The EHR evolution: new priorities and implementation challenges.

Five types of key leadership decisions can help smooth the process of selecting and implementing EHR systems and upgrades: Balancing choices with population health priorities. Considering approaches to reduce costs and ease implementation. Prioritizing steps to ease physicians' first six months with the system. Implementing all at once to eliminate "clunky" workflows. Staggering a launch to identify quick-to-value features and functions.

Finding success in ACA narrow networks.

Health systems should carefully consider the specific details of their local market before deciding to launch a narrow network plan or to join an existing insurer's narrow network. Key steps to take in the evaluation process include: Determining insurer interest in forming a true partnership. Assessing capability for greater efficiency. Assessing insurer priorities. Obtaining access to enrollee data. Identifying capabilities that differentiate it from other narrow networks.

Building blocks for organizational change.

To understand the types of organizational change that will best help them meet strategic goals, hospitals and health systems are: Projecting their quality and savings goals for the coming years and weighing their ability to meet them. Looking for partner organizations that share their culture, goals, and capabilities. Assessing the types of organizational arrangements that will provide the desired benefits. Determining the key components needed to make the arrangement fit their goals and culture.

Innovations in cost management.

To better understand true costs and use this knowledge to drive savings, health systems are: finding ways to combine clinical and financial data to identify clinical care savings, including equipment not just care variation when researching clinical cost drivers, benchmarking to identify both relatively high-cost areas and lower-cost approaches, including nonclinical support areas when looking for systemwide cost drivers.

The structure of value.

Keys to success in developing the right framework for delivering greater value in an era of reform include the following: Have a compelling vision. In evaluating potential partnerships, carefully consider the extent to which the organizations' cultures are aligned. Ensure that initiatives stay on course. Develop sustainable energy among leaders and staff through early wins. Measure patient, physician, and employee satisfaction before and after initiatives are implemented and respond accordingly.

Exchange enrollment, round 2.

Enrollment approaches hospitals plan to undertake during the second open-enrollment period for the insurance exchanges, or marketplaces, include: Deploying mobile units to help eligible consumers sign up for coverage or assistance. Working with insurers to more easily identify patients who received coverage through the exchanges. Clarifying details of coverage with patients who have marketplace coverage. Limiting use of hospital charity care programs among those who qualify for Medicaid or marketplace coverage.