​Organization Name
Aurora Health Care


Tell us a little about yourself?
I have been in the health care field for 20 years. I oversee accounting for hospitals, clinics, research, and foundation. I have recently gone through my first single audit which was challenging but I learned a lot. 
I would say my primary focus outside of the standard job duties is to always look for efficiencies in processes, challenge my staff to do the same, while maintaining internal controls.


What are 3 words to describe your company?
Challenging
Changing
Quality


What does a typical day look like for you?
A typical day consists of constantly changing priorities while managing the day to day tasks. Email seem to multiply constantly and there is never a lack of projects to be done. Often times I find myself working late due to volume of meeting throughout the day that limit my ability to keep up on daily tasks.


What is on your wish list for the next 10 years?
Continue to develop in my field, improve on my delegation skills, be the best leader possible for my staff to encourage their own growth and improve on staff engagement.


If you were stuck on an island what three things would you bring?
My family
My Kindle (of course I would need unlimited power supply and internet to load new books)
Food


Any random facts you could share with us?
I enjoy the quiet of my rural home. 
I have two wonderful sons that are now both in high school and a step son that just completed his masters.
I spend too much time working and not enough time relaxing.




You’re happiest when?
I can sit with a good book and not feel guilty that something else is not getting done.


Why did you join HFMA Wisconsin? 
I would like to meet new people in the industry and have access to resources for professional growth and to assist me in my position.

If you haven’t heard about Enterprise Membership for your organization, you’re missing out!  This new offering from HFMA allows organizations to pay a yearly membership fee for an unlimited number of the organization’s employees to join.  While individual memberships cost $425, Enterprise membership is priced to meet the needs of various organization types.  Fill out the information form here to obtain exact pricing.  There is an Enterprise Membership built to fit the needs of any organization!

Learn more at:  
www.hfma.org/membership/enterprise.html

Coming soon…   the WI Chapter of HFMA, along with all other HFMA chapters across the country will be implementing a new event management software, ‘CVent’.  What will this mean to you?   When registration opens for the Region 7 Fall Conference, as well as all other future HFMA conferences and events, there will be a new look and feel to the communication, registration and post event surveys.  The implementation of CVent nationally will provide for a unified data set that can be used to gather information on member engagement across all levels of HFMA and to set future chapter and national goals.

​​Care Pathways: A Map to Consistent, High-Quality Care
As hospitals and health care systems look for ways to improve patient outcomes while simultaneously cutting costs, one promising opportunity is the use of Care Pathways. Pathways are a workflow document of best practices for patients with specific diseases and conditions, designed to ensure patients receive consistent, high-quality care.
According to Scott Livingstone, chief operating officer (COO) of Tri-City Medical Center, Care Pathways are evidence-based, coordinated care protocols that implement standardized best practices. One notable example of Care Pathways is the Perioperative Surgical Home (PSH)—a model of care developed by leaders within the American Society of Anesthesiologists. Tri-City uses a PSH for colorectal elective surgery cases. The process begins as soon as the surgeon schedules the procedures and continues until 30 days after the patient is discharged.
“This process enables the patient to better withstand the procedure,” said Livingstone. The result is a reduction in the average length of stay (LOS) of one to one-and-a-half days, a decreased infection rate, and a drastic reduction in opioids for pain management after the procedure.
The use of Pathways within hospitals is an extension of the quality and cost-saving initiatives manufacturers began using decades ago, referred to as industrial quality management. The objective is to create standard operating procedures (SOPs), with the primary goals being quality and the efficient use of resources. The health care version of SOPs, Care Pathways, or Clinical Care Paths, were first introduced in the 1980s by Karen Zander and Kathleen Bower at the New England Medical Center.
But are they effective? In a study by Seattle Children’s Hospital (SCH), Pathways were implemented for a range of pediatric conditions with the goal of improving patient outcomes, decreasing costs, and reducing LOS and readmissions. The results revealed that both patient costs and LOS trended downward after Pathways were implemented (Figure 1). Overall, the study found that post-Pathway care was associated with a significant halt in rising costs, and “significantly decreased LOS without negatively impacting patient physical functioning improvement or readmissions.”

Extending Care Across Facilities
Pathways provide the opportunity for synergy across multiple facilities and solidify a consistent approach to patient care. Hospitals are accountable for the patient’s care three days before admission and 30, 60 or 90 days after discharge, whether the patient goes to a skilled nursing facility (SNF) or home with outpatient care.
The cost savings and improved patient outcomes as a result of this synergy can be dramatic. In addition to the results from SCH, The University of Colorado Hospital ED developed over 50 Care Pathways to guide care and use of its resources. The measurable results included:

• Use of high-cost CT scan and MRI scans dropped by 15%
• Avoidable hospital admissions decreased by 20%
• Patients with major heart attacks are in the cardiac catheterization lab in less than 90 minutes 100% of the time
• Total cost of care per patient is down 18%

The Importance of Electronic Health Records
When Pathways were first introduced, few hospitals implemented them because care-givers found it difficult to track progress, share information and capture data on paper. The advent of electronic health records (EHRs) eliminated that barrier, creating the ability to automate practice guidelines with a way to quickly monitor progress through electronic methods. The emergence of EHRs, combined with the increasing arrival of big data in medicine, has cleared the way for the medical community to be more receptive to evidenced-based medicine in general, and Pathways in particular.
Are Care Pathways Compatible With Precision Medicine?
At first glance, these standardized care protocols may appear to contradict the push toward precision medicine (PM), where treatment is individualized based upon the patient’s genetic make-up. Physicians, even within the same hospital, often vary in their treatment approaches for patients with the same diagnosis.
There is currently a shift toward PM which appears, on the surface, to make Pathways look out-of-date. Breakthroughs in next-generation sequencing and bioinformatics are paving the way for physicians to tailor treatments to a patient’s specific genotype. As such, Pathways may seem to limit the physician’s ability to tailor the treatment around the patient’s genetic make-up. Upon closer look, however, there are critical similarities between the procedures and processes of Pathways and PM. Both rely on identifying the variables involved in the treatment of individual patients and combining that with historical evidence to determine which treatment options are more effective than others. Hospitals rely on this information as they take the time to create individual Pathways to help their patients. These same processes of discovery and best practices are used in PM to ensure treatment options are focused to match a specific patient’s gene with the appropriate treatment protocol. In many ways, PM can be viewed as an enhanced version of Pathways.
Creating Pathways With Best Practices
While physicians understand the importance of following best practices, Pathways cannot dictate medical care. Physicians still must make the decision about what is best for the patient, with the flexibility to tailor the plan as necessary.
The key is to use evidence-based, confirmed-care Pathways and algorithms that are fully standardized. To ensure safety, these Pathways should be vetted by a nationwide quality team of medical professionals and experts.
As Pathways are created, hospitals must ensure that compensation is not linked to the protocol. Physicians will, from time to time, have to deviate from the plan in the interest of the patient. When this happens, the provider should not be penalized.
Going forward, the Pathway protocol may extend to care coordination among long-term care facilities, rehabilitation centers and home care. Further, as both providers and payers utilize Pathways, it is essential that they serve as a resource for clinicians, and not be a restriction on the care a patient receives. Hospitals still must see their patients as individuals and adapt the guidelines to meet their needs. The Pathway should provide the foundation and instructions to care.

Our chapter will help with education fees related to obtaining the CHFP designation for members. 
Contact the certification committee for more information.

​

​
By: Frazer Buntin, President, Value Based Services, and Kate Rollins, Vice President, Clinical Programs and Performance, - Evolent Health
​
The new skills required to operate a value-based care business successfully are vast, and the financial return becomes viable only if a provider can go at-risk for enough lives to scale their investment. This reality is a major inhibitor to providers who want to move up the risk continuum and for those who tried and failed. Unfortunately, many value-based care (VBC) initiatives fall at the lower end of a spectrum of accountability, amounting to little more than glorified pay-for-performance tasks that check the box for bonus dollars. This doesn’t drive accountability into the care delivery system in the same way that taking on both upside and downside risk does. To effect lasting change, providers are moving up this continuum of risk-taking through mechanisms that allow them to capture more of their generated savings, but also hold them financially accountable for losses—such as Next Generation ACO or Medicare Advantage for Medicare populations. 
 
Providers making the move toward risk are balancing the in-sourcing of new skillsets with outsourcing to third parties. Those who are seriously committed to VBC as their path forward are looking for partners that can help them rethink and redeploy their clinical model for effective population health, get technology in place to enable clinicians and administrators to operate effectively, and, for the most sophisticated, run the back-office administrative components that are culprit cost drivers, but which providers must own if they want to capture the maximum financial gain from the value they’re creating.
 
The way the industry is evolving, and where providers are innovating in the space, is bridging the clinical, administrative and financial:
 
1.       Clinical:

• CARE TEAM PERFORMANCE: Using a care team to support high-risk patients is not a new concept, but has traditionally been challenging to directly measure impact/ROI. Having a concrete process and key performance indicators for care managers helps providers identify exactly what tasks correlate to improved health outcomes and lower costs. It also helps identify high and low performers so teams can replicate the best practices of the highest performers and deploy skills training for those who need coaching. Getting smarter on how to orient expensive clinical resources and directing that attention where the care team can make the biggest impact is a different construct than yesterday’s disease management programs.

 

• COMMUNITY HEALTH WORKERS: In one program, a provider deployed Community Health Workers as part of an extended care team for Medicaid populations. In a preliminary analysis of the impact on the care team’s workload and productivity, early data suggest that care managers can nearly double their case loads after successful introduction of Community Health Worker support. This could have major implications for how the industry thinks about creating capacity for both doctors and nurses, what roles are needed in the healthcare workforce at large, and the benefits of a community-centric approach to operationalize and deliver care. It also has implications for avoiding physician burnout. The more productive the care team is that supports that primary care practitioner (PCP), the more that PCP can trust that patients are followed and continually engaged outside of the point-of-care office visit. This helps them succeed at population health without taking essential time away from other practice areas, and sets them up for a better relationship with the patient when they’re face-to-face.

 

• CLINICAL PROGRAM INNOVATION: The same provider is also engaged in a partnership with in which some of their partners are piloting new clincial programs for targeted populations. One in particular is a pilot to prevent chronic kidney disease from escalating to end-stage renal disease. What’s interesting about this partnership is that the provider is helping their partners take the best academic models and determine how to operationalize them on the front lines. The provider is working to iterate, test and titrate at the population- and disease-specific level to drive better patient experience and health outcomes. The goal is to refine the approach and then scale it  to the provider’s numerous national partners nationwide.

 
2.       Administrative:

• THIRD-PARTY ADMINISTRATOR (TPA) CAPABILITY: To capture the value that providers can create through clinical impact and savings, they need to be able to administrate claims, run effective utilization management and pharmacy benefits management, and in some cases support member services with call centers and staff. These aren’t traditional areas of expertise for a provider, but helping them take on these administrative services is beneficial.

 

• POWER OF CLAIMS PLUS CLINICAL: One provider successfully integrated its claims administration platform into Identifi℠, its core population health data analytics technology, last year. This means that their partner now has claims processing and data operating on the same scalable platform as their clinical and financial workflow tools. Claims traditionally have months of lagtime before they can be used to help identify patients who may need care management support. With the stratified clinical platform, knowledge about which patients may be high risk for an acute event can be quickly spread across the care contiuum, and lead to accelerated conversations with the patient and her PCP. This helps achieve the ultimate goal of interevening before a medical event occurs.

 
3.       Financial:

• FINANCIAL METRICS ARE DIFFERENT FOR VBC: When providers effectively learn the new clinical and administrative skills they need to be successful in risk, it drives financial performance, as well. Providers benefit from having reporting and analytics on the same infrastructure as their clinical and administrative tools. In the value-based care world, they need to be able to track, report and manage based on contract terms that work differently than fee-for-service.

 

• FINANCIAL PERFORMANCE READINESS: Providers participating in Next Generation ACO are faced with a complex financial situation. They need to monitor performance on clinical outcomes for a specific group of Medicare benficiaries throughout the year to know if they’re on track to achieve savings or not. Knowing the financial trend of the value business early on creates opportunity to change approaches mid-year for a better chance at achieving savings targets. However, to do this effectively, providers need to get started before their performance year begins with CMS. They can deploy tools several months prior to the performance year to start analyzing and assessing the probable risk of their Medicare panel, get people in early for preventive care, and jump start the clinical program design process so that the entire care team can make a difference on day one of the performance year. 

 
KEY TAKEAWAY: Any given provider could pull all of these levers and still not see an ideal return if they’re only doing it for a few thousand patients. Once infrastructure and process is in place and there’s a roadmap for success via a smaller population test case, providers are then ready to place more risk lives under management. How they accomplish this depends uniquely on the dynamics of their local markets, which drives the wide variety of business strategies across the country. For instance, some take their PSHP to new geographies to get more membership; some create alliances with other provider groups to get more patients attributed to a successful ACO; some have immediate scale if they’re granted the opportunity to manage hundreds of thousands of Medicaid beneficiaries. Regardless of which strategy providers choose to naviagte the shift to value-based care, it’s clear that they’re on the right track to serving a common goal of improving health.