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A Brave New World

A Brave New World
...From the pages of South Jersey Biz magazine...

To compete, to grow, to survive takes innovation. Old practices will keep you in the past, yet learning from them and developing new approaches can lead to a brighter future. No industry knows that better than health care, but the way navigate uncharted territory is the bigger story.

DEFINING THE CONCEPT
”Innovation in health care is all about changes that help patients interact with their health care professionals in a way that is most appropriate for their care—and in a way that best suits them,” says Thomas Balcavage, senior vice president of technology and program services at Kennedy Health. The patient is at the center of care and all available tools are being used to deliver an excellent patient experience. Innovation is about making changes so that health care providers can work smarter, faster, better and be more cost-effective. “For true innovation to occur, changes to health care processes must knit everything together into a well- functioning system,” he says.

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For Tabula Rasa Healthcare, this means improving health care by advancing safety in medications. “With approximately 4.4 billion prescriptions filled in the U.S. in 2015, medication treatment is the most common medical intervention, and its imprecise use represents the fourth leading cause of death and contributes to an estimated 45 to 50 million adverse drug events (ADEs) annually,” says Calvin H. Knowlton, Ph.D., chairman and CEO, Tabula Rasa Healthcare. “ADEs results in more than 100,000 deaths annually and approximately 125,000 hospitalizations, 1 million emergency room visits, 2 million affected hospital stays and 3.5 million physician office visits very year. Innovation must be used to disrupt this mis-adventuring with medications and move to more personalized medicine.”

“Innovation is the intersection of technology and medicine to allow us better outcomes,” says William Muh, Jr., M.D., president and CEO of South Jersey Radiology. “For example, 3D mammography allows us to detect invasive breast cancers at ever earlier stages, resulting in less aggressive treatments with fewer side effects and better patient outcomes.”

“Innovation means creating the best health care experience and clinical outcomes at an affordable cost for our patients and their families,” says Anthony J. Mazzarelli, M.D., senior executive vice president and chief physician executive for Cooper University Health Care. “[Our] faculty members conduct hundreds of National Institutes of Health (NIH) and industry-sponsored clinical trials each year, working on cutting-edge treatments in fields such as oncology, cardiology, critical care, diabetes and gene therapy.”

It’s more than advances in medical technology, though. Joshua S. Coren, D.O., director of continuing medical education at Rowan University School of Osteopathic Medicine, points out the importance of evolving curriculum and creating a new way of teaching medicine. “For example, our course directors have been traveling to China to teach osteopathic medicine. This has allowed them to observe another medical culture and apply their acquired knowledge to the curriculum so that we are encouraging students to think beyond the typical family practice setting,” Coren explains.

“Health care is so behind, so immature compared to other industries, so innovation is really about entering the 21st century,” says Don McDaniel, CEO of Continuum Health Alliance.” The consumer—the core stakeholder in competitive markets—is just starting to become a market force in health care. This shift is coming due thanks to high deductibles, more cost sharing, a desire for more transparency and the millennials who demand price and quality transparency, and easy access,” he says. “There is a sense that health care has not operated at all like a system, and if we focus on process improvement and innovation, we will be better off in the long run.”

“In today’s rapidly evolving health care market, both hospitals and patients demand the best care at the lowest reasonable cost. This is what defines value,” adds William Hirsch, D.O., chair, department of cardiology, Deborah Heart and Lung Center.

MAKING STRIDES
The list of innovative examples is inspiring. “We continually add new technologies that change how we actually deliver care,” says Balcavage. He mentions the Brainlab system at Kennedy’s Cancer Center, Genet- ics Counseling with Jefferson’s Sidney Kimmel Cancer Network and finding new ways for patients to interact with their doctors and other health care professionals such as through email and online.

Knowlton says that the cloud-based software solutions offered by his organization provide prescribers, pharmacists and health care organizations with tools to better manage patients’ medication-related needs, reducing multi-drug adverse drug events and promoting adherence to a patient’s personalized medication regimen. Also, their Medication Risk Mitigation Matrix enables simultaneous analyses of multi-drug requirements, providing pertinent medication decision support. By focusing on populations with complex health care needs and extensive medication requirements, they have reduced falls, hospital admissions, re-admissions and length-of- stay. With their TRHC’s software, NiaRx, they offer a medication risk mitigation simulation platform to students, pharmacists and faculty.

In addition to 3D mammography, South Jersey Radiology uses 3T MRIs to direct prostate cancer diagnosis and care, reducing over-treatment of non-aggressive tumors and pinpointing aggressive lesions. “The use of CT scanning of the abdomen and pelvis to direct surgical care in the acute abdomen patient and reduce the rate of false positive appendectomies,” says Muhr.

Mary Ann Boccolini, president and CEO of Samaritan Healthcare & Hospice says their very existence is an innovation, having been founded by a group of grass roots volunteers 36 years ago—the first to provide hospice care in southern New Jersey. Since then, they have introduced their Center for Grief Support, the first inpatient hospice center and their Palliative Medical Partners physician-nurse practitioner practice. Most recently, they opened The Samaritan Center at Voorhees, South Jersey’s first freestanding inpatient hospice center, providing “a homelike place for hospice patients whose pain or symptoms require continually supervised care, best provided outside the home,” she says.

Two years ago, Acuity Specialty Hospital implemented a redesigned patient fall-reduction program, using best practices and five years of data to design a protocol that allows nurses to use their professional judgment to implement specific interventions. “We are going on two years without a fall with injury in our hospital,” says Jenn Trallo Schreiber, R.N., chief quality, safety and risk officer for Acuity Healthcare. They also use nurse-driven protocols to reduce other health issues, so they don’t need to contact a physician in real time to obtain an order, because protocols have been approved and ordered, she explains.

Robin Priggemeier, digital marketing manager for Inspira Hospital points to several new developments, including Inspira eCare, a service that allows patients to connect via computer, smartphone or tablet with urgent care professionals for diagnosis and treatment of minor medical conditions; a new health care concierge service so patients can schedule appointments, register for classes, or find specialists and services that are nearby; and the updated Inspira Access App. It allows consumers to check ER and urgent care wait times, get in line online for an Urgent Care visit, begin a virtual visit with an Inspira provider and quickly access the concierge service.

Cooper’s partnership with MD Anderson Cancer Center is another form of innovation, says Mazzarelli. “New Jersey families [can] receive the best cancer care available or gain access to innovative clinical trials.” In addition, the Cooper Heart Institute offers minimally invasive treatment methods which significantly improve outcomes for patients. In surgery, Jeffrey P. Carpenter, M.D., chairman and chief of the department of surgery and vice president of perioperative services at Cooper University Health Care, has been a leader in developing and researching new innovations both nationally and inter- nationally, and Cooper uses robotic procedures for cardiac, prostate, bariatric and thoracic surgery, among others.

Ronald Barg, M.D., president of Clinical Health Care Associates (an affiliate of Penn Medicine Cherry Hill) points to several initiatives as examples for innovation, including multiple services at a common location, served by a common electronic medical record; a patient portal allowing patients to schedule appointments, view test results and communicate with their care team; primary care practices that emphasize populations management and team-based care delivery; and enhanced patient access through the use of walk-in visits and same-day appointments in primary care offices.

“Our first-year course directors have been planning an exciting integration of authentic medical podcasts and multimedia for the fall 2017 semester,” says Coren. While multimedia integration into curriculum is not new, pairing it with Chinese physicians is an innovative concept for the university.

“Deborah is a leader in providing non- surgical valve replacements, also known as TAVR,” says Hirsch. With these, patients can go home in a few days, with a small groin incision. Other technology includes the Watchman procedure, which allows people with a heart arrhythmia to eventually stop their blood thinners.

There is so much happening, including minimally invasive surgeries for colorectal, hernia, hysterectomy and hip and knee replacements, says Al Campanella, Virtua executive vice president for strategic business growth and analytics.”Patients can leave the hospital in half the time or less. There is also better sterilization, stronger computer security, and sophisticated QA.”

MOVING FORWARD
All of this evidence suggests it’s an exciting time for health care. But what will the future hold?

“Innovation will come from outside of health care, so we need to continue to build and refine the ability to adopt and adapt great ideas/technologies wherever they come from,” says Balcavage. “Innovation will be built on the sharing of information.”

“From the very beginning of our company, we set out to be different. ... Different in how we treat our clients, different in how we work with each other, and different in the results we achieve,” adds Knowlton. “These differences are best captured now in our 32 ‘Fundamentals,’ the foundation of our culture [and highlight] patient-centricity, entrepreneurs with domain expertise and proven efficiency,” he says.

Muhr says, “Cost drivers will ultimately foster innovative solutions to delivering care to populations,” adding that remote monitoring and feedback devices that engage patients in their own health care have tremendous potential. “Innovation is fostered by [finding] creative ways to work with our hospital and clinician partners to- ward better patient care,” he says.

“The needs of an aging population will certainly create more urgency to find new and effective ways to serve them,” says Boccolini. “Shrinking resources and increased accountability have encouraged regulatory emphasis on achieving what the Institute for Healthcare Improvement calls the triple aim of health improvement: Improving the patient’s experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.”

“Health care providers need to have the autonomy to make decisions that will improve their practice. Successful organizations strike the correct balance between delivering evidence-based care and creatively implementing interventions specific to the needs of the population served,” says Schreiber. “Innovation in health care can be encouraged by focusing on positive outcomes instead of rigid adherence to processes. Having the authority to implement changes that can take effect quickly and improve care for all patients definitely fosters innovation.”

“Technology will play a major role in the changing landscape of the health care industry and efforts to improve the overall health of its communities,” says Priggemeier. “To accomplish this, Inspira has created a culture of open communication and team- work across its network, encouraging employees to ask questions and seek solutions that improve the services we provide.”

“Advances in health information technology and payment reform are two major drivers of further innovation,” adds Barg.

“Forward-thinking course directors, sup- port of the administrative team, and the dedication of students fosters [an] innovative environment,” says Coren. “Equipping student doctors with the fundamentals of medicine and giving them access to a professional network to discuss the implementation of new medical technology is the best encouragement for health care innovation.”

“Innovation starts with people, and is enhanced by a common vision and a climate that encourages people to work toward solving customers’ problems. That demands creativity, collaboration and de- sign-oriented thinking, all starting with customer empathy,” says McDaniel. Innovation can then be any successful approach that drives efficiency, and reduces friction and roadblocks. “[In the future], most people believe the health care system will face more cost pressure, a much higher demand for transparency and a focus on efficiency.” Organizations will need to find partners that want to challenge the status quo—in- dependent-minded, physician-entrepreneurs who feel the current health economy serves none of its constituents well, he says.

Campanella feels the next wave is synchronous care, “real time” health care through technology. This includes lactation consultations for new mothers, follow-up visits for urgent care, nursing home consultations and much more. “We are working on more than 30 scenarios to be brought out in 2017. There are many opportunities here.”

“Innovation in health care will continue to be driven by the need to lower the cost of care, improve outcomes for patients, and create a better health care experience for patients and their families,” says Mazzarelli. “Only those hospitals and health care providers who innovate to do these things better will survive in the future.”

Published (and copyrighted) in South Jersey Biz, Volume 6, Issue 12 (December, 2016).
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Author: Daniel Sean Kaye

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