"The Ronan Report" provides insight about the activities at the Western Maryland Health System in Cumberland, Maryland, and about the changes taking place in healthcare today from a CEO's perspective.

Friday, January 23, 2015

Connecting with Our Community

An article crossed my desk this afternoon and I found the title to be very interesting. Hospitals and Community Health - Hospitals Partner with Local Organizations to Promote Healthy Lifestyles.  I enjoy reading articles that are going to provide new ideas for better connecting with our community, especially those with the greatest needs.  

The article used three examples of partnerships between hospitals and their respective communities. The first was a hospital providing scholarships in its community.  A great idea; we have been providing allied health profession scholarships as long as I can remember.  

The second example was a hospital providing a mobile garden of fresh vegetables in its at risk communities.  We are embarking on a community garden concept and it will be operational by this Spring.  We have held a Farmer's Market at WMHS for the last several years and recognize its success.  We wanted our most vulnerable patients and community members to have that same advantage of fresh vegetables being provided to them.  Through this initiative, there have been a host of partnerships that have evolved to ensure the program's success. Possibly, it will evolve into something much more after we get our first community garden going and just maybe we'll go mobile.  

The third example was a Raising Readers program where physicians and nurses provide books to children at the time of their birth and throughout their well child visits.  Each child receives 12 books by the time that they go to kindergarten.  A great program, but one that pales by comparison to WMHS.  At WMHS, we enroll every newborn in the Imagination Library.  Every child receives a book each month until they go off to kindergarten.  That's 60 books!  

I guess that we are going to have to start providing our successes to the American Hospital Association's Advancing Health in American website.  But, it was great to read about these programs and use it as an affirmation of what we are doing for our community in Cumberland.

Wednesday, January 21, 2015

Maryland Health Resources Commission

Last year, I was appointed by the Governor to the Maryland Health Resources Commission.  Yesterday was only my second in-person meeting, but I really enjoy being a part of this Commission.  This Commission is only one of three health care commissions in Maryland and it was created almost ten years ago to expand access to affordable quality health care services to the state's underserved communities.  I am the only health system CEO on the Commission so I am able to bring a different perspective to the group.  

During yesterday's Commission meeting, a white paper was presented on Sustaining Community Hospital Partnerships to Improve Population Health; and of course I had a lot to say.  The white paper was very well done by Fran Phillips, RN and included a number of recommendations on how to promote sustainability of Maryland's safety net providers to deliver health care services to our most vulnerable citizens.  

Some of the recommendations for the Commission were as follows: collaborate better with Maryland hospitals as they develop value-based strategies to keep patients healthy and out of the hospital; partner with hospitals on the savings that they will generate through reduced admissions, re-admissions, ED visits and reduced ancillary utilization; better coordinate with hospitals grants that are being requested by individual health care partners; promote promising hospital community partnerships around the state; encourage multi-investor partnerships to jointly fund projects of mutual interest; better link grant applicants with funding opportunities in addition to Commission grants as they become available; partner with Medicaid to jointly evaluate outcomes of partnership grants to reduce spending and improve Medicaid enrollee's health and work with hospitals to leverage Community Benefit dollars in areas with the greatest need.


I am pleased with the contents of this white paper as it attempts to better coordinate the spending of scare resources as the Commission attempts to meet its charter and hospitals attempt to meet their respective missions in the communities that they serve.

Friday, January 16, 2015

American Hospital Association Meeting

Yesterday, I was honored to speak at the American Hospital Association's State Issues Forum Meeting.  It was a meeting of State, Regional and Metropolitan Hospital Association Executives in Washington, DC.  I was invited to speak on the Possibilities and Limitations of Provider Payment Reform, specifically the Western Maryland Health System's journey related to value-based care delivery.  In addition to describing our journey, I was able to address questions related to work force, the challenges that we faced, the lessons learned, why we chose to pursue value based care delivery when no one else was, how the concept was financed, how the model is sustainable and how did we meet the needs of the behavioral health patients who also have general acute care needs.


The presentation was well received with a number of follow up requests to speak at the individual state association meetings.   All is all, a very rewarding day.

Tuesday, January 13, 2015

Weighing in on Emerging Health Care Trends for 2015

Fierce Healthcare, a national health care newsletter, contacted me last week for a piece that they were doing related to emerging health care trends for this year.  I was honored to be included and attached is the finished product.

















For the whole article, click here

Monday, January 12, 2015

America's Bitter Pill

Last night as the 60 Minutes segment on health care started, my iPhone lit up with messages about getting my thoughts on the content.  That was easy; first, Steven Brill has little credibility with the misinformation and inaccuracies that appeared in his Time article about  two years ago.  Lucky for us, he is now shilling his new book with a similar title as the article, America's Bitter Pill.  

He needed to quickly hurry up and get the book released because, in the short term, it will be more useless than it is now.  Health care is changing as demonstrated by what health systems such as ours have been doing for the last four years.  Our focus has been on value-based care delivery, not generating as many tests, procedures, surgeries, admissions and ED visits as possible.  Volume-based care paid on a fee-for-service basis is quickly being replaced with incentivizing hospitals for keeping people healthy and out of the hospital.  America will start to see a sea change in the short term related to care delivery.  Everyone recognizes that spending almost $3 trillion on health care in the US annually is unsustainable, so new approaches like Maryland's Total Patient Revenue and Global Budget Revenue will be popping up all over the country.


As for 60 Minutes, I received information last week from the American Hospital Association on last night's segment.  AHA was asked to make someone available to be interviewed for the segment.  AHA in turn asked for a copy of the book since they took great exception to his Time article again due to misinformation and inaccuracies.  60 Minutes refused. AHA said in order to respond to charges made by Mr. Brill, having an idea of what was in the book critical of hospitals would have been helpful.  As a result, they declined.  

Using the Institute for Health Care Improvement's Triple Aim of Health Care reform (better care; healthier communities and reducing the cost of care), as well as the related components of the Affordable Care Act, hospitals across the country are focused on building healthier communities. Mr. Brill in his book glosses over what hospitals do each day in the care of our patients as did 60 Minutes.  They love to focus on the negatives that are quickly being addressed and eliminated as Jeffrey Romoff, the CEO of UPMC, stated during the segment.  

Mr. Romoff agreed to be interviewed for the segment since he, UPMC and his salary have been targets of Mr. Brill's since the Time article came out in 2013.  I thought that Mr. Romoff held his own during the segment and, quite honestly, he is the CEO of the largest non-government employer in Pennsylvania with 62,000 employees and almost $12 billion in revenues.  Mr. Brill likes to equate not-for-profit health care with your typical not-for-profit organization and that is not a fair comparison.  Health care is big business and, in UPMC's case, it's very big business.  Quite frankly, they do it well.  They are ranked 12th as one of America's top health systems.   

Hospitals continue to be an easy target for the likes of Mr. Brill and 60 Minutes; however, they had better get their licks in quickly because changes are a comin'.  Stay tuned.

Thursday, January 8, 2015

It's Taken This Many Days to Get Over the Loss

I had the opportunity to attend the Steelers / Ravens game on Saturday night.  Now that's a day in my life that I will never get back.  Not only was the trip to Pittsburgh treacherous with ice, freezing rain then excessive amounts of rain and fog, but to have a group of loosely termed "professional" athletes perform as abysmally as the Steelers did last week, the weekend fell into the category of "why did I bother."  

I have never seen a football team more ill prepared for a game than the Steelers were on Saturday.  The defense was outplayed on almost every down, especially the long third downs when the Ravens completed almost every one that they had.  The offense clearly missed  one of the NFL's leading rushers in Le' Veon Bell, but that still wouldn't have been enough.  The offensive line couldn't protect Ben Rothlisberger and Ben chose not to throw the ball down field against the league's worst secondary.  Dri Archer became the go-to guy out of the Steelers backfield, all 5'7", 135 pounds of him (and he was stopped every time).  They resorted to the lousy Steelers from earlier in the season with stupid penalties and poor decisions on special teams.  

Baltimore came to play.  They were well disciplined and exceedingly well coached.  The Steelers had apparently been reading their press clippings for the week leading up to the playoff game instead of practicing and establishing an effective game plan. Congratulations to the Ravens; they deserved this victory.  I know that I have taken the fun out of the ability of the Ravens' fans to give me a hard time, but when your team dominates my team as the Ravens did on Saturday, you deserve to hear all of the platitudes directly from me.  

Now, there was a bright spot for humanity on Saturday evening, but it may fall into the category of too much information.  A number of rows in front of me were six Ravens' fans sitting together.  From when they arrived in their seats, they started talking trash.  None of it was in fun; these guys were thug like; both mean and looking for trouble.  My guess was that they were members of some gang.  They were  pushing  and shoving  fans  in the stands  without any regard for being outnumbered a zillion to one.


Right before the half, I went to the restroom.  The lines were long, but I still waited in line.  Behind me in line was a Steelers' fan who was trashing talk about Baltimore.  Lo and behold, who comes into the restroom, but the six gang bangers and that's when the "fun" began.  They start telling everyone in the bathroom what we could do to our mothers and what acts we could all perform on them. (Use your imagination.)  It was wild and began to escalate quickly.  The pushing and shoving started between the Pittsburgh trash talker and one of the gang bangers.  

Now for the humanity bright spot.  Three Steelers' fans immediately stepped between them and told the obnoxious Steelers' fan to leave the restroom.  They said get out and go use another bathroom.  Fortunately, he did and the situation immediately de-escalated.  This situation could have been really ugly.  A couple of hundred drunk Steelers' fans and six thugs who could have been carrying weapons of any sort.  I say that because the new security wanding process to get into the game was laughable.  There was some kid with "Security" on his jacket waving a wand in front of me with my pockets filled with an iPhone, keys, change, wallet; heck I could have had a rocket launcher strapped to my back and he would have missed it.  That wand or any wand never made a sound; some high intensity NFL security that they had there.  

Anyway, it was both a night to forget (the game) and a night to remember (the very impressive de-escalation of what could have been a really bad situation).  So, now I have to wait until next year to resume my fair weather fan status, but at least next season, I have significant justification.

Wednesday, January 7, 2015

89 New Accountable Care Organizations

I was reading Sean Cavanaugh's blog the other day.  Sean was formerly with Maryland's Health Services Cost Review Commission and now is the Deputy Administrator and Director for the Center for Medicare.  His blog was announcing the 89 new Accountable Care Organizations (ACOs) that joined the Medicare Shared Savings Program.  The new ACOs in the CMS program now bring the total to 405, serving close to 8 million Medicare beneficiaries.  

We are one of the new ACOs, the Western Maryland Physician Network LLC.  Together with physicians and other providers, we are focusing on providing higher quality, coordinated care for patients in the Medicare program.  We have almost 6000 Medicare beneficiaries that our ACO is serving and we hope to deliver better care consistent with our new care delivery model that is based on providing value, reducing the cost of care and ensuring that our community is healthier as a result.  All of which are consistent with the Triple Aim of Healthcare Reform.  

This partnership with our physicians and advanced practice professionals is great progress as we are continually exploring new and better ways to deliver care to our community.