Preparing for Biological Disasters

I have blogged before about the CHRISTUS Health experience with hurricanes multiple times. As many of our facilities are located on the Gulf Coast, we learned first-hand the importance of having a clear disaster response strategy in place.

This commitment to a disaster response strategy extends beyond just hurricanes, though. The world’s experience with H1N1 flu last year reminded all of us how important it is to be prepared to offer an immediate, well-coordinated response to pandemic and biological disasters as well.

At the end of March, the CHRISTUS Health Pandemic Committee conducted a system-wide drill after several months of development and revisions of its influenza/biological pandemic plan. The mock scenario was an outbreak of unusually severe illness; specifically, a particular strain of H1N1 influenza that had been identified by the Centers for Disease Control as Phase 6 (widespread) in many states including Texas, Missouri, Louisiana, Arkansas, Georgia and Utah – all regions in which CHRISTUS Health operates.

The exercise, was launched by the system Senior Leadership Team in the corporate command center in Dallas, and we immediately began assigning and prioritizing incident response activities.

Team members quickly solidified our roles and began responding to approximately 35 mock requests for assistance that were being phoned in or made via e-mail directly to the command center from across our regions and facilities. Regional emergency preparedness coordinators from the CHRISTUS Health Southeast Texas, Southwestern Louisiana, Central Louisiana and Ark-La-Tex regions, as well as CHRISTUS Spohn, CHRISTUS Medical Group, CHRISTUS St. Vincent, CHRISTUS Santa Rosa, CHRISTUS Health Utah, Infection Control and Risk Management were among those participating in the drill.

Through this exercise, we aimed to build system-wide competency and familiarization of the revised CHRISTUS Health influenza/biological pandemic plan; provide an opportunity to exercise system pandemic reporting applications (EMResource, CHRISTUS Health emergency Website resources) with participating CHRISTUS facilities and the corporate command center; and practice emergency communications protocols by relaying vital information between responding entities.

The exercise lasted approximately three hours, including a debriefing and “after-action” review to identify what went well, opportunities for improvement, gaps in our emergency preparedness planning, and policies that will be addressed. We’re also investigating how to build social media tools into our existing disaster response communication plans, realizing the need for additional communication tools in our arsenal that can be quickly updated and are easily accessible by displaced Associates via home computers or mobile devices.

ACOs: A common goal, various models

It is abundantly clear that a significant portion of the cost savings predicted by the CBO as a result of health care reform depends on the successful implementation of a myriad of accountable care organizations within the U.S. health care delivery system. Although the models for an ACO may vary in different geographical locations (depending on the service sites available and the degree of integration in place among them presently), all ACOs will share a common coal for success. This goal simply must be the re-engineering of a transformation from a productivity orientation driven by our fee-for-service transactional payment system to a clinical-oriented outcome process driven by a payment system that rewards risk-adjusted high quality and low costs. As we have articulated in prior posts, CHRISTUS Health believes the only health care systems in the U.S. that will survive and thrive long-term will be those that have hardwired high quality and low cost health and wellness services into their delivery systems. This is not an easy task, and will require an intense effort by health care leaders to eliminate the barriers to ACOs that I discussed in last week’s post.

With a common goal, why then will there be different models? The best definition of an ACO I have found thus far was part of a recent brochure that crossed my desk, announcing the first National Accountable Care Organization Summit to be held this summer.

ACOs are provider collaborations that support the integration of groups of physicians, hospitals, and other providers in different ways around the opportunity to receive additional payments by achieving continually advancing patient-focused quality targets and demonstrating real reductions in overall spending growth for their defined patient population. The ACO model is highly flexible and can be organized in a number of ways—ranging from fully integrated delivery systems to networked models within which physicians in small office practices can work effectively together to improve quality, coordinate care and reduce costs. They can also feature different payment incentives ranging from “one-sided” shared savings within a fee-for-service environment, to a range of limited or substantial capitation arrangements with quality bonuses.

It is the hope of the U.S. government, in order to halt the growth of our health care costs, that ACOs will provide a transition from our fee-for-service mentality—paying for volume and intensity—to rewarding providers for enhancing value, which requires improving quality while simultaneously reducing costs.

The degree to which ACOs will be successful yet remains to be seen. But clearly, their goals to incent integration and coordination of care and minimize fragmentation of care are absolutely the right ones and must be achieved if health care reform has any chance of success.

The Barriers to an Accountable Care Organization

In multiple health care-related journals over the last several weeks, readers viewed numerous articles as well as invitations to attend conferences to learn more about “accountable care organizations” or “creating high-performing care organizations.”

This new terminology, Accountable Care Organization, or ACO, is one of the critical efforts in the recent health care reform law that is proposed to reduce the cost of health care in the U.S. It is predicated on the belief that well-coordinated, integrated care will be more likely to increase quality of the outcomes while reducing costs in comparison to the often-fragmented care which is experienced by our patients today. This clearly makes sense to providers of care, and yet it is not the norm in medical practices today. What are the barriers that keep well-coordinated, high-quality, cost-effective treatment plans from being implemented across he care continuum? What barriers will CHRISTUS Health face in building its aggregator model, one of our five strategic directions on its continuing Journey to Excellence?

The first, and perhaps most, significant barrier is our current fee-for-service payment system. This system has unfortunately incented most providers to perform as many procedures and treatments as possible, repeating studies and tests that have been done elsewhere which, if results were obtained, would not need to be repeated.

The second barrier is that coordinating care which is personal, safe, accessible, reliable and efficient often takes time. To connect the dots between multiple points and providers rendering services to a patient on a health care journey requires phone calls, immediate completion of records so a patient can carry them from point A to point B and timely transfer of treatment plans to the next provider so studies/tests are not duplicated.

A third barrier is the educational experience of most providers, which has focused on individuals rather than a population health management model. The former focus often provides individual treatment plans with variability in quality and costs, while the latter focuses on more consistent processes which minimize duplication and rework, and maximize repeated learnings which encourage rapid-cycle improvement.

Yes, the logic behind ACOs make sense, but to make them successful, strategies must be put in place to knock down the barriers which are real and visible in U.S. health care today.

Opportunities to look forward to

I am excited about attending the 2010 World Health Executive forum in Montreal in early November, so wanted to share some information with you about it now! I will absolutely share more learnings and information after I return.

The theme of the forum is “Paving the Way toward Healthcare Sustainability,” and will be attended by a select group of international ministers, senators, permanent secretaries and CEOs who will participate in unique roundtable discussions with professional moderators. The intellectual power brought together will allow dialogue and interaction to guarantee a maximum transfer of ideas and experiences!

This forum has been called because some European countries and American states are virtually bankrupt. In the majority of these countries, health care costs are the biggest drivers of the deficit. Even in times of prosperity, costs were extremely hard to contain, with an upward spiral of 3 percent to 6 percent each year for the past decade.

However, we all know it is the end of an era. Many of those attending will be from countries faced with not only health care budget freezes, but also cutbacks ranging from 5 to 20 percent. The way each attendee looks at sustainability will be different, and it is critical for all to understand what works, what doesn’t and what simply doesn’t make sense. The goal of this authoritative meeting is to share strategic intelligence in top priority issues, determining the most efficient way to face the unprecedented changes – contingency plans and difficult choices – to address the present and new risks that are forthcoming. This incredible experience should be of great value to CHRISTUS Health and our advocacy program initiatives.

Eight drivers will be examined and discussed in detail during the intense, three-day forum. These include:
1. Reconciling political and Transformational Agendas
2. Priorities of Contingency Plans
3. Seizing “Out of Control” Costs
4. Next Wave of Regional Delivery
5. Next Wave of Integrated Delivery Systems
6. A Population-Based Model is Not Enough
7. The Role of Information Technology
8. International Collaborative Framework

It is the hope that the learnings from this forum, based on an intense discussion of each of these drivers, should keep key health care decision makers design the best future of our health care systems, and I can’t wait to share the results of these discussions with you!