Invited speaker Seth Kahan, author of the book “Getting Change Right: How Leaders Transform Organizations from the Inside Out,” challenged Clinical Impact Symposium participants to take the experience of the last two days back to their own facilities and use it to effect positive change.
Mr. Kahan described four stages of transformation, beginning with what he labeled “the call.” This could be something like a sudden promotion, a new opportunity, the illness of oneself or a family member, or, in this case, the decision to attend the symposium. The threshold stage, said Mr. Kahan, is the point when a person crosses from the normal reality to the reality of the ritual – arriving at the hotel, checking in, the adjustment of the mind to the process. “Time out of time.” The transition to a place where we have permission to have long conversations about topics we care about, and think deeply about things we normally might not have time to think about, Mr. Kahan said.
Timeliness. Legibility. Objective terminology. Those are just some of the features of SmartTX mobile technology, which made its debut in the RehabCare Division in September, 2012. The patient care tracking application can be used on Apple iPads, iPhones and iPods, which are provided to employees using the technology. SmartTX was demonstrated on the iPad mini at Kindred’s fourth Clinical Impact Symposium – Care Across the Continuum.
SmartTX has already proven to be invaluable at the point of care and beyond. The application, now in use at all nursing facility locations and most hospitals, optimizes patient care and scheduling. Built-in information filters in the program ensure that treatment plans are compatible with the patient’s diagnosis information and health care coverage.
Palliative care was the subject of a presentation this morning at Kindred’s Clinical Impact Symposium – Care Across the Continuum. The speakers, Mark Rothman, MD, Chief Medical Officer for Kindred’s Nursing Center Division, and Bonnie Austin, Senior Director of Compliance and Interim Senior Director of Clinical Services at PeopleFirst Homecare and Hospice, described some of the barriers that clinicians, patients and families face in accessing palliative care, and they addressed the importance of appropriate utilization of palliative care.
The presence of not one, not two, but three Accountable Care Organizations (ACOs) makes the Dallas-Fort Worth market a truly unique place with distinctive challenges, according to two leaders who know it well, Audra Early, Executive Director for Kindred’s Hospital Division in the Dallas-Fort Worth Market, and Julie Anderson, District Director of Sales and Business Development for the Nursing Center Division in the Rocky Mountain/ Texas District.
“We have three ACOs in Dallas-Fort Worth and they are all operating differently,” Early said.
Plus ACO is a 50/50 partnership between Texas Health Resources (THR) and North Texas Specialty Physicians, a group of 900 doctors, Early said. THR came to the partnership with a group of 500 physicians, so the ACO now features a total of 1,400 physicians. It is a pioneer ACO and they are taking an innovative approach, she said. Plus currently covers 20,000 lives and is adding 50,000 more, making it a dynamic force in the market.
The Las Vegas healthcare market has shifted almost as quickly as the action on a casino table.
There are 13 hospitals and three healthcare systems there. The area has a population of roughly 2 million, with about 83 percent in managed care.
Two years ago, there were 420 individual on-staff doctors. But a year ago, internal medicine physicians consolidated into five “super groups.” Now most of the hospital systems in Las Vegas use contracts with hospitalist groups rather than employing physicians. Physicians generally direct referrals to those that cover post-acute settings, and patients are placed when and where the care is appropriate.
Four years ago, the patient mix shifted from 65 percent Medicaid patients to mostly patients covered by commercial plans and Medicare Advantage.
Before long, Kindred employees will be able to access patient information without being tied to a PC to get it. Mobile devices like iPads and iPhones are part of the company’s transition to “cloud-based” information systems meant to convey and access information quickly – and benefit patients.
Cloud-based means information will no longer be tied to individual computers and servers. It will free information from local sites because it can be stored in a data center anywhere in the world and be accessible to anyone, anywhere and anytime, if the person is authorized to see it.
Kindred’s unique relationship with the Cleveland Clinic was the focus of a break-out session this afternoon at the fourth Clinical Impact Symposium – Care Transitions Across the Continuum.
Kindred and the Cleveland Clinic have formed a partnership that has resulted in improved communication between acute and post-acute providers, and the sharing of useful programs that can benefit patients across the continuum of care.
Some unique characteristics of the Cleveland market have facilitated this collaboration: most physicians in the market are employed by two very “healthy and large” hospital systems, with independent physicians in supporting roles, said Steve Jakubcanin, Vice President of Operations for Kindred’s Cleveland Integrated Care Market. Cleveland has a total managed care penetration of 77 percent, and above-average long-term acute care hospital utilization.
The success of Kindred’s Massachusetts Integrated Care Market, which makes it a model for other integrated care markets and those moving toward becoming integrated care markets, is largely based on receptiveness toward evolution: the evolution from case to care management, and the evolution from “discharging” toward “transitioning” a patient across sites of care.
Representatives from the Massachusetts market Joe Hugar, Division Vice President of Operations for the Boston Integrated Market, and Stacey Hodgman, Senior Director of Care Management for the Boston Integrated Market, explained the growth and development in Massachusetts and its plans for the future at the Kindred Clinical Impact Symposium – Care Across the Continuum.
The ground is changing beneath the nation’s healthcare system. To survive and thrive, Kindred brought in Franke (pronounced Frankie) Elliott in August as its Chief Managed Care Officer. His message: Things will change, but “we can’t move overnight.”
It will take time and be disruptive while experiments and pilot programs are carried out at Kindred operations before making big changes, warned Elliott, who has worked in the healthcare industry, particularly in the area of managed care, for almost 20 years.
In the meantime, however, Kindred will be building capabilities for the future and demonstrating success “before a fundamental shift in policy,” Elliott said.
The changes driving this:
“Today’s payment strategy is built around a fragmented delivery system” – a pay for services model, Elliott said.
Over one-third of the facilities in Kindred’s Nursing Center Division will be using a Web-based application called PointClickCare by the end of the year; the program replaces the traditional paper chart (which can be bulky, disorganized and hard to search) and has already made patient records easier to access and update, while protecting patient privacy.
To access PointClickCare, users must log in with a unique user ID and password, keeping it secure. Once in the system, caregivers can complete their documentation right in the electronic chart.
“Traditionally, caregivers have been able to do some things on the computer but they still had to print the pages off and put them into the paper chart,” said Martha McFadden, Manager of Clinical Systems Development for Kindred Healthcare. “Now, many things can be done and stored online. The feedback we have gotten has been very positive – people just love it.”
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