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“When you divorce providers from fee-for-service as a revenue stream, all kinds of exciting things can happen.” That blue-sky vision from Commonwealth Care Alliance Chief Medical Officer Toyin Ajayi, MD, MPhil, struck the keynote for this year’s WHCM “hot topic” Spring Forum panel presentation. Dr. Ajayi was speaking to this year’s panel topic, “Upending the Visit Paradigm: Bringing Care to the Patient.” Held at the end of March, the panel presentation also featured Alexis Bernstein, Wellframe’s Senior Director for Client Services, and Rebecca Bialecki, BSN, Ph.D., Vice President for Community Health and Chief Change Agent at Heywood Healthcare. Alexandra Schweitzer, a healthcare consultant with diverse experience building innovative care delivery models, moderated the discussion, which highlighted initiatives to expand care outside the traditional office setting.

The discussion kicked off with panelists identifying their motivation for innovating ways to deliver care to patients where they live. For Toyin and CCA, it’s about doing more for patients who need more frequent touches, while for Rebecca and Heywood Healthcare, it’s about bringing specialty care to patients in isolated rural communities. Alexis and Wellframe are looking to keep patients connected with care between visits. Heywood Health’s service area is about as rural as Massachusetts gets, so it’s hard to connect patients with care if it means getting each patient to where the care is.  True to her title of Chief Change Agent, Rebecca found different route through telemedicine.

Heywood began by creating one of the first teleneurology services, providing access to a scarce but much needed specialty resource by building on their tele-stroke experience, which connected their care teams with physicians at Mayo Clinic via remote consultation.  That success led to Heywood’s recent telepsych service for children.  The service initially links behavioral health providers with families via a telehealth connection, and then sends out nurses to provide follow-up home visits. The model has enabled children with more acute mental health needs to get stabilized at home and avoid hospitalization. Heywood has seen gratifying results, with kids able to stay well with less psychiatric medication, and a decrease in hospital admissions. The resulting improvement in the hospital’s Leapfrog score will eventually mean better payment.

At Wellframe, care managers reach out to patients between visits, focusing on transitional or other vulnerable times.  At each touch the care manager works on a small piece of the care plan with the patient, making the information more manageable for patients, many having multiple medical conditions. Through this highly efficient “mobile amplification” of care management, more patients are able to stay connected to care. Wellframe has demonstrated an ability to reduce no-shows for the critical post-hospital-discharge visit, as well as to boost medication and care plan adherence.

At CCA, Toyin and the team are developing ways to measure value when bringing care to highly vulnerable patients at home or in other new alternatives sites.  When a provider organization leaves “transactional” care — and is no longer relying on the usual tallies of admissions, procedures, etc. – how will the providers know if they are getting the behaviors they want?  Rather than measuring the absence of poor outcomes, CCA has been working on measuring the positive. Instead of counting hospital admissions, for example, measure days at home. Toyin and her team caution that it takes 18-24 months to see the benefits of increased investments in primary and behavioral health care through new models, but patience pays off, as costs are definitely reduced.

After our panelists had unpacked their organizations’ experiences, the question-and-answer session yielded a few gems for successful implementation of initiatives to expand care beyond traditional delivery settings:

• Make believers by sharing stories – providers engage peers in the excitement of patient successes.
• Expect glitches – technology is great at enabling care, but computers can go down!
• Better to go all in. Pilot projects can undermine adoption, because reluctant adopters think that if they wait long enough, the disruption to business as usual will go away. Instead, communicate that “this is now how we do our work.”
• Work with policy makers and payers to advocate for payment parity to support innovative delivery.
• Go to the patient to gain insight on what works – patients tend to show high engagement with these new “visit” paradigms.
• At the end of the day, we’re trying new things because we want to bring better care to people. Find common ground where it matters.

Blog post by WHCM Steering Committee Member Emily Brower

Although I have worked in government affairs most of my professional life, I am always struck by the many times I’ve had the opportunity to learn and grow based on my various interactions with colleagues. I consider it my responsibility to continually challenge myself to work to improve and no matter where you may be in your career, I believe there are always ways to enhance your communication skills and your personal “brand.”  Several years ago a colleague pointed out to me that I always seemed to give credit to others, but never took the time to “toot my own horn” and by doing so, I diminished my own accomplishments.

I took this constructive criticism to heart, and really gave a great deal of thought to what my colleague had said to me.  I think as women, we often are not comfortable showcasing our own triumphs and achievements.  However over time, I have made a great deal of effort to take a step back and make certain that where appropriate make sure others know where I contributed to the success of a project. It has definitely been something that I continually have to remind myself to do and something I would encourage all members of WHCM to be mindful of as well, whether you are early in your career or further along in your career.  I must say that it has been among the best advice that I have ever received from a colleague and one that I have taken to heart and made as one of my mantras.

Blog post by WHCM Steering Committee Member Kathy Keough

As leaders in healthcare organizations, we often need to take the time to pause and have a gut check; these can be with ourselves, our staff, our leadership. Most recently I had our department do a check on our overall outlook: Who is looking toward decreasing workload, retirement, life changes that will alter the productivity of our team? We looked also at the wish list we are looking to accomplish within the next five years, referring to our mission, vision, values and strategic plan for the organization. Where will we expand regionally, what investment are we capable of making, and what is the return?

Most importantly, as leaders we tend to forget to gut check within ourselves. Are we where we want to be? Are we looking to further our education, obtain additional certification, again, what is the investment and what is the return?

Taking time for ourselves seems an unattainable goal most days, performing these gut checks give us a little reprieve from the day to day business, and look within ourselves as well as our business to see the potential.

Blog post by WHCM Steering Committee Member Jen Pendleton

Author Alan Burdick’s new book, “Why Time Flies,” examines his own life as he watches his kids grow up but also how our brains observe and process time.  He discussed it with Robert Siegel on All Things Considered, my favorite show on public radio.  What I found fascinating is our brain’s ability to “think on its own” and actually trick our perception of reality by anticipating when and how long things take.  

He says, “Our brains do a lot of work to hide what you might call reality from us. So, every time you type, for instance, on a computer keyboard there’s actually about a 35-millisecond delay between you pressing a key on the keypad and that letter appearing on the screen. But as far as your brain is concerned, it happens instantaneously. There’s no gap. It’s actually been shown that your brain can sustain about a tenth-of-a-second delay between your action and its consequence.”

Think about that – and your place in time can get pretty philosophical.

Listen to the podcast or read the transcript here.

I heard an interesting snippet on NPR the other morning, about women and our ambition. Shankar Vedantam, NPR’s social science correspondent and the host of a podcast I love called the Hidden Brain, discussed a study which found single women as much less likely to express career ambitions compared to married women or men.  What is the reason behind this?  Are we creating a glass ceiling for ourselves? 

Listen to the podcast or read the transcript here.

I’ve been thinking a lot lately about the judgment of others and how that plays into our everyday lives – both personally and professionally.  Do you write people off because of the way they act or look?  Perhaps it’s not consciously done, but are we predisposed to it?  I watched a TED talk on the existence of prejudice and bias and how it can help us categorize our lives.  In the video Paul Bloom shares stories from research on prejudice including one study that illustrated young children showing  an affinity for certain stuffed animal characters over other stuffed animals based on the stuffed animals’ “preference” for foods like green beans vs. graham crackers.  Are we wired to like people -and even stuffed animals – based on some subconscious cues that may not make a lot of rational sense?  Acknowledging that is a part of being human and may be the first step toward reducing the impact prejudice has on the way we think and act.  Take a look if you have a moment.

The first few months in a new leadership role are usually an exciting and challenging time. The hard work of networking, research, applications, and interviewing has finally paid off.  You got the job!  Congratulations, but now is no time to relax.

Did you know the first 100 days in a new job establish your foundation as a new leader?   Many new leaders arrive on Day One “ready to go” but without a plan.  Rather than “hitting the ground running,” early messages are off target, relationships are slow to form, and results are unpredictable. In today’s business world there is no such thing as a “honeymoon period.” All eyes are on the new leader to produce results quickly and efficiently.

The key is to develop your transition game plan long before your start the job. Clarify expectations, uncover landmines and avoid missteps that can negatively impact first impressions and your long term success.  There are plenty of resources and tools to help with this. One book I found particularly useful is The New Leader’s 100 Day Action Plan by George Bradt, Jayme Check, and John Lawler.  In it, the authors present a compelling case for flushing out your onboarding plan even before you have accepted the job.  Four main concepts for a successful transition and increased chances of long term success are succinctly detailed: Getting a head start by assessing risks, identifying landmines, jump-starting relationships; Managing the message by creating a strong first impression, opening message and ongoing communication; Setting direction and building your team by co-establishing 30-45-70 day objectives; Sustaining momentum and delivering results by continuing to evolve your leadership and practices. With background information, examples, diagrams and tools this book offers ways to assess your new situation and begin develop an on-boarding plan that gives you more control from Day One.

Just as you diligently prepared for your job interviews, advance planning of your first days and months on the new job should be an integral part of your next career move.

Blog post by WHCM Steering Committee Member MaryGaye Grizwin

Most people have smart phones now, and if they don’t, they probably have a tablet.  For instance, my dad, who is 65+, is holding onto his flip phone for dear life but LOVES his iPad / iPod and has many apps he finds useful on them.

I went to a conference a few months ago and as an “ice breaker” in a room of about 30 people, we went around and shared our favorite app and its function.  It was interesting to hear what people discovered value in, and what their interests were.  Podcast and music apps were especially popular.  One of my favorites is SpotHero, an app that uses your location to find the cheapest parking – whether it be in a garage or in the back of a Boston Brownstone – and all currency is exchanged through the phone.  Two new ones I learned about are; Cash , a free to download app by Square that instantly transfers money between friends for free as long as you are both signed up and connect your debit cards, and OneNote for iPhone, a virtual notebook you can write memos in, save images and articles from the web and audio files – and it’s completely searchable!  I think this question is a great conversation starter and you might just learn something new about the person you are speaking with.