During a visit, the community paramedics perform a detailed physical assessment on the patient and ensure they are maintaining or improving their post-discharge status. They also will consult with the patient and/or caregiver to ensure the patient understands their condition, is eating properly, and knows how to take prescription medications. Visits also include a home safety check to reduce risk of accidental injury and to avoid potential emergencies.

San Bernardino County is home to one of the largest per capita populations of CHF patients in the U.S. Sufferers of this condition who are unable to properly have their disease managed depend on the emergency medical system (both 911 and emergency departments) to keep their condition in check; community paramedics help address the healthcare needs of this population.

Fort Worth, TX – The National Safety Council is recognizing MedStar for its proven commitment to traf-fic safety.

MedStar is one of four organizations receiving the prestigious Our Driving Concern Texas Employer Traffic Safety Awards, presented in partnership with the Texas Department of Transportation.

“This is our second year to receive a traffic safety award through the “Our Driving Concern” program with the National Safety Council and the Texas Department of Transportation, and the first time we have been recognized with their ‘Exemplary’ distinction. It’s a wonderful recognition of all the efforts MedStar’s team members undertake to help assure our team members and the public are safe while we respond to over 140,000 ambulance calls in our community” explains Shaun Curtis, MedStar’s Safe-ty Manager.

According to the National Highway Traffic Safety Administration (NHTSA), there are an average of 4,500 ambulance crashes annually in the U.S.[1]

MedStar units experience 0.25 crashes per 100,000 miles driven, an exceptionally low rate of ambu-lance crashes given the 2.4 million miles MedStar units log annually!

MedStar’s ambulance operators are certified as Certified Emergency Vehicle Operator (CEVO) and un-dergo continuous ambulance operations training and monitoring through the use of Lytx Drivecam units installed in all response vehicles.

MedStar will be recognized at the National Safety Council Texas Safety Conference & Expo March 5-7 in Fort Worth.

About the National Safety Council
Founded in 1913 and chartered by Congress, the National Safety Council, nsc.org, is a nonprofit organization whose mission is to eliminate preventable deaths at work, in homes and communities and on the road through leadership, research, education and advocacy. NSC advances this mission by partnering with businesses, government agencies, elected officials and the public in areas where we can make the most impact – distracted driving, teen driving, workplace safety, prescription drug overdoses and Safe Communities.

About the Our Driving Concern Texas Employer Traffic Safety Program
The Our Driving Concern Texas Employer Traffic Safety Program is a landmark driving initiative of the National Safety Council funded, in part, by the Texas Department of Transportation. This initiative supports a statewide network of employer involvement in crash prevention for the benefit of employees, both on and off the job. Our Driving Con-cern provides a variety of free resources, training opportunities and educational materials to help employers en-gage their employees in safe driving behaviors. Have a question or a request for your organization? Please contact Lisa Robinson, CFLE, Our Driving Concern program manager, (512) 466-7383.

About MedStar
Responding to over 140,000 calls each year, MedStar Mobile Healthcare is the exclusive emergency and non-emergency ambulance service provider to over 936,000 residents throughout Fort Worth and 14 other Tarrant County cities including Haltom City, Burleson, Saginaw, White Settlement, Forest Hill, River Oaks, Lake Worth, San-som Park, Westworth Village, Blue Mound, Edgecliff Village, Haslet, Lakeside and Westover Hills. Established in 1986, MedStar is governed by the Area Metropolitan Ambulance Authority board of directors, is one of only 132 ambulance services in the country to receive national accreditation by the Commission on Accreditation of Ambu-lance Services. MedStar was named the 2013 Paid EMS Provider of the Year by the National Association of EMTs and EMS World Magazine and is a three time awardee of EMS10 Innovator Awards by the Journal of Emergency Medical Services (JEMS).

Like many hospitals, Sunrise Hospital & Medical Center, Las Vegas was receiving more patients in its emergency department than it was equipped to manage regularly.

One of the largest Medicaid providers in Nevada and situated minutes from the rowdiness of the Las Vegas Strip, Sunrise was struggling with hold hours in its ED. In its worst month, the hospital experienced 28,000 hold hours, with the normal average nearing 20,000 per month, says Alan Keesee, COO, Sunrise Hospital & Medical Center.

Ever since the passage of the Affordable Care Act, and Nevada’s decision to expand Medicaid, Sunrise’s utilization of emergency services has increased double-digits each year. Last year, the Las Vegas hospital received 157,000 ED visits, the largest in the state, by far, says Keesee. With well over half of those visits attributed to Medicaid patients, he added.

Something had to be done to ease the burden on providers. Keesee says leadership saw an opportunity to streamline processes and get patients up to the floors and reduce patients’ length of stay overall.

Sunrise decided to integrate its emergency department and hospital medicine teams into one — unifying them under a single medical director.

The result was a one-team, one culture philosophy, says Keesee. The hospital’s efforts to increase the number of providers through recruitment and the development of team-based models for observational patients and protocols as part of the integration has also helped reduce hold hours.

Whereas most hospitals have their observational patients spread across the facility, Sunrise created a 30-bed observation unit, and dedicated providers and case managers to oversee that unit and monitor results, which has helped increase the number of patients discharged prior to 11 a.m. to 50 percent, up from 10. These measures have also contributed to a one day decline in length of stay for patients.

And not only have those hold hours dropped 79 percent in the ED to 6,000 hours per month, but there has been a palpable change in culture and care. One of the most noticeable changes has come from a nursing standpoint, says Keesee. Nurses now know who is on a team that day, and trust has greatly improved since having a dedicated leadership team focused on shared goals. Nurses will call and text physicians, and are able to know who their doctor is that day, says Keesee. “It’s really increased overall nursing and physician collaboration,” he added.

Keeping the momentum going and avoiding old pitfalls is always a concern after a large integration. Keesee notes that in order to keep pushing forward, leadership needs to come together to continually look for areas to collectively improve.

“You can’t do that in a silo, just the ED, just the hospitalists, you have to really have all those voices at the table, to make the improvements [and] continue to move forward,” says Keesee.

“If you’re disconnected, as an administration, with your medical leadership it’s really hard to move the organization forward with patients.”

Original article can be accessed here.

President Donald Trump has promised health care will be one of his top priorities in office. Hours after he was sworn in last Friday, he signed his first executive order outlining plans to repeal the Affordable Care Act.

Now while patients and providers wait to see what’s next, MedStar ambulance service in Fort Worth is trying its own method to cut costs and offer better care.

Patients spend hours of their lives and thousands of dollars in the emergency room, often for treatment they could get a better way. Plus, under the Affordable Care Act, hospitals can be penalized for patients who are admitted over and over.
So MedStar is setting a model to match the right care with the right price.

When you think of paramedics, an ambulance goes hand-in-hand. But four years ago John Farris traded out the sirens for a sedan and a simple mission.

“Having the right patient get to the right resource at the right time,” said Farris, a MedStar community paramedic.

“I love every minute of it,” Farris said. “It’s the best job in health care.”

He’s going back to a method of the past: house calls.

“Howdy howdy. You doin’ OK?” Farris said, while walking in to visit Allean Isaac.

Isaac is about to turn 89 years old and needs help managing diabetes and congestive heart failure.

“Beating good and strong,” Farris said while checking her pulse.

Isaac was going to the emergency room about once every three months, a costly and inconvenient way to get treatment. Now she gets twice-weekly visits at home from Farris.

“I don’t have to sit in the waiting room, wait until they call my name or nothing. They come right here,” Ms. Isaac said.

Farris has helped a lot with Isaac’s diet. She’s lost 11 pounds in three weeks, which has helped bring her health conditions under control. He also sees what’s happening in her daily life.

“Which kiddo out of the 12 that you got is coming to see you tonight?” Farris asked.

It’s time with a patient, that’s getting harder to come by.

“Everybody in health care is having to become more lean and more time-efficient,” Farris said.

But that short-term efficiency can lead to long-term costs if a small problem missed in the living room snowballs to the emergency room.

MedStar estimates that over the past three years, it has prevented 66 hospital admissions from some of these repeat patients, for a savings of $6,600 per patient.

MedStar was one of the first to start this model. Now it has spread across the country to more than 250 other programs.

Original article can be accessed here.

President Donald Trump signed an executive order Friday evening aimed at immediately lessening the economic burden of the ACA as Republican lawmakers work on a repeal and replacement plan.

Here are five things to know about the scope of the executive order.

1. The order offers broad guidance. It authorizes states and agencies to make changes “to the maximum extent permitted by the law,” which is somewhat limiting. Not much can be done until the heads of the federal departments that oversee the ACA are officially appointed, according to Timothy Jost, a professor at Lexington, Va.-based Washington and Lee University School of Law. Mr. Jost wrote in a Health Affairs blog, “In sum, nothing happens yet, nor is it likely to happen until the heads of HHS, Treasury, and probably Labor, as well as the CMS Administration and IRS Commissioner are in place; even then it will take a while for changes to be put into motion.”

2. The executive order could end the individual mandate. According to Mr. Jost’s blog, the main way the order can undo the individual mandate is by creating new types of hardship exemptions from the penalty. If this were to happen, it could kill the individual insurance markets, which rely on healthy enrollees to help fund coverage for those with pre-existing conditions. Kellyanne Conway, the counselor to the president, told ABC News Saturday President Trump may stop enforcing the mandate. “[H]e wants to get rid of that Obamacare penalty almost immediately, because that is something that is really strangling a lot of Americans to have to pay a penalty,” she said told George Stephanolopoulos on ABC’s “This Week.”

3. It could also expand Medicaid waivers under the ACA, giving states more flexibility in how they implement the law. In particular, the executive order signals “Section 1115 Medicaid waivers will be granted more liberally, but that was expected, and until they are changed, 1115 waiver regulations promulgated by the Obama administration will continue to apply,” according to Mr. Jost. Section 1115 Medicaid waivers allow states to implement their own budget-neutral expansions of Medicaid and CHIP coverage and determine who and what the programs cover.

4. It encourages the creation of interstate insurance markets. This is one of the main goals listed in the order to be executed to “the maximum extent permitted by law.” The sale of insurance across state lines is allowed under the ACA, according to Mr. Jost’s blog, so it is likely we will see this change. Ms. Conway confirmed this in her interview with ABC Saturday. “[H]e’s going to replace this with a plan that allows you to buy insurance across state lines, that is much more centered around the patient and [improves] access to healthcare,” she said.

5. The order could also undo some taxes under the ACA, according to Politico. These include the tax on health insurers and taxes on pharmaceutical companies. It encourages agencies to delay or waive taxes, fees and penalties created under the law. Many of the revenue-generating taxes of the ACA are already on the chopping block in Congress as it works on drafting a reconciliation bill aimed at axing budget-related parts of the ACA.

Original article can be accessed here.

CMS and Pennsylvania are joining forces on a new model designed to improve health and healthcare is rural areas of the state.

Here are eight things to know about the model.

1. The Pennsylvania Rural Health Model, announced Tuesday, is a new initiative by CMS, through the CMS Innovation Center, and Pennsylvania. CMS and the state’s health department will administer the model together.
2. The goal of the model is not only to improve health and healthcare in rural areas of Pennsylvania, but also to reduce the growth of hospital expenditures across payers — including Medicare — and improve the financial viability of the state’s rural hospitals, according to CMS.
3. The model is broken up into seven performance years, according to CMS. It is scheduled to begin Jan. 12, 2017, and end Dec. 31, 2023.
4. CMS said Pennsylvania rural hospitals participating in the model will receive all-payer global budgets — funded by all participating payers — to cover inpatient and outpatient services they provide. In exchange, these hospitals will use the money “to deliberately redesign the care they deliver to improve quality and meet the health needs of their local communities,” the agency added.
5. Pennsylvania, during each performance year, will prospectively set the all-payer global budget for each participating hospital, CMS said. The all-payer global budget will primarily be based on hospitals’ historical net revenue for inpatient and outpatient hospital-based services from all participating payers, according to CMS.
6. Participating hospitals will also detail a plan to improve care quality by preparing a Rural Hospital Transformation Plan that must be approved by Pennsylvania and CMS.
7. CMS said it will provide Pennsylvania with $25 million, which is a portion of the funding to begin implementing the model.
8. Any critical access hospital or acute care hospital in rural Pennsylvania may participate in the model.

Original article can be accessed here.

Health care is an “attractive” industry. Everybody wants it. It is vital to people, families, neighborhoods, cities, states, countries and their governments. It therefore attracts an abundance of bright, motivated, caring people and some of the world’s most sophisticated technology.

Health care also attracts money. U.S. health care, in particular, has a great deal of financial resources and has attracted a continued inflow of capital. For example, U.S. health care spending was $3 trillion in 2014 and is predicted to consume 20 percent of U.S. gross domestic product in the next few years. That’s a lot of attraction.

But health care has a “value” problem. Managed care started in the United States in the late 1970s with the goal of providing better care at lower cost. Despite 40 years of dedicated effort using all these attractive forces and resources, everyone agrees we have a big value problem to solve.

I propose value in health care is easy to measure: more access to better, safer care, at continually lower cost. No large health care organization in America can consistently do that. If that’s the measure, despite our attractiveness, value has eluded us. We still struggle with the following questions:

• Why, despite our great resources, does value remain so elusive?
• How, learning from other industries, can we attract value rather than chase it away?
• What does attracting health care value look like?

Relying on past success

Health care organizations, like those in every industry, suffer from what made them great. In the history of innovation, great capabilities can become disabilities when it is time to innovate and attract value. For example, take a look at the following lists of great, or formerly great, companies:

List 1	List 2
Digital Equipment	Intel
General Motors	Toyota
Blackberry	Apple

The companies on list 2 have profitability, customer satisfaction, staff engagement, innovation, growth and industry leadership; they attract value.

List 1 companies attracted layoffs, downsizings, bankruptcies, closures and failure.

Here is a difference: The list 1 companies were powerful leaders in their industries that failed to develop or attract simple innovations that list 2 companies, when they were smaller and weaker, used to create competitive advantage that changed their industry. They attracted value. When the list 1 companies discovered they were losing, they all failed to make a transition, even if it meant bankruptcy or extinction. They had great resources but failed to attract new value.

I studied this phenomenon working with Professor Clayton Christensen as a visiting scholar at Harvard Business School. 

Christensen developed the theory of disruptive innovation — “great capabilities become innovative disabilities” is one of its principles. Perhaps that is why we fail to attract value in health care — our past capabilities have become innovation- and value-repelling disabilities.

But what are those value-repelling disabilities? And how can we create new, more attractive capabilities? The work of Stephen Haeckel, former director of strategic studies at IBM’s Advanced Business Institute, has helped me develop some “attractive,” strategic answers and solutions to our chronic value problems.

Improvement versus innovation

Organizations became great in the 20th century by developing capabilities to make, improve and sell products and services. They built hierarchical organizational structures to gather and analyze data, make decisions, implement solutions, cut costs and increase productivity. They implemented changes through projects, often using consultants, Lean/Six Sigma process improvement, new technology and training.

People were an important cost to control or eliminate. Key to success was standardizing work processes and holding people accountable to do their work as designed. Once the companies produced standardized products and services, companies expertly marketed and sold them to customers and end users.

Make/standardize/sell organizations are terrific at improving. They don’t waste time trying to reinvent the wheel. They just keep making that wheel better and better and better. If it works, don’t fix it.

But problems start to occur when it’s time to reinvent the wheel. Make/standardize/sell organizations know how to improve what they know how to do but find it almost impossible to do what they don’t know how to do, i.e., innovate.In Christensen’s database of thousands of companies, he discovered it was almost impossible for an established, successful company to take the lead in developing an industry-transforming innovation.

A recent McKinsey & Co. survey of CEOs across the world showed that 87 percent of them believed that “innovation is essential to our company’s future,” while an astonishingly small 6 percent were satisfied with their company’s innovation success. Make/standardize/sell companies have a hard time attracting innovation in any industry, not just health care.

Attracting greatness in 21st-century health care

The great health care organizations of the 21st century will make new choices that attract innovation. So what attracts innovation? Decades of well-accepted research across the globe and in many realms has shown that innovation requires a different set of capabilities: sense/respond/adapt.

Every successful startup has to sense, respond and adapt to succeed. My work has focused on the small number of successful make/standardize/sell companies that were also able to sense, respond and adapt: Toyota, Intel and Apple, for example. 

Sense/respond/adapt requires different capabilities than make/standardize/sell does. Here are the characteristics of sense/respond/adapt success, whether in a new startup or an innovative venture inside a large, established organization:

• A market or customer-centric value proposition focused on an unmet need. In health care, it’s easy: more access to better, safer care at continually lower cost. Leaders then translate the value proposition into a meaningful purpose to align the people attracting innovation.
• A replicable, scalable, low-risk, high-reward system with these tenets: People with autonomy build mastery, simple rules match accountability to control, and self-managing teams rapidly prototype new value opportunities close to real-time work.
• Sustainable, inspiring results that are low-risk, high-reward and fast.

Consider the case of the Mayo Clinic Health System. Mayo tested a sense/respond/adapt approach to diabetic population health at five different clinic sites. Within one year, the physicians in those clinics had improved their diabetic scorecard results by 122 percent compared with the cumulative results of the rest of the Mayo system.

That was a significant pay-for-performance benefit for the system, while the physicians gained the value of all the flexible, responsive teams that sense/respond/adapt thinking developed to support them. Four years later, theAmerican Journal of Medical Quality (Jan. 11, 2013) documented that those sense/respond/adapt clinical teams continued to outperform the rest of their Mayo Clinic Health System peers.

Make/standardize/sell fails at innovation because it views the workplace as a machine with identifiable problems and implementable solutions. Innovation is seen as a technical “fix.” But innovation isn’t a mechanistic improvement because, by definition, it doesn’t exist. It’s new and yet to be discovered. Make/standardize/sell organizations are great at improving what they know how to do, but the data show that they find it almost impossible to do what they don’t know how to do. It is clear that value-driven health care is not a system fix, consulting engagement, new technology or implementation; it is something you attract value to and create.

The potential for innovation is everywhere. You have to attract its components and bring them together. Purpose; the ingenuity of people; simple rules focused on low-risk, high-reward discovery; and a safe place to work are the attractors. Once you start, it’s so attractive it’s difficult to get people to stop innovating to create new value.

Attraction creates the innovation, and the innovation closes the loop. Now, the parent organization has something new to make, standardize and sell. That’s the great advantage that the attractive 6 percent acquire. 

In the future of high-value health care, the choice is not either make/standardize/sell or sense/respond/adapt, it’s and.

That’s very attractive.

Original article can be accessed here.

In an effort to fulfill its mission to expand its provider footprint to serve about two-thirds of the U.S. population, Optum has agreed to acquire Surgical Care Affiliates for about $2.3 billion in a cash and stock deal.

Deerfield, Il..-based SCA owns or operates 190 ambulatory surgery centers and surgical hospitals, most as joint ventures with physicians and health systems. The company says SCA and its affiliates serve approximately 1 million patients per year in more than 30 states. In 2015, it had operating revenue of around $1.1 billion.

The deal signals that Optum is betting that any changes to the Affordable Care Act, which have lowered the level of the uninsured throughout the country and brought in patients to healthcare providers in droves, will continue to provide coverage to the up to 30 million people it has insured.

“Joining with OptumCare will enable us to better support and empower independent physicians, helping them provide high-quality care for their patients while making healthcare more affordable,” said Andrew Hayek, chairman and chief executive officer of SCA. “We already have a strong relationship with OptumCare, so we have seen firsthand that our cultures and strategies are aligned and complementary.”

Larry C. Renfro, vice chairman of UnitedHealth Group and Optum chief executive officer, said: “Combining SCA and OptumCare will enable us to continue the transition to high-quality, high-value ambulatory surgical care, partnering with the full range of health systems, medical groups and health plans.”

UnitedHealth has said Optum aims to provide primary care and ambulatory services in 75 markets, representing about two-thirds of the U.S. population. Over the past year, Optum has purchased physician practices around the country. It also acquired urgent-care provider, MedExpress.

The company told investors in late November that it had clinical practices in 26 markets.

Optum, which is the healthcare arm of the nation’s largest insurer, UnitedHealth Group, will pay $57 per share of SCA to be funded between 51% and 80% with UnitedHealth common stock. Optum will have an outstanding payout in cash. The deal is expected to close in the first half of 2017.

Hayek and the SCA leadership team are expected to remain a part of the merged company.

Original article can be accessed here.