October 28, 2016
The Crest of the Transformation Wave
If we employ a metaphor to think of the broad health care delivery transformation movement - that of a wave sweeping across America - Maryland is surely riding the crest. Our unique hospital payment system has paved the way for the novel partnerships and cooperative spirit that are essential for value-driven care to succeed. Both of those were on full display yesterday in Howard County at a public forum about how care is changing in Maryland.
 
While Transforming Healthcare in Howard County of course had a local focus, the impact and message have no borders: health care is changing and communities and consumers are becoming equal partners in health, along with doctors, nursing facilities, hospitals, and others.
 
This fourth in a series of public forums throughout the state about care evolution was a joint effort of MHA, the American Hospital Association, Howard County General Hospital, DHMH, the local health improvement coalition, NAACP, Maryland Citizens' Health Initiative, and several others.
 
Nearly 150 people attended, a testament to the importance Marylanders place not just on their own health, but also on their commitment to ensure that health care in Maryland a model of equity, efficiency and excellence.
 
Here's further evidence that Maryland is on the leading edge of a fundamental and permanent national shift: American Hospital Association President & CEO Rick Pollack was the keynote speaker, not as a favor to a longtime friend and colleague, but because AHA understands the national impact of what we're doing locally across our state.
 
"Maryland understands something crucial - something that we all must understand ... we need to look beyond the physical walls of our hospitals if we're to keep our communities healthy," Pollack said. "Health care has never stopped changing. [Hospitals] will be more responsive to the patients and communities we serve. That blue 'H' will always be a beacon for everyone who needs help."
 
Dr. Howard Haft, DHMH Deputy Secretary for Public Health, talked about how Maryland's unique system has paved the way for partnerships that hadn't been conceived before. He said that, while the volume-to-value road may be bumpy, we can successfully navigate it together. The bottom line: the state is fully behind what hospitals are doing and where we are headed.
 
Steven Snelgrove, President of Howard County General Hospital, noted that the culture at his hospital has shifted from episodic care toward whole-person care, and explained how community organizations have rallied around a shared vision of the Triple Aim: better health for whole communities, improved patient experiences, and lower per capita costs.
 
During my time to speak, I shared with the audience MHA's consumer engagement campaign, A Breath of Fresh Care, which provides tools (links to hospitals' patient bill of rights, population health activities, and health literacy) that create a meaningful opportunity for consumers to engage in their health care and their health.
 
The next care delivery transformation forum is November 10 in Prince George's County. And early next year, Health Care for All is expected to expand another vehicle that helps hospitals bring care beyond their four walls: the Maryland Faith Health Network. Based on a successful model in Memphis, Tenn., and currently being piloted at LifeBridge Health, the network connects hospitals with faith-based congregations so both can better serve ailing members.
 
As we come to the end of these public forums having heard real-world examples from Howard County, Baltimore County, Montgomery County and Baltimore City, it's clear that Maryland's hospitals, sitting atop the health care transformation wave, are laying the foundation for long-term success in, as Haft put it, "a brave new world" of health care.

HSCRC Recommendations Call for Sharing of Care Alerts, Care Plans
The HSCRC's recommendations for achieving a full rate year 2017 global budget update include a suggestion that hospitals work with the Chesapeake Regional Information System for our Patients (CRISP) to "... exchange information regarding care coordination resources aimed at reducing duplication of resources, ensuring more person-centered approaches, and bringing additional information to bear at the point of care for the benefit of patients."  One way to do that is to upload and share Care Alerts for high-risk Medicare patients. Care alerts are targeted, direct messages intended to assist clinicians in acute-care settings like emergency departments. Several hospitals already create and share such alerts internally, and others have begun to share them more broadly.
 
There are three steps you can take to help your hospital meet this recommendation:
  1. Sign up for a webinar to be hosted by MHA and CRISP on November 1 from 11 a.m. until noon. The webinar will highlight three hospital pilots that are using care alerts and care plans to reduce potentially avoidable utilization. You can register here.
  2. Meet with CRISP to determine how your hospital's information system can interface with CRISP's. Chief information officers, chief medical officers and/or population health leads should meet with CRISP to identify the members of a patient's care team, including the primary care provider and care manager, and how existing IT systems can be used to populate care alerts. To schedule a meeting, contact Craig Behm at craig.behm@crisphealth.org.
  3. Participate in a dedicated Care Alert and Care Planning Learning Network. The network, for chief medical information officers, clinical integration leads, and emergency department leads, will be convened by MHA and CRISP to will share content, benefits, and resources for hospitals that are ready to develop and share care management data to reduce potentially avoidable utilization and improve care coordination. Click here for details.
 
If you have questions, email Nicole Stallings at nstallings@mhaonline.org, or call 410-379-6200.
HSCRC Webinars Underway
The third of seven webinars with HSCRC staff to provide hospitals with detailed information on the amendment to the All-Payer Model and on care redesign programs is next week; the schedule for the remain webinars is below. The amendment, approved earlier this month:
  • Gives hospitals and their care partners access to comprehensive Medicare data across the care continuum that supports care coordination and a focus on controlling total cost of care
  • Creates the next steps toward total cost of care and delivery system transformation
 
Under the amendment, the first two care redesign programs are:
  • the Complex and Chronic Care Improvement Program (CCIP)
  • the Hospital Care Improvement Program (HCIP)
 
The remaining webinars are:
  • Webinar 3: (9 a.m. Wednesday, November 2) - CCIP Program Template and Implementation Protocol
  • Webinar 4: (9 a.m. Friday, November 18) - HCIP Program Template and Implementation Protocol
  • Webinar 5: (9 a.m. Wednesday, November 30) - Comprehensive Medicare Data Process and Use
  • Webinar 6: (9 a.m. Wednesday, December 7) - Care Redesign Program Monitoring
  • Webinar 7: (9 a.m. Friday, January 13) - Care Partner Agreements
 
During each webinar, participants can ask questions of HSCRC, the Center for Medicare & Medicaid Innovation, MHA, and CRISP. For those who cannot attend, webinar recordings will be posted on the HSCRC website. Click here to find the registration links for each webinar and the recordings of previous webinars. If you have any questions or comments, send an email to hscrc.care-redesign@maryland.gov.
CHRC Issues FY 2017 Call for Proposals
The Maryland Community Health Resources Commission this week issued the Fiscal Year 2017 Call for Proposals, which looks to support programs that will build capacity and expand access, promote health equity, and improve population health. The commission anticipates awarding $3.6 million in new grant funding this fiscal year. Letters of Intent are due November 16 by noon, with full grant proposals due December 19 by noon. Grant awards are expected to be made in mid-February. The commission is hosting a public information call for potential applicants on November 7 at 10 a.m. (Dial in number: 1-866-247-6034, Access code: 4102607046). Following the call, the commission will post a "Frequently Asked Questions" document. A copy of the RFP is available here. This year's RFP looks to support programs that:  
  1. Expand access to primary and preventative care services and chronic disease management
  2. Integrate behavioral health service delivery and addressing the heroin and opioid epidemic
  3. Address childhood and family obesity and promoting food security
  4. Expand access to dental care
  5. Promote comprehensive women's health services and reducing infant mortality rates
FDA Seeks Input on Medical Device Data Collection
The U.S. Food and Drug Administration this week posted a blog highlighting the challenges surrounding reporting of adverse events related to medical devices and pledging to work with the hospital field and clinicians to improve the reporting system. Based on media reports of adverse events related to some devices, the FDA initiated inspections at 17 hospitals to identify possible breakdowns in the reporting system and start a dialogue on how to improve it. The agency found that some of the inspected hospitals did not submit reports to the FDA for deaths or serious injuries associated with medical devices, and that staff were not always aware of or trained to comply with the FDA's reporting requirements. The FDA requires hospitals to report a suspected medical device-related death to both the FDA and the device manufacturer. Hospitals also must report any medical device-related serious injuries to the device manufacturer, or to the FDA if the manufacturer is unknown. In addition, hospitals must submit annual reports to the FDA by January 1 for the preceding year. A summary of the reporting requirements is here.
 
In addition, the FDA's Office of Health & Constituent Affairs recently released two educational videos on MedWatch. The videos review the purpose of MedWatch, and describe available resources. One video targets a health professional audience, while the other targets a consumer audience. The FDA will solicit input on how to improve its data collection through a public workshop on December 5. It also will seek input on the broader role of hospitals in helping the agency evaluate how well devices work in the clinical setting.
 
What hospitals can do:
  • Share this advisory with your chief quality officer, chief medical officer and your compliance officer to ensure they understand the current reporting requirements
  • Review any adverse events that have occurred in your facility and resulted in death or serious injury that were related to a medical device and ensure proper reporting procedures were followed. If not, report the event to the FDA
  • Consider submitting ideas on how to improve the FDA's data collection to the December 5 public workshop.
Change, Culture and Accountability
 
If we can master these three concepts, then the transition to population health can be achieved more easily and more quickly.

Improve Patient Access Management
 
With increasingly changing reimbursement models and high-deductible health plans forcing patients to shoulder more payment liability, health systems must improve their registration and financial clearance to ensure up-front cash collections, reduce front-end denials and improve patient registration efficiencies to maintain patient satisfaction.

AHA Debuts Video Series to Help Hospital Leaders Prepare for MACRA
 
The AHA this week released a MACRA 101 video series to help hospital leaders and trustees prepare for the new Medicare physician quality payment program, for which performance measurement starts in 2017 under the Medicare Access & CHIP Reauthorization Act. 

THE WEEK AHEAD
Wednesday, November 2
MHA Corporate Affiliate Member meeting

Saturday, November 5
Carmela Coyle presents at the Living Legacy Foundation in Cambridge
TOP NEWS FROM THE WEEK
The Baltimore Sun, By Andrea K. McDaniels, October 23
 
The Baltimore Sun, By Meredith Cohn, October 23
 
The Baltimore Sun, By Andrea K. McDaniels, October 25
 
Baltimore Business Journal, By Morgan Eichensehr, October 26
 
The Baltimore Sun, By Meredith Cohn, October 26
 
The Baltimore Sun, By Andrea K. McDaniels, October 27