Evolution of physician-hospital alignment models: a case study of comanagement.

BACKGROUND: Recently, quality, financial, and regulatory demands have driven physicians to seek alignment opportunities with hospitals. The motivation for alignment on the part of physicians and hospitals is now accelerating because the new paradigm under healthcare reform requires an increased focus on improving quality, cost, and efficiency. QUESTIONS/PURPOSES: We (1) identify the key drivers for physician-hospital alignment models; (2) summarize comanagement as a physician-hospital alignment model; and (3) explore a detailed case study of comanagement as an option to better align physicians with hospital goals on quality, safety, and outcomes. METHODS: A Medline abstract review was performed that identified 45 references that discuss options for physician-hospital alignment. None of the articles identified provide a detailed example of successful alignment structures. A detailed case study of a successful comanagement alignment program is reviewed. RESULTS: The key drivers for alignment are inpatient growth rates, declining reimbursements, and the opportunity to improve quality, decrease costs, and increase efficiency. Two general strategies of alignment involve noneconomic and/or economic integration. In our example, comanagement with economic integration was chosen as the preferred structure for physician-hospital alignment. CONCLUSIONS: The choice of structure will vary depending on the existing relationships and governance of the hospital and the physicians in the targeted area of focus. The measure of success in building physician-hospital alignment is measured in improvements in care for the patient, reduced cost of care delivery, and improved relations between physicians and hospital leadership.

Understanding how orthopaedic surgery practices generate value for healthcare systems.

BACKGROUND: Orthopaedic surgery practices can provide substantial value to healthcare systems. Increasingly, healthcare administrators are speaking of the need for alignment between physicians and healthcare systems. However, physicians often do not understand what healthcare administrators value and therefore have difficulty articulating the value they create in discussions with their hospital or healthcare organization. Many health systems and hospitals use service lines as an organizational structure to track the relevant data and manage the resources associated with a particular type of care, such as musculoskeletal care. Understanding service lines and their management can be useful for orthopaedic surgeons interested in interacting with their hospital systems. QUESTIONS/PURPOSES: We provide an overview of two basic types of value orthopaedic surgeons create for healthcare systems: financial or volume-driven benefits and nonfinancial quality or value-driven patient care benefits. METHODS: We performed a search of PubMed from 1965 to 2012 using the term "service line." Of the 351 citations identified, 18 citations specifically involved the use of service lines to improve patient care in both nursing and medical journals. RESULTS: A service line is a structure used in healthcare organizations to enable management of a subset of activities or resources in a focused area of patient care delivery. There is not a consistent definition of what resources are managed within a service line from hospital to hospital. Physicians can positively impact patient care through engaging in service line management. CONCLUSIONS: There is increasing pressure for healthcare systems and hospitals to partner with orthopaedic surgeons. The peer-reviewed literature demonstrates there are limited resources for physicians to understand the value they create when attempting to negotiate with their hospital or healthcare organization. To effectively negotiate for resources to provide the best care for patients, orthopaedic surgeons need to claim and demonstrate the value they create in healthcare organizations.

Factors driving physician-hospital alignment in orthopaedic surgery.

BACKGROUND: The relationships between physicians and hospitals are viewed as central to the proposition of delivering high-quality health care at a sustainable cost. Over the last two decades, major changes in the scope, breadth, and complexities of these relationships have emerged. Despite understanding the need for physician-hospital alignment, identification and understanding the incentives and drivers of alignment prove challenging. QUESTIONS/PURPOSES: Our review identifies the primary drivers of physician alignment with hospitals from both the physician and hospital perspectives. Further, we assess the drivers more specific to motivating orthopaedic surgeons to align with hospitals. METHODS: We performed a comprehensive literature review from 1992 to March 2012 to evaluate published studies and opinions on the issues surrounding physician-hospital alignment. Literature searches were performed in both MEDLINE(®) and Health Business™ Elite. RESULTS: Available literature identifies economic and regulatory shifts in health care and cultural factors as primary drivers of physician-hospital alignment. Specific to orthopaedics, factors driving alignment include the profitability of orthopaedic service lines, the expense of implants, and issues surrounding ambulatory surgery centers and other ancillary services. CONCLUSIONS: Evolving healthcare delivery and payment reforms promote increased collaboration between physicians and hospitals. While economic incentives and increasing regulatory demands provide the strongest drivers, cultural changes including physician leadership and changing expectations of work-life balance must be considered when pursuing successful alignment models. Physicians and hospitals view each other as critical to achieving lower-cost, higher-quality health care.

Evaluación del proyecto de producción pública de fitomedicamentos en la provincia de Misiones durante el período 2006-2007 / Project evaluation phytomedicines public production in the province of Misiones in the period 2006-2007

En el presente trabajo nos proponemos estudiar el proyecto realizado por el Ministerio de Salud Pública de la Provincia de Misiones de elaboración de fitomedicamentos, utilizando la infraestructura del Laboratorio Provincial de Producción de Medicamentos, por el cual se ha abierto una línea de producción de fitomedicamentos (fitofármacos aprobados y distribuidos en efectores públicos) tales como: crema de caléndula officinalis.L. , comprimido de maytenus ilicifolia Mart. ex. Reiss. y jarabe de cecropia adenopus M, en reemplazo de ciertas drogas convencionales; y evaluar si la producción pública a mediano plazo de estos medicamentos fitoterápicos representará una disminución de costos del gasto público total en medicamentos.Los fitomedicamentos son medicamentos naturales que para su elaboración llevan una serie de pautas de tipo científico-tecnológico, controles de toxicología, respaldo de estudios clínicos, que garantizan la calidad y los controles necesarios para su elaboración. Este estudio nos permitirá la realización de recomendaciones económicas a decisores políticos en lo referente a la implementación de políticas de medicamentos, considerando la indicación de los fitomedicamentos como sustitución de drogas adquiridas en el mercado, válidos en términos de costo-efectividad. Además, estaremos en condiciones de evaluar el impacto de la producción de medicamentos fitoterápicos en la disminución de costos del gasto público provincial en esta materia.(AU)

SUMMARY: In this paper we propose to study the project developed by the Ministry of Public Health of Misiones Province of preparing phytomedicines, using the Public Laboratory of Drug Production infrastructure. It has opened a production line of phytomedicines (herbal medicines approved and distributed in public effectors) such as calendula cream officinalis.L, Compressed Maytenus ilicifolia Mart. former. Reiss. and M adenopus cecropia syrup, replacing some conventional drugs, and assess if public production of these herbal medicines represent a cost reduction of total public expenditure on drugs in the medium-term. Phytomedicines are natural medicines which required a series of scientific-technological controls, toxicology, clinical trial support, quality assurance and controls necessary for their processing. This study will allow the realization of economic advices to policy makers regarding the implementation of drug policies, considering the indication of phytomedicines as replacement drugs acquired on the market, valid in terms of cost-effectiveness. In addition, we will be able to assess the impact of the production of herbal medicines in reducing costs of provincial government in this area.(AU)

Evaluación del proyecto de producción pública de fitomedicamentos en la provincia de Misiones durante el período 2006-2007 / Project evaluation phytomedicines public production in the province of Misiones in the period 2006-2007

En el presente trabajo nos proponemos estudiar el proyecto realizado por el Ministerio de Salud Pública de la Provincia de Misiones de elaboración de fitomedicamentos, utilizando la infraestructura del Laboratorio Provincial de Producción de Medicamentos, por el cual se ha abierto una línea de producción de fitomedicamentos (fitofármacos aprobados y distribuidos en efectores públicos) tales como: crema de caléndula officinalis.L. , comprimido de maytenus ilicifolia Mart. ex. Reiss. y jarabe de cecropia adenopus M, en reemplazo de ciertas drogas convencionales; y evaluar si la producción pública a mediano plazo de estos medicamentos fitoterápicos representará una disminución de costos del gasto público total en medicamentos.Los fitomedicamentos son medicamentos naturales que para su elaboración llevan una serie de pautas de tipo científico-tecnológico, controles de toxicología, respaldo de estudios clínicos, que garantizan la calidad y los controles necesarios para su elaboración. Este estudio nos permitirá la realización de recomendaciones económicas a decisores políticos en lo referente a la implementación de políticas de medicamentos, considerando la indicación de los fitomedicamentos como sustitución de drogas adquiridas en el mercado, válidos en términos de costo-efectividad. Además, estaremos en condiciones de evaluar el impacto de la producción de medicamentos fitoterápicos en la disminución de costos del gasto público provincial en esta materia.

SUMMARY: In this paper we propose to study the project developed by the Ministry of Public Health of Misiones Province of preparing phytomedicines, using the Public Laboratory of Drug Production infrastructure. It has opened a production line of phytomedicines (herbal medicines approved and distributed in public effectors) such as calendula cream officinalis.L, Compressed Maytenus ilicifolia Mart. former. Reiss. and M adenopus cecropia syrup, replacing some conventional drugs, and assess if public production of these herbal medicines represent a cost reduction of total public expenditure on drugs in the medium-term. Phytomedicines are natural medicines which required a series of scientific-technological controls, toxicology, clinical trial support, quality assurance and controls necessary for their processing. This study will allow the realization of economic advices to policy makers regarding the implementation of drug policies, considering the indication of phytomedicines as replacement drugs acquired on the market, valid in terms of cost-effectiveness. In addition, we will be able to assess the impact of the production of herbal medicines in reducing costs of provincial government in this area.

Complementary and alternative medicine--a consumer CAM-paign.

Complementary and alternative medicine (CAM) isn't just for the "New Age" set anymore-increasingly, patients are voting with their feet, choosing those institutions that offer CAM therapies.

The Canadian Natural Health Products (NHP) regulations: industry perceptions and compliance factors.

BACKGROUND: The use of natural health products, such as vitamins, minerals, and herbs, by Canadians has been increasing with time. As a result of consumer concern about the quality of these products, the Canadian Department of Health created the Natural Health Products (NHP) Regulations. The new Canadian regulations raise questions about whether and how the NHP industry will be able to comply and what impact they will have on market structure. The objectives of this study were to explore who in the interview sample is complying with Canada's new NHP Regulations (i.e., submitted product licensing applications on time); and explore the factors that affect regulatory compliance. METHODS: Twenty key informant interviews were conducted with employees of the NHP industry. The structured interviews focused on the level of satisfaction with the Regulations and perceptions of compliance and non-compliance. Interviews were tape recorded and then transcribed verbatim. Data were independently coded, using qualitative content analysis. Team meetings were held after every three to four interviews to discuss emerging themes. RESULTS: The major finding of this study is that most (17 out of 20) companies interviewed were beginning to comply with the new regulatory regime. The factors that contribute to likelihood of regulatory compliance were: perceptions and knowledge of the regulations and business size. CONCLUSION: The Canadian case can be instructive for other countries seeking to implement regulatory standards for natural health products. An unintended consequence of the Canadian NHP regulations may be the exit of smaller firms, leading to industry consolidation.

An academic-community cardiovascular service line affiliation: design, implementation, and performance.

Both affiliation with an academic medical center and implementation of service line management may be effective management strategies for community health care organizations. The authors describe the design, implementation, and performance of a unique combination of these two distinct strategies for cardiovascular program development in the affiliation of the University of Florida Health Science Center with Health First, a regional community-based integrated delivery system.

Are consumers reshaping hospitals? Complementary and alternative medicine in U.S. Hospitals, 1999-2003.

All types of acute care hospitals across the U.S. are becoming increasingly involved in offering CAM services. Hospitals appear to be responding to consumer demand, CAM specific market forces, and their organizational missions but not to regulatory mandates.

Marketing the health care experience: eight steps to infuse brand essence into your organization.

One of the most elusive challenges in health care marketing is hitting on a strategy to substantially differentiate your organization in the community and drive profitable business. This article describes how Sharp HealthCare, the largest integrated health care delivery system in San Diego, has proven that focusing first on improving the health care experience for patients, physicians, and employees can provide the impetus for a vital marketing strategy that can lead to increased market share and net revenue. Over the last five years, this nonprofit health system has transformed the health care experience into tangible actions that are making a difference in the lives of all those the system serves. That difference has become Sharp's "brand essence"--a promise to the community that has been made through marketing, public relations, and advertising and then delivered through the dedicated work of Sharp's 14,000 team members. They call this performance improvement strategy The Sharp Experience. This article outlines the eight-step journey that led the organization to this brand essence marketing campaign, a campaign whose centerpiece is an award-winning 30-minute television documentary that use real-time patient stories to demonstrate Sharp's focus on service and patient-centered care against a backdrop of clinical quality and state-of-the-art technology, and documentary-style radio and television commercials.

The new health care paradigm: roles and competencies of leaders in the service line management approach.

PURPOSE: The purpose of this paper is to discuss the need for the service line management approach in health care. Service line management is increasingly utilized by US health care organizations as an innovative method for providing the needed stimulus to increase viability and profitability for the ailing health care sector. DESIGN/METHODOLOGY/APPROACH: Using current literature, this study describes a paradigm shift from traditional health care management approaches to focus on the importance of a service line management approach with its specific emphasis on competencies of leaders. RESEARCH LIMITATIONS/IMPLICATIONS: Four essential competencies--conceptual, participation, interpersonal, and leadership--must be gained by leaders to bring about organizational growth. PRACTICAL IMPLICATIONS: Health care managers must understand and practice these four key competencies to become effective health care leaders. ORIGINALITY/VALUE: This paper provides useful information on the need for the service line management approach in health care.

Early-stage success in service line implementation.

The results of a multimethod, qualitative data collection approach reveal a high level of consistency between early-stage dynamics identified in service line implementation and dynamics viewed within life cycle theory as more observable during the birth stage of development. This finding supports the idea that service line implementation unfolds similarly compared with other types of structures. In addition, it presents a more complex view of service line implementation at any given point in time by linking its unique aspects with issues and dynamics particular to the developmental stage in which the structure exists. The organization examined was the Behavioral Health Service Line of the Upstate New York Veterans Healthcare Network.

Strategic service-line planning. Building competitive advantage.

Service-line planning requires a healthcare organization to develop a business plan for each of its service lines. Successful service-line planning requires top leadership support, a willingness to allocate resources, the development of support mechanisms, the active support and involvement of physicians, and management commitment and accountability during implementation.

Frail elderly patients. New model for integrated service delivery.

PROBLEM BEING ADDRESSED: Given the complex needs of frail older people and the multiplicity of care providers and services, care for this clientele lacks continuity. OBJECTIVE OF PROGRAM: Integrated service delivery (ISD) systems have been developed to improve continuity and increase the efficacy and efficiency of services. PROGRAM DESCRIPTION: The Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) is an innovative ISD model based on coordination. It includes coordination between decision makers and managers of different organizations and services; a single entry point; a case-management process; individualized service plans; a single assessment instrument based on clients' functional autonomy, coupled with a case-mix classification system; and a computerized clinical chart for communicating between institutions and professionals for client monitoring. CONCLUSION: Preliminary results on the efficacy of this model showed a decreased incidence of functional decline, a decreased burden for caregivers, and a smaller proportion of older people wishing to enter institutions.

St. John Health integrating new corporate identity, brand. Brand/logo to be rolled out over two-year period.

St. John Health, Warren, Mich., is integrating a new corporate identity and brand strategy for its network of nine wholly-owned and two affiliated hospital, along with more than 100 physician offices and specialty centers in southeast Michigan. "A new identity is a great rallying cry. It automatically says. 'We have a new mission. We have a new system. We are reaching new people,'" said Eunice O'Loughlan, VP, corporate communications for St. John Health.