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Conference overview

The American healthcare industry has undergone significant organizational changes over the past decade. The nation is rapidly aggregating into larger and more complex health systems that are vertically and horizontally integrated. The trend is being driven by both business conditions and government policy, such as policies encouraging the creation of Accountable Care Organizations, medical homes, and bundled payments. The current climate results in collaborations among entities that historically have not worked together. Some of these partnerships will likely face challenges that can be roughly characterized as stemming from “shotgun marriages.” The conference sought to determine which elements of more mature healthcare systems result in the best clinical outcomes, and whether the microsystems are transferable to smaller, newer, or less integrated systems.

ECRI Institute’s 19th Annual Conference, Creating “Systemness” within Healthcare Delivery: Can Success be Proven and Shared?, brought together a range of constituencies, including public and private providers and payers, policy makers, clinicians, industry, regulators, consumers/patients, and researchers. 

The conference’s examination of “systemness” ranged broadly, asking thought-provoking questions, such as:

  • What is "systemness?"

  • Which elements within mature healthcare systems result in the best clinical outcomes?

  • Are approaches taken by long-established healthcare systems transferable to smaller, newer, or less integrated systems?

  • Are financial incentives alone enough to drive change?

  • How can EHRs help improve "systemness?"

  • Do "transformation" units within health systems produce results?

Additional resources

  • Read a special overview of the key trends discussed at the conference in ECRI Institute's executive newsletter, Health Technology Trends.

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Printable conference brochure

WEDNESDAY, NOVEMBER 28, 2012

Welcome and Introduction to the Format and Major Themes of the Conference

  • Jeffrey C. Lerner, PhD, President and Chief Executive Officer, ECRI Institute

Brief Remarks

  • Joel Kupersmith, MD, Chief Research and Development Officer, Veterans Health Administration
  • Sharon Levine, MD, Associate Executive Director, The Permanente Medical Group, Inc., Kaiser Permanente

Session 1: Developing an Effective Culture: Why Financial Incentives are not Enough

Aligning financial incentives in healthcare systems is essential for making them productive. Mature healthcare systems have had time to develop cultures that can have strong appeal to professionals, such as clinicians and managers, and to patients who use the health system. Systems created relatively recently are often put together almost exclusively on a financial basis, and sometimes without regard to whether there is a true cultural fit among the participants in the new systems. Mature healthcare systems do not just have a culture, but rather they work to create one and maintain it. This session will explore whether and why these nonfinancial incentives work and the extent to which aspects of a system's culture can be transferred. Our speakers will also address the heterogeneity in types of healthcare systems, as well as issues of governance and leadership.

Learning Objectives

  • Examine the governance and leadership of various types of health systems.
  • Debate whether and why nonfinancial incentives work and how they interface with financial incentives.
  • Assess whether a health system's culture is transferable to newer or growing systems.

Presenters

  • Sarah Krevans, MBA, MPH, Chief Operating Officer, Sutter Health
  • Ralph Muller, MBA, Chief Executive Officer, University of Pennsylvania Health System
  • Robert A. Petzel, MD, Under Secretary for Health in the Department of Veterans Affairs
  • Moderator: Susan Dentzer, Editor-in-Chief, Health Affairs

Session 2: Creating Teams to Improve Inter- and Intra- Health System Operations: Does the Evidence Show Benefit?

               

Team building is a commonly accepted "best practice" in a great many organizations, but is there evidence that multi-disciplinary teams have a positive impact on clinical and business processes? This session will examine whether the use of teams has improved long-standing continuity of care issues within and between health systems.

Learning Objectives

  • Compare the use of multi- disciplinary teams across various health systems with those from other industries.
  • Interpret the evidence behind multi-disciplinary teams to determine whether they have a positive impact on clinical outcomes.
  • Interpret the evidence behind multi-disciplinary teams to determine whether they have a positive impact on business outcomes.
  • Question whether the use of multi-disciplinary teams can be transferred by other types of health systems.

Presenters

  • Katherine Klein, PhD, Vice Dean for Social Impact; Edward H. Bowman Professor of Management, The Wharton School, University of Pennsylvania
  • David Mayer, PhD, Managing Director, National Transportation Safety Board
  • Lisa Schilling, RN, MPH, Vice President, National Health Care Performance Improvement; Director, Center for Health Systems Performance, Kaiser Permanente
  • Jessie Gruman, PhD, President, Center for Advancing Health
  • Moderator: Jeffrey C. Lerner, PhD, President and Chief Executive Officer, ECRI Institute

Session 3: Transformation Centers and the Evidence: Where are We Now?

An increasing number of hospital systems are creating transformation centers that specialize in bringing innovation into a healthcare system. This session will discuss how these transformation centers seek to establish themselves in the face of ingrained hierarchies, and whether they are able to have an influence and produce significant outcomes.

Learning Objectives

  • Recognize the role of transformation centers in health care systems.
  • Examine what impact transformation centers have had on creating "systemness" within healthcare.
  • Judge whether the outcomes produced by transformation centers are significant.

Presenters

  • Alide Chase, MS, Senior Vice President, Quality and Safety, Kaiser Foundation Health Plan, Inc.
  • Naomi Fried, PhD, Chief Innovation Officer, Boston Children's Hospital
  • Earl Steinberg, MD, Executive Vice President, Innovation & Dissemination; Chief, Healthcare Solutions Enterprise, Geisinger Health System
  • Paul C. Tang, MD, MS, Vice President, Chief Innovation and Technology Officer, Palo Alto Medical Foundation
  • Moderator: Lee A. Fleisher, MD, Chair, Department of Anesthesiology and Critical Care, University of Pennsylvania Health System

Session 4: The Use of EHR in Furtherance of "Systemness": Case Studies

The Veterans Health Administration is widely acknowledged as having transformed itself from a poorly functioning system to one that has become a model for healthcare delivery. The VA has been a leader in the use of Electronic Health Records, and has influenced many other health systems to adopt them. As EHR technology advances, EHRs can now do more than just capture patient's medical information, and are seen as a means of creating more efficient systems. The panelists in this session will discuss how the use of EHRs has changed the experiences of practicing medicine and being a patient, and will examine the evidence to determine whether the use of EHR actually promotes more cohesive, effective, and efficient systems. 

Learning Objectives

  • Examine the impact of Electronic Health Records (EHR) on health systems and the patient experience.
  • Appraise the evidence behind the use and implementation of EHR by major healthcare systems, including Sutter Health, Veterans Administration, Kaiser Permanente, and Nemours.
  • Debate whether EHR has achieved its goals of sewing a system together and improving their quality and efficiency.

Presenters

  • Theresa Cullen, MD, MS, Director, Health Informatics, Veterans Health Administration
  • Michael Kanter, MD, Medical Director of Quality & Clinical Analysis, Southern California Permanente Medical Group, Kaiser Permanente
  • Stephen T. Lawless, MD, MBA, Vice President, Quality and Patient Safety, Nemours Health System
  • Gordon Hunt, MD, Senior Vice President and Chief Medical Officer, Sutter Health
  • Moderator: Joe V. Selby, MD, Executive Director, Patient Centered Outcomes Research Institute

Commentary and Perspectives

Learning Objectives

  • Reflect on the views and experiences of high level executives on the concept of "systemness."
  • Describe the challenges that health systems face in trying to improve their "systemness."
  • Compare the views of the hospital executives with those of the other session participants.

Presenters

  • George C. Halvorson, Chairman and Chief Executive Officer, Kaiser Permanente
  • Jonathan Perlin, MD, PhD, President, Clinical and Physician Services Group and Chief Medical Officer, HCA, Inc.
  • Moderator: Jeffrey C. Lerner, PhD, President and Chief Executive Officer, ECRI Institute

Q&A

  • Moderator: Joe V. Selby, MD, Executive Director, Patient Centered Outcomes Research Institute

Session 5: Beyond the Borders of Traditional Systems: The Changing Locus of Care?

Some healthcare systems have experience and evidence of success in providing care outside conventional institutional frameworks. One among a growing number of examples is the military medical system's work to create medical homes. Can this approach and other approaches to establishing new healthcare delivery models be replicated in whole or in part? This session will examine whether new approaches to healthcare delivery, including the use of social media, can improve the effectiveness and efficiency of medical care, social services, and the array of services that comprise long term care, and will discuss whether these new models can be adopted by new and existing systems.

Learning Objectives

  • Identify the growing number of programs that are providing care outside conventional institutional frameworks.
  • Interpret the evidence behind these alternative approaches to health care delivery to determine what kind of outcomes they are producing.
  • Debate whether these alternative modes of care delivery can be replicated by other organizations in whole or in part.
  • Assess whether newer media be used to extend the care beyond institutional walls.

Presenters

  • Warren Lockette, MD, Deputy Assistant Secretary of Defense, Clinical and Program Policy; Chief Medical Officer, TRICARE Management Activity, United States Department of Defense
  • Joanne Lynn, MD, Director, Altarum Center for Elder Care and Advanced Illness, Altarum Institute
  • Farris K. Timimi, MD, Medical Director, Mayo Clinic Center for Social Media
  • Moderator: Margaret E. O'Kane, MHA, President, National Committee for Quality Assurance

Session 6: System Evolution: Incorporating New Partners and Partnerships

Long-standing healthcare systems often add new facilities and provider groups, or work to change the priorities of their existing partners to improve the effectiveness and efficiency of their services. Integrating these new partners and partnerships culturally as well as financially can be a challenge. In this session we discuss the evidence to date about successes and failures, in both clinical and business behavior, that result from incorporating new and transforming existing partners.

Learning Objectives

  • Recognize how systems expand and add new provider groups and facilities.
  • Examine the evidence to date related to the successes and failures of those expansions and the usefulness of that evidence for those planning expansions.
  • Describe how different systems have approached the issue of "culture" and imparting that culture to new partners and partnerships.
  • Debate the ethical implications that arise from incorporating new partners and partnerships.

Presenters

  • Peter S. Anderson, Senior Vice President of Strategy and Business Development, Sutter Health
  • John Colmers, MPH, Vice President, Health Care Transformation and Strategic Planning, Johns Hopkins Health System
  • Philip Mehler, MD, Chief Medical Officer, Denver Health and Hospital Authority
  • Moderator: John B. Reiss, PhD, JD, Partner, Saul Ewing LLP; Chair, Board of Trustees, ECRI Institute

Wrap of Day 1

  • Jeffrey C. Lerner, PhD, President and Chief Executive Officer, ECRI Institute

THURSDAY, NOVEMBER 29, 2012

Introduction

  • Jeffrey C. Lerner, PhD, President and Chief Executive Officer, ECRI Institute

Session 7: Federal and State Initiatives: What does the Evidence Show?

Both Federal and State governments have a long-standing and increasing interest in creating or supporting systems of care rather than serving mainly as payers. Government policies strongly support the development of ACOs, for both the general population and for Medicare beneficiaries and Medicaid recipients. New ACOs are primarily financial arrangements, raising questions about whether modified internal cultures can be created effectively and how the mandated goal of improving population health can be met. Is there persuasive evidence about the effectiveness of ACOs in modifying cultures and addressing population health? Is there useful learning from types of systems other than ACOs? The panelists will address what evidence is being used to revise policies for accountability and processes to implement them, to re-structure management structures, and to measure the effectiveness of institutional changes that seek to align financial and non-financial incentives.

Learning Objectives

  • Examine the evidence behind new models of care, such as ACOs, to determine whether they are effective in modifying cultures and addressing population health.
  • Contrast the different metrics that are being used to measure the effectiveness of institutional change.
  • Debate whether there is both success and useful learning from different types of systems established by the States.

Presenters

  • Mike Fogarty, MSW, JD, Chief Executive Officer, Oklahoma Healthcare Authority
  • Bruce Goldberg, MD, Director, Oregon Health Authority
  • John Selig, MPA, Director, Arkansas Department of Human Services
  • William Shrank, MD, MSHS, Director, Rapid Cycle Evaluation Group, Center for Medicare and Medicaid Innovation
  • Moderator: Daniel M. Fox, PhD, President Emeritus, Milbank Memorial Fund

Session 8: Evidence-Based Management: Lessons and Demands from the Business World

The business community is increasingly interested in moving beyond just paying for health bills and is viewing healthcare as an issue of importance to a broad array of corporate departments. Medical directors of corporations are accustomed to evidence-based management in which they report on and document the reasons for the outcomes of the work they supervise to their colleagues in senior management. The session's panelists will discuss what they as medical directors and officers and their colleagues are developing with health systems and health plans to enhance recognition of the benefits of evidence-based management within health systems and health plans, and whether evidence-based management can produce evidence.

Learning Objectives

  • Describe how companies and organizations are now managing healthcare as a corporate asset.
  • Compare the different healthcare programs that medical directors are developing to enhance recognition of the benefits of evidence-based management.
  • Judge whether these programs have produced any evidence of outcomes.

Presenters

  • Paul Grundy, MD, MPH, FACOEM, FACPM, Global Director, IBM Healthcare Transformation, IBM
  • Clarion E. Johnson, MD, Medical Director, Medicine and Occupational Health, Global Exxon Mobil Corporation
  • Richard Snyder, MD, Senior Vice President and Chief Medical Officer, Independence Blue Cross
  • Moderator: Jeffrey C. Lerner, PhD, President and Chief Executive Officer, ECRI Institute

Session 9: Measuring the Success of Systems

Although healthcare system success is measured internally, it is also subjected to external comparative evaluation. How well have systems performed, and in what areas has success been proven? In this session, we learn the perspectives and recent approaches of key evaluators.

Learning Objectives

  • Explain how the "success" of healthcare systems is being measured.
  • Assess how well have systems performed.
  • Identify which areas success been proven in.
  • Reflect on the perspectives and recent approaches of key evaluators.

Presenters

  • Brent James, MD, MStat, Chief Quality Officer and Executive Director, Institute for Health Care Delivery Research, Intermountain Healthcare
  • Patrick Conway, MD, MSc, Chief Medical Officer, Center for Medicare and Medicaid Services, Office of Clinical Standards and Quality
  • Joel Kupersmith, MD, Chief Research and Development Officer, Veterans Health Administration
  • Margaret VanAmringe, MHS, Vice President for Public Policy and Government Relations, The Joint Commission
  • Moderator: J. Sanford Schwartz, MD, Leon Hess Professor of Medicine, Health Care Management, and Economics, School of Medicine and the Wharton School, University of Pennsylvania

Commentary and Perspectives

Learning Objectives

  • Reflect on the views and experiences of public and private policymaking on the concept of "systemness."
  • Describe the challenges in trying to improve "systemness."
  • Compare the views participants in prior sessions.

Presenters

  • Sharon Levine, MD, Associate Executive Director, The Permanente Medical Group, Inc., Kaiser Permanente
  • Gail Wilensky, PhD, John M. Olin Senior Fellow, Project HOPE
  • Moderator: Jeffrey C. Lerner, PhD, President and Chief Executive Officer, ECRI Institut

Session 10: Special Interest Session: Going Forward: Regulatory and Legal Issues of Systemness

The session will address the regulatory and legal issues that can be barriers to "systemness," including board governance, anti-trust issues, medical staff implications, ensuring privacy, as well as the policymaking process. This session will feature panelists who are experts in the fields of health policy, health law, and regulatory affair.

Learning Objectives

  • Identify the regulatory and legal issues that can be barriers to "systemness."
  • Describe how issues such as board governance, anti-trust issues, medical staff implications, ensuring privacy, and the policymaking process are creating challenges to "systemness."
  • Debate the ethical issues related to the creation of "systemness."
  • Appraise what the panel experts predict will happen in the future regarding the law and systemness.

Presenters

  • Anthony A. Barrueta, Esq, Senior Vice President, Government Relations, Kaiser Permanente
  • Douglas A. Hastings, Esq, Chair, Board of Directors, Epstein Becker & Green; Member, Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care, Institute of Medicine; Past President and Fellow, American Health Lawyers Association
  • Tony Clapsis, Professional Staff Member, Senate Committee on Finance
  • Moderator: Ronni Solomon, JD, Executive Vice President and General Counsel, ECRI Institute

Commentary and Perspectives

  • Kenneth W. Kizer, MD, MPH, Distinguished Professor, University of California Davis School of Medicine and Betty Irene Moore School of Nursing; Director, Institute for Population Health Improvement, UC Davis Health System

Closing Remarks

  • Jeffrey C. Lerner, PhD, President and Chief Executive Officer, ECRI Institute

​Planned and organized by:

  • ECRI Institute*
  • The United States Department of Veterans Affairs*
  • Kaiser Permanente*
  • Sutter Health*
  • Health Affairs
  • The Milbank Memorial Fund
  • The Leonard Davis Institute for Health Economics at the University of Pennsylvania

* Principal financial supporters of this free public service.

 

This event occurred in the past at:
Washington, DC at the National Transportation Safety Board Conference Center