Product line development: a strategy for clinical success in academic centers.

OBJECTIVE: Academic medical centers, which have traditionally been relatively inefficient, have increasing difficulty in meeting the missions of patient care, teaching, and research in a progressively competitive medical marketplace. One strategy for improved efficiency in patient care while keeping quality high is utilization of a product line matrix. This study addresses the outcome of utilizing a product line strategy consisting of 3 service lines during the past 5 years at the University of Wisconsin Hospital and Clinics (UWHC). METHODS: Service lines in heart and vascular surgery, oncology, and pediatrics have been organized since 2001, and report directly to hospital leadership as a product line. Service line leadership consists of a combination of medical leaders plus representatives of hospital administration, and service lines are allowed direct access to resources for program development, marketing, and resource allocation. Measurements of patient numbers, market share, length of stay, net margin, and patient satisfaction have been gathered and compared with the preproduct line era. RESULTS: In the 3 service lines, UWHC has seen variable but steady growth in patient numbers, enhanced market share, positive net margins, and improved patient satisfaction during the period of measurement. During this same period, the insurance milieu has resulted in consistent downward pressure on reimbursement, which has been offset by improved patient care efficiency as measured by length of stay, enhanced preferred provider status, and gains in market share. Scorecard measures of quality are also being developed and show enhanced teaching and research opportunities for students and trainees as well as improved Press Ganey patient satisfaction scores. CONCLUSIONS: At UWHC, the development of a product line matrix consisting of 3 service lines has resulted in more patient care efficiency, enhanced patient satisfaction, improved margin for the hospital, and enlargement of teaching and research opportunities. The key to successful implementation of the product line concept is a close working relationship between the hospital administration and service line medical leadership.

Growth outside the core.

Growth in an adjacent market is tougher than it looks; three-quarters of the time, the effort fails. But companies can change those odds dramatically. Results from a five-year study of corporate growth conducted by Bain & Company reveal that adjacency expansion succeeds only when built around strong core businesses that have the potential to become market leaders. And the best place to look for adjacency opportunities is inside a company's strongest customers. The study also found that the most successful companies were able to consistently, profitably outgrow their rivals by developing a formula for pushing out the boundaries of their core businesses in predictable, repeatable ways. Companies use their repeatability formulas to expand into any number of adjacencies. Some companies make repeated geographic moves, as Vodafone has done in expanding from one geographic market to another over the past 13 years, building revenues from $1 billion in 1990 to $48 billion in 2003. Others apply a superior business model to new segments. Dell, for example, has repeatedly adapted its direct-to-customer model to new customer segments and new product categories. In other cases, companies develop hybrid approaches. Nike executed a series of different types of adjacency moves: it expanded into adjacent customer segments, introduced new products, developed new distribution channels, and then moved into adjacent geographic markets. The successful repeaters in the study had two common characteristics. First, they were extraordinarily disciplined, applying rigorous screens before they made an adjacency move. This discipline paid off in the form of learning curve benefits, increased speed, and lower complexity. And second, in almost all cases, they developed their repeatable formulas by studying their customers and their customers' economics very, very carefully.

Para crear un nuevo futuro. Informe UDENOR / In Order Create a New Future. Report UNDENOR

Modelo de gestión a nivel de: infraestructura social.-Componente de infraestructura productiva.-Desarrollo productivo, económico, ambiental y comunicacional, de los proyectos en ejecución y terminados.-El Programa se elaboró sobre la base de la recopilación de proyectos de distintos estamentos del gobierno central y los gobiernos locales

Musculoskeletal disorders and the consumption of disability products.

Although consumers' need assessment generally suggest that, what consumers need as products or services influence their consumption, little research on consumption of disability resources, relating to musculoskeletal disorders exists. However, most medical practitioners defined musculoskeletal disorders by symptoms or clinical disorders and other used self-report. The authors examined the effects of musculoskeletal disorders and ultimate consumption of specific products (orthopedic devices, medications), as well as the cost of surgical options (e.g., gastric reduction surgery). Emphasis was on product categories, such as disability devices and consumption of disability resources. The authors conclude that there are positive relationships between musculoskeletal disorders and consumption of disability products, either to maintain certain lifestyles or reduce pains and sufferings. Finally the authors discussed the advancement of marketing theory with musculoskeletal consumption analysis. Opportunity for further research in the area is enhanced and encouraged.

Analyzing hospital market share along product lines.

This article illustrates a method of analyzing market share based on product lines or specific hospital services, using 1990 data from a health service catchment area in South Carolina. Hospital discharges from two specific services: vascular and cardiac surgery; and obstetrics, were used to compute market rates of retention, discharge, escape, commitment, opening, and capture. The results confirm that as hospitals become more specialized, market share analysis based on total discharges is often misleading. Rather, discharges should be disaggregated and separate service areas with different boundaries constructed for different product lines. This method of market analysis can be performed easily and periodically by hospitals to monitor the market situation of their product lines.

Ten-year experience in managing a capitated ophthalmology carve-out by an academic eye center.

A 10-year experience of managing a capitated opthalmology carve-out by an academic health unit is presented. Lessons learned regarding pricing, utilization, and managing this contract are discussed. Handling the cost of education and remaining competitive is presented as a not-insurmountable hurdle. Academic health units can compete in today's environment; however, the learning curve is steep and the problems many.

Knowing your costs: the key to financial success of ambulatory surgery centers under prospective payment.

The need for ambulatory surgery centers to have accurate cost accounting systems will only continue to grow in the years to come and such systems can only improve the quality of decisions made for these facilities. With the advent of prospective payment for ambulatory services and continued escalating health care expenditures by government and commercial payors, continued rate cutting can be expected. Therefore, ASCs must know their costs, be able to compare costs to payments, and be able to respond to this information accordingly. Consequently, a strong cost accounting system is an essential vehicle for ambulatory surgery centers that wish to successfully venture into the mid-1990s and beyond.

Action steps for effectively managing ambulatory surgery under outpatient prospective payment.

This article reviewed common problems faced by managers in effectively using resources in ambulatory surgery. The article also recommended action steps for programs to consider to gain better control over the resources used in surgery. As reimbursement for outpatient surgery shifts to more resource use-based approaches, the importance of examining patterns of surgery and identifying opportunities for more efficient use of resources will grow in order to maintain financial and clinical performance.

Cancer at the crossroads.

A number of elements are transforming cancer care in hospitals. First is ongoing, rapid technological advance: Experts contend that biotechnology therapies will shift the site of cancer treatment from external, systemic treatments like radiation and chemotherapy, to targeted, tumor-specific drugs that boost the immune system. That change alone holds many implications for oncology management. In addition, an aging population, longer cancer survival rates, reimbursement concerns, and the increasing involvement of patients and their families in treatment decision making, will all have an impact on the way cancer care is designed and delivered. The time to plan, say experts, is now. Meanwhile, innovative treatment plans, patient care approaches, and collaborative efforts among institutions are moving hospital oncology into the 1990s in a dramatic way.

Marketing imaging services.

"Communication with physicians and patients is critical to successfully marketing technology," says Mr. Bouchard, author of a new handbook for radiology managers. In this section from his book, he describes the components of a successful marketing plan and tries to dispel several myths about marketing. He also describes benchmarks for success, and provides a sample plan to promote mammography services.