"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.

Wednesday, July 1, 2015

Another Year of Value-Based Care Delivery

On Monday, I had the opportunity to serve as a panelist on the topic of Value-Based Care Delivery for the Society for Healthcare Strategy and Market Development.  This was a continuance from my role with its  Thought Leader panel in October of 2014.  Joining me were Lynn Miller, EVP at Geisinger, and Henry DePhillips MD, CMO for Teledoc.  Two very bright people also doing some amazing things for those whom they serve.  

Actually, it was a good idea on the part of SHSMD to check in with the panelists to hear what continues to develop in our respective worlds related to evolving, growing and thriving is this era of health care change.  I had the opportunity to talk about the continued change and innovation occurring at WMHS.  How we continue to learn to do new things and continue to stay ahead of the industry since we crafted change well ahead of others under Maryland's Total Patient Revenue demonstration project.  How we continue to harness efficiencies and share new ideas.  How we continue to disrupt pretty much everything that we do related to care delivery in a positive and constructive way.  How we continue to educate our staff, physicians, advanced practice professionals, our patients and our community on value-based care delivery since the entire concept is counterintuitive to fee-for-service payment based on volume of care delivered.  

Lastly, how we deal with the new entrants into our market whether they are partners, competitors or "frenemies."  In this instance, so far, most have become partners in our delivery of health care.  The competitors are those who seek to decrease our market share by shifting care to their acute care centers.  They aren't doing anything to reduce or bend the cost curve, only bolstering revenues under what is fast becoming an outdated strategy and payment methodology.  The frenemies are Walmart (its new approach to primary and chronic care), CVS (Minute Clinics), and Med Express (urgent care), but for us they are partners since they are / will be caring for patients in the most appropriate location.  Our goal is to assure that patients are cared for in the best setting.  These alternatives to the Emergency Department and admitting patients unnecessarily are what is necessary to reduce the cost of health care while ensuring that care is delivered to those in need.  

It is so very rewarding to not only watch but to be a part of such an amazing transformation of an entire industry.

Tuesday, June 30, 2015

As you know, I read the newsletter from Fierce Healthcare, which writes each day on a variety of issues in health care.  A recent article about the five traits of the ideal healthcare CEO caught my attention and I responded with a blog post, which was published last week.  


Adding credence to the ideal traits of a healthcare CEO

June 25th, 2015 
by Barry Ronan
Last week, I read the FierceHealthcare article, "5 traits of the ideal healthcare CEO." I am here to tell you that the article, which was based on a recent Hospitals and Health Networks article, was right on the money. As CEO of the Western Maryland Health System in Cumberland, Maryland, I am beginning my fifth year under value-based care delivery, and I have certainly had to adjust my approach to managing under a new care delivery model.
Taking the five traits one by one, I offer the following insights based on my experience:
Embrace Change: The change has been amazing in that I, along with my management team, our staff and our physicians, have had to virtually re-learn every aspect of care delivery under a global budget. We are partnering with everyone, even those who were previously our competitors, and we try to keep the patient at the center of everything that we do.
[More:]
Clinical Competence: I don't have a clinical background, but I have a great team of clinicians around me advising me every step of the way. I created the President's Clinical Quality Council, consisting of 12 physician champions--our early adopters and our movers and shakers. I also created the Triple Aim Coordinating Council, consisting of physicians, executives, directors, nurses and IT experts. The council provides oversight of every aspect of value-based care delivery. Whether it's the many initiatives that we have put in place, our partnerships or new programs and services, this group makes sure that if we say that we are delivering value-based care, that we deliver that care. I will say that I have never understood the care delivery process as well as I do today as a result of delivering care based on value.
Use Data to Drive Strategy: The amount of data and IT systems now available are truly amazing. Previously, we received data months after the fact; now it real time so we can be proactive with our patients, especially our high utilizers (the sickest of the sick).
Agile Managers: Over time our staff and physicians have embraced our new care delivery model. We did resort to mandatory education for all employees and that continues today. The shift from volume-based care based on a fee-for-service payment methodology has been a dramatic departure from the care that we now deliver. Our goal now is caring for patients the right way from the start so they are not being readmitted, having unnecessary testing or visiting the emergency department needlessly. We have many initiatives in place to ensure that we are making a difference in the lives of our patients.
Focus on Finances: The state of Maryland made the financial part somewhat easier for us in that we became part of a demonstration project that began in 2011. After one challenging year financially, we have had three financially successful years. We have also joined two other health systems in our region in an alliance to maximize additional savings through shared services.
Being the CEO of a health system that is truly making a difference though an elevated standard of care has resulted in probably the most exciting time in my healthcare career that has spanned 40 years.

Monday, June 29, 2015

Medical Marijuana

I may surprise some by my support of medical marijuana being legalized in Maryland.  I have blogged before on the topic and I do not support legalization of marijuana for recreational use.  Although legalization for such a use is tempting from state revenue and economic development perspectives, we have enough issues to deal with related to alcohol and illegal, as well as, over prescribed drugs.  

As for medical marijuana, it has a place in the treatment of many illnesses; most significantly, a derivative being used most effectively in epileptic children.  The results are amazing with the dramatic reduction in seizures.  These children are now leading a somewhat normal life as a result.  

When my son-in-law was going through his cancer treatments last year and if medical marijuana would have been an option for him, I certainly would have wanted him to have it.  I look at it as another tool in the toolbox, but it has to be appropriately regulated and that appears to be the case in Maryland.  First, there is a Maryland Medical Cannabis Commission and it is led by Hannah Byron, one of my Leadership Maryland classmates.  From my perspective, the commission is in very good hands.  Hannah has served in a number of leadership roles in Maryland government and has done so very well.  

Secondly, not just anyone will be able to put up a growing or a dispensing facility in Maryland; there are regulations that are in the comment period until the end of next month. Maryland has gone to school on other states, if you will, that have already approved medical marijuana.  They know what works and what doesn't work.  The fees to grow marijuana, again in a highly regulated and controlled environment, are $125,000 every two years and $40,000 to have a dispensary.  

Growers will not be acquiring a field somewhere in western Maryland or on the Eastern Shore to grow marijuana.  To see for myself, I visited a medical marijuana production facility two weeks ago in another state.  The operation was first rate with extensive security, so much so, it would put most banks to shame.  I saw the various stages of growing, the harvesting process and the production of medical marijuana in its various forms.  I also visited their very impressive vault where it was stored and was subjected to the standard pat down procedure upon the conclusion of my visit.  

One also has to take into the consideration the economic development aspects of medical marijuana.  Not only the fees, but the many good paying jobs that are created, the substantial taxes and fees that are generated, the additional businesses that are created as a result of the production facility and the list goes on.  

After the tour, I attended part of a symposium on medical marijuana held by that state's Pharmacy Association.  Many pharmacists and physicians were in attendance and the legalization of medical marijuana appears to have been embraced by both groups.  

Medical marijuana will be a reality in Maryland in the very near future and so far, from what I have seen, it is being well handled by all who are involved.


Monday, June 22, 2015

The New Leading Cause of Injury-Related Deaths

I just read a report published by the Robert Wood Johnson Foundation that drug overdoses at 44,000 deaths per year is the now the leading cause of death from injuries in the US.  These deaths have doubled in the last 14 years, with over half coming from prescription drug use.  

Motor vehicle related deaths were the previous leading cause of injury-related death in the US until this year. As for Maryland, drug overdoses are the leading cause of death here, along with 35 other states.  The remaining 14 states have motor vehicle related deaths as their leading cause of death.  

Nationally, over two million people are abusing prescription drugs, leading to heroin users doubling over the last seven years.  Motor vehicle deaths have declined by 25% over the last decade.  The suicide rate has remained stable for the past 20 years, with still 70% of all suicides being among white males.  Lastly, falls are increasing as baby boomers age. 

There is  a direct correlation between preventing motor vehicle deaths and laws addressing seat belt use, car seats for infants and toddlers, and ignition locks for convicted drunk drivers.  I was shocked to read that 16 states still do not have a primary seat belt law.  Twenty states do not have an ignition lock law for convicted drunk drivers and, 16 states do not require car / booster seats for children up to age eight.

In the injury related death rankings, Maryland ranks 42 out of 50 states with Pennsylvania at 23 and West Virginia at 1.  The higher the number, the better.  With drug overdoses, Maryland is 26th; PA is 9th and WV is again, 1st.

Obviously, a great deal needs to be done to fight drug abuse in Maryland, PA and WV;  clearly an issue in our own community with the abuse of prescription drugs and the increased use of heroin.  

Tuesday, June 16, 2015

The Unintentional Squelch

How many times have you asked for someone to follow up on an idea or concept only to never hear from them about it again?  It used to happen to me.  You may say, "but you are the CEO, who would ever not follow up on a request from you?"  It happens more than you might think.  Actually, it USED to happen to me.  What I learned to do was to make sure that there was a written record of the request, usually an email.  I would then, usually on weekends, review my sent file for the last week and send reminders until I received a response.  There would also be a reminder placed in the employee's hold file to ensure that we discussed the request at our next meeting.  It is critical after you ask to have an idea analyzed to always ensure that follow up is scheduled.


I always hope that the squelch is unintentional, but I also recognize that there are those managers who think, "this is a bad idea that needs to be killed.".  Embracing change can be difficult for some, especially if it's coming at you in a constant barrage.  However, that is what our business has become.  It is ever changing and if people don't understand why change is necessary, they see it as bad change and resist it.  If change is thoroughly explained, it should be met with far less resistance.

Thursday, June 11, 2015

Relay for Life

Last Friday, I had the honor of serving as the honorary chairman for the  American Cancer Society's Relay for Life.  I haven't been to the event in a number of years but it continues to be an amazing night.  It recognizes those currently battling cancer, those who have survived it, the caregivers who support their loved ones, the nurses, and the doctors and it also remembers those who have lost the fight.  

WMHS is always the major sponsor and our team usually raises the most money in the fight against cancer.  It is important to note that money stays in our community through programs and services such as Look Good Feel Better, patient navigator, wig fittings and distribution and the list goes on.  


Even with the basis for the evening being related to cancer, it was a wonderful evening.  Once it was announced that I was selected as honorary chair, I had many people coming up to me telling their story about a loved one battling cancer or their own battle with cancer.  I am so fortunate to have been asked to participate in the event and so proud to be associated with our team of nurses, nurse practitioners,technicians, support staff and physicians who are there for these patients and their families every day.




Friday, June 5, 2015

Maryland's Department of Economic Development

Yesterday, I had the opportunity to have lunch with the new Secretary for Economic Development for Maryland, Mike Gill.  The Greater Cumberland Committee hosted Secretary Gill and I was invited to sit at his table.  

What a breath of fresh air!  He was right on point with the audience on what the state needs to do to be more business friendly: less regulation; an educated work force; tax incentives; less dependance on federal government jobs; work more effectively with every city and county government in Maryland; partner with economic development across the state and work in partnership with the other Secretaries in the Hogan Administration to facilitate economic growth statewide.  

I found the Secretary to be extremely knowledgable, upbeat, positive, very personable and great with names.  Secretary Gill committed to a return trip to visit key economic drivers in our region..........first stop, WMHS!