Maryland Community Health Resources Commission (MCHRC)

I have the honor of serving on the above commission.  Last week, the Commission met and we had the opportunity to hear from a variety of providers about their respective grant proposal submissions.  It is amazing as to how creative these providers, consisting of primary clinics, hospitals, health departments, FQHCs, mental health clinics and the list goes on, have become.  

With Maryland now requiring all hospitals and health systems to provide care delivery under a value-based care delivery model, a lot of partnerships have evolved and that's the way it should be.  Providers need to partner with each other and I can now assure you that it's happening in Maryland.  The Commission is awarding millions in grant dollars in areas such as care coordination, dental care, primary care and behavioral health partnerships, infant mortality and diversity in the provision of care.  We voted at the end of the meeting as to who would be awarded the grants and these grantees should be thrilled with our decisions.  

However, it will also be necessary in the near future to use the savings that hospitals and managed care organizations are benefiting from as their utilization begins to decrease and savings begin to occur.  We have been benefiting from our savings by re-investing them in the organization as well as sharing it with agencies in our communities that assist with the social needs of our patients.  We are precluded from applying for grant funding under the MCHRC because I am a commissioner; but I find it rewarding to see these partnerships evolve to better address the care of their patients, and the many ideas are great for potential consideration at WMHS.

Questioning Protocols

Last week, the System Management group met to discuss a variety of issues facing WMHS over the next five years.  For that meeting, the group had been asked by me to read the book, Questioning Protocols, by Randi Redmond Oster.  Randi is a mother of a teenage son with Crohn's Disease.  The book describes how the mother and son navigated the health care system while dealing with such a challenging illness.  

The book discussion on Friday was exceptional.  Part of the group loved the book and the other part of the group didn't like the book or the author.  At the end of the day, everyone agreed as to the overall value of the book as we attempt to do our jobs better, especially as it relates to keeping the patient and his family in the center of all that we do.  

Some of the common threads throughout the book were as follows: the importance of advocacy on behalf of the family for their loved one and that we need to understand and embrace such advocacy; the importance of communication and that we, as health care providers, can fail at that from time to time; that we need to involve the family in the plan of care to a much greater extent; and lastly, that we need to meet the needs and expectations of the family as well as the patient.  

Through the discussion, we now have a host of initiatives under each of the above threads that we will be putting into place as we deliver value-based, patient-centered care.

You Gotta Love These States and Their Taxes

Last night, Pamela and I ate at a very small, unassuming restaurant in Bedford, PA.  If you are a foodie, then again even if you aren't a foodie, you have to go 10/09 Kitchen on Pitt Street. Wow, the food was amazing.  

The owners just got their liquor license and the bar just opened last night. Pamela and I challenged them with a French Martini (her) and a Maker's Mark Manhattan (me); both were great. Previously, they served only beer and wine, but you could bring your own bottle of wine and pay a corkage fee of $15, which is very reasonable.  Restaurants, especially in Cumberland, should consider a corkage fee.  You can buy some great wines for $23 a bottle, but not Pinot Noir. I don't mean to sound snooty, but that's a fact! 

Anyway, at 10/09 Kitchen you can bring your own bottle of wine; but after a recent visit by the Pennsylvania Liquor Control Board, the restaurant now has to ask for proof that the wine was purchased in the Commonwealth of Pennsylvania.  You have to show your receipt to verify that you paid the PA liquor tax.  Without that verification by the restaurant, they could lose that newly attained, much coveted liquor license. And here I thought it was only the People's Republic of Maryland that had cornered the market on taxes and fees!  Rain tax, need I say more?

Again, you have to try 10/09 Kitchen as it will be well worth the trip. Reservations are required since the restaurant holds only 48 people.  Enjoy!

Turning Bad into Good

This morning, I read Paul Levy's blog (Not Running A Hospital) regarding a new health care task force consisting of hospitals, physicians, employers and payors that has committed to shift 75% of its members to value-based care delivery by 2020. Really? How progressive. Do you think that you have given yourselves enough cushion with five years?  That story is for another day.  The title of Paul's blog was "Marching but where? Moscow, I fear" and the graphic was a depiction of Napoleon's disastrous march on Moscow.   The graphic served as an immediate reminder of a time at WMHS that many could easily want to forget.

A number of years ago during the early stages of the affiliation of Memorial Hospital and Sacred Heart Hospital to form the Western Maryland Health System, we engaged an architectural firm to assist with our master facility plan.  As some will remember, the many scenarios that were created included such things as build a “new” Memorial at Scared Heart, Sacred Heart as an inpatient hospital and Memorial as an outpatient hospital or the division of clinical services between the hospitals, which we ended up with at the end of the day.  The interesting part was during one of his many presentations, our architect presented a depiction of Napoleon's March on Moscow in 1812 to show how we could depict the various factors at work with our project.  Napoleon's March depiction (shown below) graphs the number of troops at each position, their location by date and the temperature at any given time during their march.  This depiction is probably the best statistical graphic ever drawn and our architect tried to use it to describe our project.  After his presentation, I got a closer look at the depiction and I too was enamored with the graph.  However, I pointed out to our architect that while the depiction was powerful, what it was describing was an unmitigated disaster for Napoleon.  He lost over 400,000 men and he was chased out of Russia suffering one of the greatest defeats in history.  This defeat led to Napoleon's downfall as a world leader and began Russia's dominance as a world power.  

At the time, little did I realize as to how accurate that depiction was to our situation that was soon to evolve.  Now, I am not trying to compare Napoleon's defeat to the early years of our affiliation but, quite honestly, the message was there and at the time everyone laughed it off.  Those early years were difficult and challenging; some days were downright horrible.  However, what has become of the Western Maryland Health System has been amazing and would not have happened without those many early challenges.  Unlike Napoleon, it was well worth for us.

OK So Which Is It? Are ED Visits Increasing or Decreasing?

Over the last two days, I have read two articles on ED Visits.  One article was in Modern Healthcare and the second was in a Pittsburgh newspaper.  Modern Healthcare is stating that ED visits are increasing nationwide as more people are eligible for care under the Affordable Care Act, but they still wait until they are really sick to seek care.  

The second article says that patient navigators are being especially effective in directing patients to the most appropriate care.  In western Pennsylvania, there was a study of the effectiveness of patient navigators funded by Highmark and, not only was there a decrease in ED visits, but also in admissions and readmissions.  The navigators were able to direct patients to access care more efficiently.  That doesn't seem to be the case for the busiest EDs around the country.  They are seeing increases due to patients who are now covered, physicians closings practices and other practices no longer taking Medicare or Medicaid patients.  

This is an interesting dichotomy, in that we have had the experience that is more like western PA, at least up until the current flu season.  If you take time to understand the changes needed for the successful delivery of value-based care, such as increasing primary care centers, dedicating patient navigators like the Pennsylvania study did, adding community health workers, expanding home care, growing hospital medicine programs to better accommodate physicians who want to focus on an office practice exclusively, identifying and caring for your high utilizers in a settings that is outside of acute care and the list goes on.  Until all hospitals are focused on transitioning away from volume-based care to value-based care, the busiest EDs are going to continue to experience this.  It is also important to note that these initiatives take time to really see a difference.  

At WMHS, in a little more than a year, we have saved $4.5 million with our high utilizers alone through our Center for Clinical Resources through a reduction in admissions, readmissions, non-emergent use of the ED, less ancillary testing and by providing more directed care in the most appropriate location.

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.

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.