PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357 Middle Tennessee’s Primary Source for Professional Healthcare News ON ROUNDS PRINTED ON RECYCLED PAPER Hovious Reflects on New Role Leading Health Care Council Last month, the Nashville Health Care Council Board of Directors an- nounced staff member Hayley Hovious would become the next president of the organiza- tion effective June 1. She was tapped as suc- cessor to Caroline Young, who announced her intention to step down as Council president in March after seven years in the lead role and 11 years with the organization ... 2 Y-90 Radioembolization Liver cancer is the fifth most common cancer in men, the eighth most common in women and fourth in annual cancer mortality rates, but advances in treatment options are helping patients live longer, better lives ... 9 June 2015 >> $5 FOCUS TOPICS MEN’S HEALTH PATIENT CARE MODELS ONLINE: NASHVILLE MEDICAL NEWS.COM Emphasis on Innovation A Look at the Tennessee Health Care Innovation Initiative BY CINDY SANDERS The move away from fee-for-service healthcare is sweeping across the country as payers and providers come together to search for innovative ways to improve outcomes while lowering costs. With Tennessee’s robust resources, the state is well positioned to take a lead role in transforming the delivery of healthcare. “In 2013 Governor Haslam launched the Tennessee Health Care Innovation Initiative to move from volume to value,” said Brooks Daverman, director of Stra- tegic Planning and Innovation for the Tennessee Division of Health Care Finance and Administration (HCFA). “Our mission is to reward providers for the outcomes that we want – high quality and efficient treatment of medical conditions and better health over time.” (CONTINUED ON PAGE 6) Stephaine Walker, MD, MPH PAGE 4 PHYSICIAN SPOTLIGHT (CONTINUED ON PAGE 8) Vanderbilt’s Institute for Research on Men’s Health Dispelling Myths, Finding Answers BY MELANIE KILGORE-HILL What roles do gender, society and culture play in a man’s health? Those are the questions driving the work at the Institute for Research on Men’s Health (IRMH) at Vanderbilt. The institute opened in 2012 following the ar- rival of program director Derek Griffith, PhD. “We really wanted to understand the role of gender in men’s health and how to apply it to health promotion efforts, intervention strategy, and ways to communicate messages and mo- tivate men in healthier behaviors,” Griffith explained. Dispelling Men’s Health Myths When discussing men’s health, Griffith said a common, knee- jerk reaction is to think of men’s mis- behaviors rather than intervention. “We’re very comfort- able blaming men’s health problems solely on behavior,” he said. “We have all the op- portunities women do, but there’s something about what it means to be male … an at- titude … that’s the barrier.” Griffith continued, “When we talk about things like women’s health, racial disparity, or socioeconomic differences, we have a much broader perspective on what influences health than what’s limited to men. It’s helpful to think about men’s health in a broader context.” Not unlike women, a man’s health is determined by priorities often set by others – employers, spouses, and kids all demand time JUNE IS MEN’S HEALTH MONTH. New Look • More Information • Breaking News Alerts • Industry Events COMING SOON: THE NEW
Transcript
PRSRT STDU.S.POSTAGE
PAIDFRANKLIN, TN
PERMIT NO.357
Middle Tennessee’s Primary Source for Professional Healthcare News
ON ROUNDS
PRINTED ON RECYCLED PAPER
Hovious Refl ects on New Role Leading Health Care CouncilLast month, the Nashville Health Care Council Board of Directors an-nounced staff member Hayley Hovious would become the next president of the organiza-tion effective June 1. She was tapped as suc-cessor to Caroline Young, who announced her intention to step down as Council president in March after seven years in the lead role and 11 years with the organization ... 2
Y-90 RadioembolizationLiver cancer is the fi fth most common cancer in men, the eighth most common in women and fourth in annual cancer mortality rates, but advances in treatment options are helping patients live longer, better lives ... 9
June 2015 >> $5
FOCUS TOPICS MEN’S HEALTH PATIENT CARE MODELS
ONLINE:NASHVILLEMEDICALNEWS.COMNEWS.COM
Emphasis on InnovationA Look at the Tennessee Health Care Innovation Initiative
By CINDy SANDERS
The move away from fee-for-service healthcare is sweeping across the country as payers and providers come together to search for innovative ways to improve outcomes while lowering costs. With Tennessee’s robust resources, the state is well positioned to take a lead role in transforming the delivery of healthcare.
“In 2013 Governor Haslam launched the Tennessee Health Care Innovation Initiative to move from volume to value,” said Brooks Daverman, director of Stra-tegic Planning and Innovation for the Tennessee Division of Health Care Finance and Administration (HCFA). “Our mission is to reward providers for the outcomes that we want – high quality and effi cient treatment of medical conditions and better health over time.”
(CONTINUED ON PAGE 6)
Stephaine Walker, MD, MPH
PAGE 4
PHYSICIAN SPOTLIGHT
(CONTINUED ON PAGE 8)
Vanderbilt’s Institute for Research on Men’s HealthDispelling Myths, Finding Answers
By MELANIE KILGORE-HILL
What roles do gender, society and culture play in a man’s health? Those are the questions driving the work at the Institute for Research on Men’s Health (IRMH) at Vanderbilt.
The institute opened in 2012 following the ar-rival of program director Derek Griffi th, PhD. “We really wanted to understand the role of gender in men’s health and how to apply it to health promotion efforts, intervention strategy, and ways to communicate messages and mo-tivate men in healthier behaviors,” Griffi th explained.
Dispelling Men’s Health MythsWhen discussing men’s health, Griffi th said a common, knee-
jerk reaction is to think of men’s mis-behaviors rather
than intervention. “We’re very comfort-
able blaming men’s health problems solely on behavior,” he said. “We have all the op-portunities women do, but there’s something about what it means to be male … an at-titude … that’s the barrier.”
Grif f i th continued, “When we talk about things like women’s health, racial disparity, or socioeconomic differences, we have a much broader perspective on what
infl uences health than what’s limited to men. It’s helpful to think about men’s health in a broader context.”
Not unlike women, a man’s health is determined by priorities often set by others – employers, spouses, and kids all demand time
Research on Men’s Healthjerk reaction is to think of men’s mis-behaviors rather
than intervention. “We’re very comfort-
able blaming men’s health
JUNE IS MEN’S HEALTH MONTH.
New Look • More Information • Breaking News Alerts • Industry Events
COMING
SOON:
THE NEW
2 > JUNE 2015 n a s h v i l l e m e d i c a l n e w s . c o m
By KELLy PRICE
The Nashville Health Care Council’s annual event, “Financing the Deal,” has become almost a prescription for those trying to diagnose the lay of the land and health of various industry sectors.
This year was no exception. In May, the Council brought together a panel of fi-nancial experts to offer insights on the new and ongoing trends in access to healthcare capital and the state of the market, M&A activity, and the outlook for funding the growth of Nashville’s $70 billion dollar healthcare industry.
The panel discussion was moderated by Nicole Maynard, Tennessee market president for JP Morgan Chase. The panel featured Robert L. Crutchfield, general partner, Harbert Venture Partners; Ben-jamin Edmands, managing partner and co-founder of Consonance Capital Part-ners; Eb LeMaster, managing partner and co-founder of Ponder & Co.; and Phillip Pucciarelli, managing director and head of Health Care Services for BMO Capital Markets.
Pucciarelli noted the more than $92 billion strength of M&A activity that has already occurred in healthcare this year served as a strong predictor of confidence. “M&A discussions are extremely active at the moment, and we’re seeing a whole host of creative approaches. In addition, balance sheets are strong and confidence around M&A is quite evident in the boardroom,” he continued.
The experts gave their picks for further consolidation and pointed out chronic care services, post-acute care providers and pop-ulation health entities would all need addi-tional technology and resources to support rapid growth. Panel members also made note of Nashville’s large concentration of healthcare companies and unique posi-tion to attract capital as a result. The city is home to more than 250 healthcare compa-nies that work on a multi-state, national or international basis, and 15 publicly traded healthcare companies are headquartered in the Nashville area.
“Nashville is the epicenter of health-care innovation and will continue to grow and expand to meet the changing needs of the market,” Pucciarelli added. “Entre-preneurs should tap into this community of experts and resources, determine the problems inherent in the system, and cre-ate disruptive enterprises to address those challenges.”
Some of those challenges include the
shift from fee-based payment to value-based care and the consolidation, joint ventures and partnerships necessary to achieve outcomes across the continuum of care. No matter what the Supreme Court decides about subsidies and what the ulti-mate impact on the Affordable Care Act, the panelists generally agreed the industry has already begun the shift to value-based care. Deviating from that course would be difficult as so many key players in the in-dustry are on board to change the delivery of care in America.
“Hospitals are seeking ways to en-hance the quality of care while lowering cost and preparing for this rapidly chang-
ing new world,” LeMaster pointed out of a major sector already making changes to ‘business as usual.’ However, he noted, that isn’t to say hospitals wouldn’t deeply feel the impact if subsidies are stripped from states in the wake of the King v. Bur-well decision.
Although the need for capital is often immediate, the panelists noted building a strong investor-management relationship doesn’t happen overnight. Edmans said, “Trust between an investor and manger is risky and it takes time to build.” He added, “It’s important for both parties to have a commonality of vision on where the business is going and the flexibility to
understand the vision may change as the environment shifts.”
Luckily for local industry innovators, Crutchfield said, “If you are an entre-preneur in Nashville, you are living the dream. This is a robust community of re-sources, capital and expertise to develop solutions to move the industry forward.” He added there is great opportunity for entrepreneurs who are able to develop strategies in a changing landscape. “We are rapidly expanding to an area where people live, work and play,” he predicted.
LeMaster said, “The hard decision is how to allocate capital, and how we take advantage of the need to be creative.”
Forecasting the Industry’s Financial Future
By CINDy SANDERS
Last month, the Nashville Health Care Council Board of Directors announced staff member Hayley Hovious would be-come the next president of the organization effective June 1. She was tapped as succes-sor to Caroline Young, who announced her intention to step down as Council presi-dent in March after seven years in the lead role and 11 years with the organization.
Hovious previously served as executive direc-tor of the Council Fellows initiative. “This nationally unique program to engage and educate top executives allowed me to interact with current and future C-suite healthcare leaders and explore the issues facing healthcare companies today,” she said. “I am excited to expand on these re-lationships and ideas in this new role.”
Prior to joining the Council in 2014, Hovious was trade director for the Tennes-see Department of Economic and Commu-nity Development. As part of her mission to promote economic prosperity for the state, she had the opportunity to interact with numerous organizations including the Council. While still at ECD, Hovious was a participant in the Council’s international healthcare mission to France in 2013.
“I also have a background in the
consumer products industry, which in-terestingly is coming full circle for me as healthcare moves to a more consumer-focused model,” Hovious noted. Earlier in her career, she served as a brand manager at E.J. Gallo Winery in Modesto, Calif.
The Nashville native is active in the local community and was appointed by the U.S. Sec-retary of Commerce to serve on the Tennessee District Export Council. Hovious graduated with honors from Smith College and earned her MBA from Vanderbilt University Owen Graduate School of Management.
“Hayley has proven her-self to be a valuable asset to the Council. Her experience, character and management
abilities make her the outstanding choice for this position,” said Council Chair Bill Carpenter, chairman and CEO of Life-Point Hospitals, in announcing Hovious as president.
“I am honored to lead an organiza-tion with such a strong legacy,” Hovious said. “The Council is celebrating its 20th anniversary this year so it’s a great time to celebrate what this organization and our members have accomplished in that time and look ahead to what we want to accom-plish in the next two decades.”
With 268 member companies, the Council is well versed in promoting and
supporting the city’s $70 billion health-care industry. Hovious said programming ranges from large ballroom events to small gatherings that provide executives with un-paralleled access to national policymakers, industry innovators and thought leaders. Unique networking opportunities, inter-national and domestic delegations, and in-novative programming to help mentor and educate emerging healthcare leaders are also central to the Council’s core mission.
“Council programs focus on the pil-lars of finance, policy, and the latest in-dustry trends, providing members with the vital information necessary to make well-informed decisions that promote con-tinued business growth and high-quality patient care,” said Hovious. “With health-care changing at such a rapid pace, there is much to address, and I look forward to working with our team and partners to lay out plans for the coming year.”
With great change comes great op-portunity, she noted. Hovious added she believes Nashville to be in a unique posi-tion to meet those challenges. “The Coun-cil’s greatest strengths, without a doubt, are our members,” she stated. “Nashville’s healthcare community is like no other. We are truly lucky to have this active, diverse network of the smartest leaders in health-care who support the Council’s mission and want to see this community grow and thrive,” she said.
“The future for Nashville healthcare is bright,” Hovious concluded.
(L-R): Nicole Maynard, Phillip Pucciarelli, Bob Crutchfield, Benjamin Edmands, and Eb LeMaster.
PHOTO: DONN JONES PHOTOGRAPHY
Hovious Reflects on New Role Leading Health Care Council
Hayley Hovious
n a s h v i l l e m e d i c a l n e w s . c o m JUNE 2015 > 3
Wang Vision 3D Cataract & LASIK Center615.321.8881 | WangCataractLASIK.com
The doctors’ doctor:Dr. Ming Wang
Harvard & MIT (MD, magna cum laude); PhD (laser physics)
Performed surgeries on over 4,000 doctors
Inventions & Patents1. LASERACT: All-laser cataract surgery U.S. patent fi led.
2. Phacoplasty U.S. patent fi led.
3. Amniotic membrane contact lens for photoablated corneal tissue U.S. Patent Serial No
5,932,205.
4. Amniotic membrane contact lens for injured corneal tissue U.S. Patent
Serial No 6,143,315.
5. Adaptive infrared retinoscopic device for detecting ocular aberrations U.S. Utility Patent
Application Serial No. 11/642,226.
6. Digital eye bank for virtual clinical trial U.S. Utility Patent
Application Serial No. 11/585,522.
7. Pulsed electromagnetic fi eld therapy for nonhealing corneal ulcer U.S.patent fi led.
8. A whole-genome method of assaying in vivo DNA protein interaction and gene expression regulation U.S. patent fi led
Dr. Ming Wang, Harvard & MIT (MD, magna cum laude); PhD (laser physics), is one of the few cataract and LASIK surgeons in the world today who holds a doc-torate degree in laser physics. He has performed over 55,000 procedures, including on over 4,000 doctors (hence he has been referred to as “the doctors’ doctor”). Dr. Wang currently is the only surgeon in the state who offers 3D LASIK (age 18+), 3D Forever Young Lens surgery (age 40+) and 3D laser cataract surgery (age 60+). He has published 7 textbooks, over 100 papers including one in the world-renowned journal “Nature”, holds several U.S. patents and performed the world’s fi rst laser-assisted artifi cial cornea implantation. He has
received an achievement award from the American Academy of Ophthalmology, and a Lifetime
Achievement Award from the American Chinese Physician Association. Dr. Wang founded a 501c(3) non-profi t charity, the Wang Foundation for Sight Restoration (www.Wangfounda-tion.com), which to date has helped patients from over 40 states in the U.S. and 55 countries worldwide, with all sight restoration surgeries performed free-of-charge.
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AMNIOTIC MEMBRANECONTACT LENS
Dr. Wang’s inventionU.S. patents:
5,932,205 & 6,143,315
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Amnioticmembraneis obtained afterthe baby’s birth
4 > JUNE 2015 n a s h v i l l e m e d i c a l n e w s . c o m
ICD-10 Boot CampThis fast-paced boot camp is designed for coders and others in health information management and compliance who are already ICD-9 proficient and need to maintain their professional credentials.
Two course options available for participants:Course 1: ICD-10 CM Boot Camp Course 2: ICD-10 PCS Boot Camp
Materials will be provided, and CEUs will be available (12 CEUs per course).
Speaker Monica Smith, RHIT, CPC, is an AHIMA-approved ICD-10 CM/PCS trainer and is a coding and compliance consultant with Kraft Healthcare Consulting, LLC.
This program has been approved for continuing education units (CEUs) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.
August19, 20, 21
Location:KraftCPAs PLLC555 Great Circle Rd.Nashville, TN 37228MetroCenter
Learn more and register atkraftcpas.com/events.php
Stephaine Walker, MD, MPH, is help-ing Mt. Zion Baptist Church members run the race with endurance.
In 2010, the Vanderbilt University neonatologist and assistant professor of Pe-diatrics co-founded ChurchFIT alongside her husband, Bishop Joseph Walker, III. The couple yields a powerful influence as leaders of Nash-ville’s oldest and largest black church, now boasting 29,000 members in three Middle Tennessee locations.
Starting OutOne of seven children,
the Los Angeles native first arrived at Nashville in 1993 as an undergrad at Vanderbilt University. She attended medical school at Cornell University and completed her residency at Children’s Hos-pital of Philadelphia before briefly moving back to L.A. for a fellowship in neonatology.
While pursuing her Master’s of Pub-lic Health at Harvard University, she was introduced to her would-be husband and
soon joined him in Nashville with yet an-other new title – pastor’s wife.
As the newlyweds settled in, they also turned to a personal trainer to help them get fit. Their weight loss piqued the inter-est of church members.
“When you start shrinking, peo-ple sometimes assume you’re
sick, especially in the Af-rican American com-
munity,” Walker said. “We wanted to change the paradigm
of what good health looks like. The ChurchFIT
program was started to show peo-ple – ‘this is how we did it … and you can join us, too.’”
Three years later, 1,500-plus members regularly participate in ChurchFIT’s no-cost comprehensive healthy living wellness initia-tive. Nutritional cook-
ing programs, along with classes ranging from heart health and breast cancer awareness to kickbox-
ing and Pilates are offered at two Mt. Zion locations five days a week.
“We try to focus on not just provid-ing classes but teaching real tools,” Walker said. “We’re really trying to make mem-bers more conscious of health. Before it was something you might only talk about with your doctor, but they’re learning that ‘health’ is every day. That language be-comes a part of who you are.”
Bucking TraditionThat mindset has integrated into Mt.
Zion’s culture, where meals now often in-clude grilled options and low-calorie des-serts – small steps with big results.
“We stress that those small steps make a difference in life and impact not only you but future generations,” Walker said. “We want to stop the vicious cycle from what our grandparents did. Members are becoming the first people in their families to come off their diabetes medication so it’s really about changing lifestyles.”
She continued, “For me, the best part is seeing people who are excited. Now a couple of years in people are still excited, because it’s a change in mindset.”
ChurchFIT’s successTheir annual 12-week ChurchFIT
competition sees teams compete for up to $10,000 worth of prizes. During 2014’s challenge 160 teams competed, and 1,600 participants lost some 4,300 pounds.
ChurchFIT teams are now a regular presence at Nashville events … from the Country Music Marathon to glow runs and cancer walks. They’ve partnered with The New Beginnings Center and are a gearing up a KidsFIT Program to offer the same hope to a younger generation.
So how does a program garner that kind of success?
“You really have to give them a con-text, teach them how it matters from a Biblical standpoint,” Walker said. “We talk about Jesus Christ and his walk to Calvary. How can a man endure that kind of beating and scrutiny and carry his own cross if not in good health? We’re all here for a purpose beyond our kids and ourselves – a purpose that impacts others in the world. If you’re not healthy enough to fulfill your God-given role, you’ve missed your real purpose.”
What can the medical community learn from ChurchFIT’s success story? From a clinician’s standpoint, Walker said it’s important to understand that church is a culture in and of itself, and there’s a certain way you have to engage a church culture to be received.
“Historically there’s been a rift be-tween African American churches and the academic community,” Walker said. “How do you engage that community? Oftentimes researchers have a great idea and want to go in and do a study, but now people are leery because you’ve gotten their information and numbers but left them high and dry. It’s important to make it a win-win when you research. Leave them empowered with programs and skills so they can continue what it is you want them to improve upon.”
ChurchFIT is always interested in partnering with organizations seeking to support their mission. Specifically, Walker said a partner is needed to help pool data. They currently work closely with Meharry Medical College and local physician offices to offer screenings and education. For more information, visit mtzionnashville.org.
PHOTO: DAEMON WATSON
Dr. Stephaine Walker and
husband Bishop Joseph
Walker, III help church members get healthy and
stay fit.
Building Better Flu VaccinesVanderbilt researchers have received a five-year, $9 million grant from the NIH to
design more effective flu vaccines and novel antibody therapies.Current flu vaccines trigger immune responses against proteins on the viral “coat.”
Because these proteins constantly change, they help the virus evade immune detection. However, vaccines could be ‘universally’ protective if they induced immunity against highly conserved, unchanging places on the surfaces of proteins found in every flu virus or if antibodies could be developed that recognized every strain of influenza, said James Crowe Jr., MD, co-principal investigator of the grant with Jens Meiler, PhD.
In collaboration with scientists from The Scripps Research Institute in California, Vanderbilt researchers are using a computer program to predict protein structure from the amino acid sequence to hopefully design antibodies that hone in on influenza’s Achilles’ heel.
n a s h v i l l e m e d i c a l n e w s . c o m JUNE 2015 > 5
By CINDy SANDERS
First the good news … providers are generally excited about the idea of mov-ing to more holistic, integrated care with a focus on prevention, quality and out-comes. Now the not-so-good news … we have to figure out how to pay for it.
“Providers are on board for the po-tential benefits from changes to the way we provide care, which is different from the way we pay for care,” noted Dion P. Sheidy, a part-ner in KPMG’s Health Care Advisory Practice. “This is a little bit of the elephant in the room.”
N a s h v i l l e - b a s e d Sheidy said the Centers for Medicare and Medicaid Services have stated their plans to significantly increase value-based payments to providers over the next few years. In a fact sheet released in late January, CMS noted improving quality and affordability of healthcare was as much a pillar of the Affordable Care Act as expanding access. The goal, the memo continued, is to reward value (measured by quality of outcomes) and care coordi-nation and efficiency rather than volume and duplication. To that end, the Depart-ment of Health and Human Services has adopted a framework of four categories of payment:
• category 1: fee-for-service with no link of payment to quality,
• category 2: fee-for-service with a link of payment to quality,
• category 3: alternative payment models built on fee-for-service ar-chitecture, and
• category 4: population-based pay-ment.
Value-based purchasing includes payments in categories two through four. The stated goal is to have 30 percent of Medicare payments in alternative pay-ment models (categories three and four) by the end of 2016 and 50 percent by the end of 2018. Additionally, HHS hopes to have 85 percent of Medicare fee-for-ser-vice payments in categories two through four by the end of 2016 and 90 percent by 2018.
“Although they have put that out there, they have yet to put out guidance about how they expect to achieve it,” noted Sheidy. “These are huge jumps. We’re going to go from less than 10 per-cent in fiscal year 2015 to 90 percent with some link to quality in fiscal year 2018.”
Sheidy added there is some ambigu-ity as to what CMS calls ‘alternative fee arrangements’ and that at this point there are a lot more questions than answers. While he doubts normal market forces would push payment reform fast enough to hit the HHS targets in the next three years, he said regulatory changes could be the driver to hasten the transition to value-based payment.
“There are elements of the Affordable Care Act that have some pretty significant
unknowns attached such as the Cadillac tax,” he continued. The chief unknown, he continued, is “Does the Cadillac plan tax survive and get implemented as it stands today?” That question, he added, probably won’t be answered until after the presidential election.
The 40 percent excise tax, which is currently scheduled to go into effect in 2018, is levied on healthcare benefits that exceed certain pre-set limits. Despite the name of the tax, Sheidy said its impact would be felt far beyond affluent circles. In fact, the thought is that a significant num-ber of employers could wind up incurring the tax. “This cuts across political parties when it comes to the impact of this,” he said, noting teachers, labor unions and public officials often have strong health-care benefit packages. “You’re talking about having an excise tax that indirectly impacts a significant amount of the popu-lation through employer-provided ben-efits.”
He continued, “If this Cadillac tax survives, employers are going to be faced with having to change benefits, maintain benefit levels under a different cost struc-ture, or pay the tax.” Sheidy added that since there doesn’t seem to be much en-thusiasm for paying the tax, employers are going to look at how to bend plan design or the cost curve and will be more willing to consider value-based network designs.
“The government … through state-ments around the move to the 80 percent (value-based purchasing) along with the
continuing lingering effects of the Afford-able Care Act … has really set the industry up for the opportunity for some significant impact on payment reform over a fairly short time frame,” he noted. “On the payer side, CMS is looking to change the payment mechanism. On the commercial side, we’re looking at the Cadillac tax and how to get costs under control. And all of those things share the potential to come into play over the next several years. It’s almost like the perfect storm.”
It’s not that the industry hasn’t taken any steps to prepare for a move to a differ-ent type of payment mechanism. Sheidy said the industry is already involved in demonstration projects, quality reporting and capturing data points. However, he pointed out, the true impact on payment of all that collection and monitoring is still pretty narrow.
“People confuse population health with risk and payment,” he said. Now, we’re at the intersection of how to more effectively, efficiently manage the health of a population while simultaneously figur-ing out how to link payment to these new practice models.
While the industry has floated along with a foot in both the fee-for-service and value-based worlds for quite a while, Sheidy said the drivers are now in place, barring any changes, to force the move-ment to a more outcomes-based payment methodology in a very short window of time.
The Competing P’s: Provision & PaymentChanging Reimbursement for New Models of Care
Dion Sheidy
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Providers, Insurers UniteIn late January Modern
Healthcare reported a group of large health systems and insurers were uniting to create the Health Care Transformation Task Force. The group is bringing together patients, payers, providers and purchasers to align efforts to transform delivery and reimbursement. The goal is to shift 75 percent of their business to contracts that include incentives for hitting quality benchmarks and delivering lower cost healthcare by 2020.
The industry consortium has nearly three dozen participants to date. Large providers including Ascension, Optum, Trinity Health and Fresenius Medical Care are on board along with Aetna, Health Care Service Corp. (HCSC) and Blues in California and Massachusetts. The task force has also created a number of workgroups focused on ACOs, bundled payments, and high-cost patients to provide ‘actionable policy and program design recommendations’ to CMS, the private sector, legislators and others. For more information, go to hcttf.org
6 > JUNE 2015 n a s h v i l l e m e d i c a l n e w s . c o m
Health Alliance to employer organizations including the Memphis Business Group on Health and East Tennessee’s HealthCare 21 Business Coalition, Daverman said pay-ment reform could not occur in a vacuum.
Ongoing meetings with payers, pro-viders and workgroups are used to design strategies to be broadly implemented across the state. Routine meetings are held with major provider organizations including the Tennessee Medical Association (TMA), Tennessee Hospital Association (THA), Hospital Alliance of Tennessee (HAT) and Tennessee Nurses Association (TNA), along with a host of specialty statewide organizations representing family physi-cians, physician assistants, pediatricians, children’s hospitals, mental health organi-zations, primary care providers, and medi-cal education. In addition, Amerigroup, BlueCross BlueShield of Tennessee, Cigna, and UnitedHealthcare meet regularly with the team.
While the initiative took off in May 2013, Daverman said the roots of payment reform go back even further to a vision task force, which included members of TMA, THA, Darin Gordon from HCFA, and others. “It was a group of likeminded, in-fl uential people in the state thinking about how we can move things forward in terms of healthcare payment and delivery,” Daverman noted. “I think the strategies we have chosen are all ones that were dis-cussed in those meetings.”
As a result of stakeholder input, strat-
egies in three key areas are being implemented: primary care transfor-mation, episodes of care, and long-term services and supports. There is a Technical Advisory Group (TAG) for each strategic area to provide guidance on quality mea-sures and program design.
Primary Care TransformationDaverman noted this component fo-
cuses on the “primary care provider – pre-venting illness, managing chronic illness and coordinating with other providers such as specialists.” He continued, “This is re-warding activities that are very important in primary care that aren’t necessarily paid for now.”
Daverman pointed out coordinating with a specialist takes time and effort for the primary care provider but isn’t neces-sarily reimbursable. Yet, the results of that coordination are often critical to a patient’s health.
“With all our strategies, we want to put the doctor in the driver’s seat,” he said. Daverman added this focus on outcomes might require changes in communication, clinic hours, phone staffi ng, and other pa-tient engagement activities in order to im-prove health and cut down on expensive emergency room visits. “If it results in bet-ter outcomes for quality and utilization, we
want to reward that.”Although he praised with work being
done by ACOs, Daverman stressed the primary care transformation strategies are different and easily scalable. “All of our strategies are feasible for providers without making signifi cant changes to business rela-tionships,” he said.
The starting point is with patient cen-tered medical Homes (PCMH), health homes for SMPI (serious and persistent mental illness) patients, and provider alerts for hospital and emergency department ad-missions, discharges and transfers. “We’ll start with about a dozen practices and want to go statewide within a couple of years,” Daverman said of programming, which is slated to launch in mid-2016.
Whether or not providers are in a PCMH, those who sign up can tap into the web-based statewide alert system. “We’re going to work to have real-time notices every time a patient goes to the emergency room of a hospital,” Daverman said of the data being populated by participating pay-ers. In addition, he said the system would be able to generate a ‘gaps in care’ report and alert providers to their patients’ drug fi lls. “It’s really, really important informa-tion to have if you want to manage your patients.”
Episodes of Care“This is the strategy that’s the furthest
along,” Daverman noted of aligning in-centives with desired outcomes. Episodes reward high quality care, promote the use of clinical pathways and evidence-based guidelines, and encourage coordination to reduced ineffective or inappropriate care. Under the initiative, episode-based pay-ment is being rolled out in waves with the goal of implementing 75 episodes by the end of 2019.
Wave 1 launched in May 2014 with three episodes of care: acute asthma ex-acerbation, perinatal, and total joint re-placement. For six months, more than 500 providers received detailed preview reports from TennCare and commercial payers before the wave went live in 2015.
“Providers are getting new informa-tion they’ve never had before in quality reports,” Daverman explained. “They can see how they compare to their peers on cost, and we break down those costs into categories to make it actionable.”
He continued, “Providers who have the most expensive average episode cost for the year across the state are penalized by a portion of their excess cost.” How-ever, Daverman noted, the threshold for a penalty is set pretty high and is considered only after adjusting for exclusions such as high-risk patients or extraordinary events. Ultimately, the projection is the most ex-pensive 10 percent of providers will face a penalty. On the other hand, he said, “It’s very important we reward providers who meet quality measures and provide effi -cient care with shared savings.” Daverman predicted, “The majority of providers will have no change or will get rewarded.”
Preview reports for Wave 2 – acute COPD exacerbation, screening and sur-veillance colonoscopy, outpatient and non-acute inpatient cholecystectomy, and acute and non-acute PCI – began at the end of last month. The advisory group has just completed their process for Wave 3, which will roll out preview reports next year and go live at the beginning of 2017.
Long-Term Services & SupportsDaverman said the main premise of
this strategy is to tie payment to quality and acuity. “Some of the measures are around the patient experience, and some of the quality measures are around the caregiv-ers,” he said.
Key points include implementing qual-ity- and acuity-based payment for nursing facilities and home- and community-based services, value-based purchasing initiatives for enhanced respiratory care, and focusing on workforce development.
More InformationDetails on each of the strategies is
available online in the Strategic Planning and Innovation Group section of HCFA at tn.gov.
Emphasis on Innovation, continued from page 1
Brooks Daverman
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PwC Health Research Institute Spotlights U.S. Telehealth Industry
This spring, experts at PwC’s Health Research Institute (HRI) released a new spotlight on the nation’s growing telehealth industry that noted providers are seeing increased demand as consumers fi nd value in these services. Nearly half of consumers surveyed by HRI indicated they would be willing to pay for an online service or app that could diagnose and prescribe based on symptoms described by the user. Moreover, state and federal governments are driving expansion – more than 40 states have expanded Medicaid to cover telehealth and over 20 are mandating private insurer reimbursement.
Recent regulatory activity is also driving telehealth expansion. The spotlight noted, “Recent regulatory action may be the catalyst to spur the fl edgling telehealth market. In October 2014, the federal government expanded Medicare reimbursement for telehealth services, including remote chronic care management and an addition of seven new covered procedure codes for telehealth, including annual wellness visits, psychotherapy and prolonged services in the offi ce. In November, the USDA awarded $8.6 million in telehealth grants, many of which are being used for equipment such as high-tech cameras. Over 20 states are mandating payment parity between telehealth and in-person visits, and eight more have proposed similar rules.”
To read the full report, go online to pwc.to/1FkwOXH.
n a s h v i l l e m e d i c a l n e w s . c o m JUNE 2015 > 7
By CINDy SANDERS
“There is a finite number of resources available to treat people in this country,” stated Peter A. Ambrose, Jr., PhD, MBA. Finding a way to stretch those resources and transcend barriers to integrating behavioral health into the primary care setting was the im-petus behind the launch of Frankl in-based MindCare Solutions 18 months ago.
Ambrose, the telemedicine compa-ny’s CEO, is a licensed psychologist with a wealth of experience in population-based behavioral health. Previously, he served as regional vice president of Be-havioral Health for Anthem Blue Cross Blue Shield where he was responsible for enterprise operations of behavioral health benefits for 20 million members. His experience also includes executive posi-tions with behavioral health oversight for Barnes Jewish Christian Health System in Saint Louis and for Blue Cross Blue Shield of Missouri.
“Forty percent of people who have a chronic illness also have a psychiatric component to it,” Ambrose said. “For any chronic illness, we know if you don’t take care of the behavioral health condition, you won’t achieve optimal outcomes – health outcomes, quality of life outcomes or financial outcomes.”
Although the link between physical and mental health is well established, Am-brose said it hasn’t been easy to integrate care delivery in tandem for a number of reasons ranging from a shortage of pro-viders to a historical separation of the dis-ciplines to logistical barriers within some care settings such as correctional facilities.
For months prior to MindCare So-lution’s launch, Ambrose said the leader-ship team, investors and industry insiders worked to develop the company’s con-cept to best address existing needs across the country. “We went through a design shop where two of our board members, Dr. Harry Jacobson and Duncan Dashiff, brought together 60 healthcare experts to vet the idea and then to solicit their ideas on what would be the important aspects (of the business model),” Ambrose recalled. Using technology as an integration tool emerged as a viable solution to overcome many cost, geographic and timing barriers that have hindered efficient access to care.
Ambrose noted while there is a general shortage of psychiatrists across the country, the deficit becomes more pronounced when drilling down into specialty areas such as pediatric or geriatric psychiatry. Replac-ing retiring physicians is another concern. “Currently, 60 percent of psychiatrists are 55 and older. Based on today’s numbers, in
a generation, we’re going to lose 40 percent of psychiatrists,” he said. Since behavioral health issues have not shown a decline, the presumption is the need for services will stay steady or increase in the coming years creating a widening gap between demand and resources, which will be exacerbated in rural areas.
Telemedicine technology allows MindCare to provide broad geographic access in a timely manner. “We’re able to provide a virtual clinic so I can provide ser-vices to 25 different physician offices in one day without the psychiatrist having to leave his office,” Ambrose said. He added Mind-Care’s business model also has been able to dramatically cut appointment wait times for their clinical partners. “You’re able to get more hours in a day. You’re able to see more patients more efficiently,” he added.
From a cost perspective, which is in-creasingly important in the shift to value-based payment models, Ambrose pointed out spending a little could save a lot. “There is generally between a 30-40 per-cent increase in the medical spend if you don’t take care of the behavioral health
issue,” he said. Ambrose noted while it might take
$1 to care for someone with diabetes, that same patient costs $1.40 if depression is also present. “If you address the behavioral health issue, you may spend a nickel, but you wind up spending $1.05 as opposed to the $1.40,” he said. In essence, Ambrose continued, “You can save money. You can increase someone’s health … they feel bet-ter. And you increase their quality of life.”
When establishing a relationship with a practice or institution, MindCare So-lutions’ licensed, credentialed clinicians have the ability to transfer notes and data to populate patient records. “Not all elec-tronic medical records by design speak to each other, but the fact is with some tech-nology additions, they can. For the most part, the operational issues in telemedicine are becoming less and less an issue,” Am-brose said.
While the company has a robust tech-nology platform, Ambrose was quick to stress MindCare isn’t a technology com-pany. “We are providers of care. We use technology as a tool … not as what we
do. We’re not reinventing the wheel,” he continued. “All we’re doing is taking the best practices available today and combin-ing them with technology. We like being partners. We like providing care. We like improving outcomes,” he said of the com-pany’s mission.
It’s a strategic model that seems to be resonating with providers across the United States. By the end of 2015, Am-brose said MindCare Solutions would be available in 28 states. “Five years from now, I venture we’ll be in every state,” Ambrose said. He added during that same timeframe, he foresees the company en-tering into risk-sharing agreements with their strategic partners as reimbursement models shift.
The company currently provides be-havioral health solutions for a wide range of healthcare clients and industry sectors. Ambrose said that in their first 18 months of business, some partners have asked MindCare to add primary care to their customizable offerings. “Realistically, there are no cookie cuter solutions any-more. Clients want their needs met their way, and we’re able to do that,” he said of expanding the types of services and range of providers to address specific needs.
“We see our future … and the future of telemedicine … as providing a variety of specialty services to institutional cli-ents,” Ambrose concluded. “This isn’t going to take over medicine, but it will be an important complementary piece to the health system.”
Mind over MatterMindCare Solutions Utilizes Technology to Transcend Barriers to Care
HealthcareEnterprise
Dr. Peter A. Ambrose, Jr.
For more information, go online to:MindCareSolutions.com
8 > JUNE 2015 n a s h v i l l e m e d i c a l n e w s . c o m
and keep men searching for a healthier career/family balance.
“Frankly, we tend to reward men more for taking care of their family and job than their health,” Griffith said. “It’s a real issue.”
Despite their reputation for neglect-ing medical care, men actually fare simi-larly to women when it comes to seeking out medical help for symptoms. The glar-ing gender difference is in the area of pre-ventive care – a gap Griffith hopes to close through research and education.
“We’re trying to understand, are these things true that we treat as normal max-ims about men’s health? Often there’s an element of truth, but when you ask men and engage women about men’s health and talk through processes, you get very different re-sults,” he noted.
Another striking gender difference is that men tend to define their health relation-ally – by looking at what they’re able to do physically and not at medical results. For example, men who can still go to work and play with their kids after work often consider themselves healthy. Griffith hopes to help men translate tests that look at internal functioning and motivate them to engage in healthier behavior.
African American Men & HealthIRMH has been especially busy with
studies to better understand and address issues impacting the health of African American men. A recent “Men on the Move” physical activity study looked at the feasibility of using text messaging and wearable devices like Fitbits. Griffith said the technology proved useful in increas-ing physical activity and self-awareness of activity.
“Whether it’s just competition or having others hold you accountable, those devices and additional features helped participants connect with others and de-velop a support network,” Griffith said. “Men don’t tend to have as strong or large of social networks as women and don’t uti-lize them the same way. We’re trying to find strategies to help men engage more and normalize some of the things they’re experiencing.”
An ongoing challenge facing many African American communities is ac-cess to healthy foods and safe, affordable places to exercise. “It’s almost like we’re trying to engage in healthy behaviors in potentially unhealthy environments,” Griffith said. To that end, the institute is working with policymakers to increase access to healthy foods and activities. In the meantime, they’re focused on helping people learn to navigate in not-so-healthy environments.
“The most fascinating thing about these studies is that it’s not that men don’t know what to do,” Griffith said. “But the question is – ‘Why do you do things that aren’t in your best interest?’” More often
than not, the answer to that question goes back to the priorities of a man and the people in his life. “The challenges we face with men’s messaging and motivat-ing them to be healthier tends to pit health against social priorities and trying to bal-ance the two … to be healthy and also be successful in the rest of life. We don’t want to offer excuses, but we’re trying to figure out ways to honor men while identifying challenges and motivating factors.”
Many men studied turned to their faith for motivation and found the focus also helped with stress reduction and re-lationship improvement. “You can’t find motivation to be healthy in just health-related things,” said Griffith. “It has to connect to something larger and more important.”
More Questions, More Answers
Currently, the institute is striving to better understand how men think about health: what does it means to be a man, and how do you connect the two?
“We tend to separate men’s health from men’s identity as men, but we want to connect those two to see how being healthy helps men achieve goals,” Griffith
said. “They’ll be more motivated to try to overcome time and environmental barri-ers to be more healthy and active.”
In their search for answers, IRMH has garnered support from Vanderbilt’s Institute for Medicine and Public Health. Griffith’s role also spans the campus as he works with medical school and undergrad programs. Outside Vanderbilt, the Nash-ville community has embraced opportu-nities to participate in studies and surveys posted on IRMH’s website. Griffith en-courages the local medical community to get involved in health initiatives, advisory boards, surveys and Tennessee’s bi-yearly men’s report card that has become a model for other states. Last released in 2014, the eight-month project was coordinated in conjunction with IRMH, the Tennessee Department of Health and the Tennessee Cancer Coalition. (See findings in sidebar.)
As for the IRMH, their next step is to move beyond the African American com-munity to examine health attitudes among white and Latino men.
“Men’s health and even gender dif-ferences are more than biology,” Griffith said. “They have roots in real behav-ior generated across racial and ethnic groups.”
Vanderbilt’s Institute for Research on Men’s Health, continued from page 1
Grading Men’s Health in TennesseeThe 2014 Tennessee Men’s Health Report Card, the latest edition, highlighted
areas of progress for men in our state, areas where Tennessee men still lag far behind national goals, and areas where racial and ethnic disparities in health outcomes persist.
The data in the Report Card was provided by the Tennessee Department of Health, which has been a partner in both the Men’s and Women’s Health Report cards since 2008. The health outcomes and health behaviors reported were from 2012, the most recent year for which full data was available. Changes in health indicators, both positive and negative, over the years 2007 through 2012 were also reported.
Key Findings
Men in Tennessee lived, on average, five years less than women in 2012.
Over half of the deaths for men in Tennessee in 2012 could be attributed to three conditions – heart disease (24.7 percent), cancer (24.4 percent) and chronic lung disease (5.6 percent). These are conditions where improvements in levels physical activity, diet, tobacco use behaviors and early diagnosis and care could make a difference in outcomes, quality and length of life.
Main causes of death for men vary dramatically by age. Among younger adult men (ages 18-34), 40 percent of deaths were due to unintentional injuries and motor vehicle accidents, and another 30 percent to intentional homicide and suicide.
The rates of deaths examined in the Report Card were not distributed evenly among men in our state by ethnicity, race, or place.
Black men in Tennessee bear an excess burden of heart disease, stroke, diabetes, kidney disease, homicide, pneumonia and influenza, AIDs and cancers of the prostate, colon and rectum, and lung. However, between 2007 and 2012, the rates of each of these conditions showed improvement.
White men bear an excess burden of suicide, unintentional injuries (including drug-related poisonings and overdoses), motor vehicle accidents, lung disease and liver disease. Between 2007 and 2012, the rates for each of these conditions for white men, with the exception of motor vehicle accidents and lung disease, were statistically stagnant or getting worse.
Hispanic men, overall a younger population, have lower rates of death for most chronic conditions and higher grades overall, but received their lowest grades on rates of colorectal cancer, chronic liver disease, motor vehicle accidents and suicides. Death rates from kidney disease among Hispanic men also worsened between 2007-2012.
When data was mapped by Health Department Region, there were often wide variations geographically, and it is not clear whether these are due to differences in environmental factors, in urban vs. rural lifestyles and occupations, or in access to and use of healthcare services.
Dr. Derek Griffith
Where advanced cytogenetic technology meets old-fashioned servicewww.geneticsassociates.com
Genetics Associates Inc. is CAP accredited, CLIA and State of Tennessee Licensed.
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By MELANIE KILGORE-HILL
Liver cancer is the fifth most common cancer in men and the eighth most com-mon in women. While the disease ranks fourth in annual cancer mortality rates, oncologists say patients today can liver longer, better lives thanks to ongoing ad-vances in medical treatment.
Andrew Kennedy, MD, physician-in-chief of Radiation Oncology at Sarah Cannon and director of Radiation Oncology Research at Sarah Can-non Research Institute, said men are more likely to fall prey to liver can-cer for several reasons. “Primary liver cancers have a number of risk factors, and men typically have those riskier behaviors,” he explained.
Primary liver cancer is associated with hepatitis, infections and heavy al-cohol use. Men are often heavier drink-ers and are more frequent IV drug users. Additionally, hepatitis was once prevalent among military personnel serving outside the United States. Another growing cause of liver cancer is nonalcoholic steatohepa-titis (NASH), or fatty liver disease. Doctors say NASH is becoming more common, possibly because of the greater number of Americans with obesity. In the past 10 years, the rate of obesity has doubled in adults and tripled in children. Obesity also contributes to diabetes and high blood cholesterol, which can further complicate the health of someone with NASH. He-reditary risk factors make up less than 1 percent of liver cancer cases.
Liver Tumors & Treatment According to the National Institutes
of Health, hepatocellular carcinoma (HCC) is the more common primary malignant tumor of the liver. Symptoms typically include pain in the upper right quadrant and jaundice. The best treat-ment for HCC is liver transplant or resec-tion, although transplant available to only 10 percent of patients and resection avail-able to 15–25 percent. That’s because the tumor – a byproduct of injury to the liver - is typically found when the liver is too sick to allow resection.
“Cirrhosis is what causes cancer to develop; and if you have moderate to severe cir-rhosis, the tumor can’t be resected,” explained Daniel Brown, MD, di-rector of Interventional Oncology at Vanderbilt-Ingram Cancer Center and professor of Radiol-ogy. Still, oncologists say physicians are often unaware of therapies that can extend a patient’s life or even halt growth of the liver tumor, allowing oncol-
ogists to focus on growths in other parts of the body in the case of metastatic disease.
Y-90 Radioembolization Today, a leading therapy for liver
cancer patients is Y-90 microsphere ra-dioembolization. At press time, Vander-bilt-Ingram Cancer Center and Sarah Cannon programs at TriStar Centennial Medical Center and TriStar Skyline Med-
ical Center are all offering Y-90 radioem-bolization in the Nashville area.
During radioembolization, tiny ra-dioactive beads of Yttrium-90 (Y-90) are injected into the hepatic artery. HCC tumors are generally highly vascular and receive the majority of their blood supply from the hepatic artery. The non-biode-gradable microspheres attack only the tumor, sparing the remainder of the liver.
The 30-minute procedure has proven to be well tolerated by most patients, who report little more than fatigue following surgery.
According to the NIH, there are two commercially available microsphere devices in which Y-90 is incorporated – one with microspheres made of glass (TheraSphere; MDS Nordion, Ottawa,
Y-90 Radioembolization Means More Time, Options for Patients with Liver Cancer
Dr. Andrew Kennedy
Dr. Daniel Brown
(CONTINUED ON PAGE 10)
10 > JUNE 2015 n a s h v i l l e m e d i c a l n e w s . c o m
ON, Canada) and the other with microspheres made of resin (SIR-Spheres; Sirtex Medical, Sydney, Australia). The SIR-Spheres use also was granted approval for metastatic colorectal cancer in 2002. The two devices vary in their physical composition and radioactivity levels.
Looking Back & Ahead An original Y-90 FDA investigator,
Kennedy treated some of the nation’s first patients in 1999 and has trained countless physicians since. “I’ve been very pleas-antly surprised that it continues to do a good job because there aren’t a lot of dials to adjust here,” Kennedy said of the therapy. “While radiation levels [in each microsphere] have remained unchanged, the technique has evolved to be safer and more effective.”
So what have physicians learned since 1999? Patient selection has become critical, and 15-plus years of research has helped providers select the best candidates for radioembolization. “We’ve also got better imaging techniques, but ultimately the skill of the physician at getting the catheter in the right position and deliver-ing the right amount of radiation makes all the difference,” Kennedy said. “There’s a lot more behind the scenes leading up to that treatment.” Advances like 3D re-construction of liver vessels also help with complicated cases.
Improving OutcomesAccording to Kennedy, 50 percent
of Y-90 patients see measurable improve-
ment in liver tumors. “That’s substantial because options are either no treatment or reusing chemo,” he said. “Before SIRT those patients would sometimes be offered a clinical trial, but most went to hospice. This treatment has enabled us to help them have minimal side effects and such good responses that patients don’t need to jump back into chemo for five to seven months. This has provided us something we didn’t have before.”
Vanderbilt, which has been offering radioembolization since 2005, performed more than 200 procedures in 2014 and is expected to exceed that number in 2015.
“We work collaboratively as a group with transplant surgeons and the tumor board and decide if treating through the artery will help get the patient to trans-plant or if this will be their ultimate desti-nation therapy,” Brown said.
Both physicians said the therapy of-fers the best hope at survival or as a bridge to transplantation or resection and en-couraged physicians to think outside the box when it comes to liver cancer.
“Oftentimes our colleagues’ assump-tion is that tumors in liver mean pallia-tive care,” Kennedy said. “They should be thinking of aggressive treatments,” he continued. “We can control many tumors of the liver and sometimes change the pat-tern of how it reoccurs. Sometimes the disease changes from liver dominant and patients can live longer lives. We have pa-tients who have lived years because their tumor was controlled through a whole continuum of care that includes internal radiation and chemo.”
By JULIE PARKER
The most influential demographic group – millennials, ages 21-32, empow-ered by advances in technology – is turn-ing America’s healthcare landscape upside down.
In a recently released survey commis-sioned by PNC Healthcare, more than 5,000 participants nationwide explored the impact of patient-centered care among various age groups, including millennials, Generation X or Gen-Xers (ages 33-49), baby boomers (ages 50-71) and seniors (72+). The most significant finding: online shopping for doctors, web-based diagnos-tic tools and research about treatment op-tions have a role in healthcare decisions for millennials, replacing the single-source primary care physician (PCP) favored by older generations.
“As millennials overtake boomers as the nation’s biggest consumer buying group, they will expect more efficient ways to make healthcare payments via digital
channels that are consistent with their ex-periences in other industries,” said Shane Print, vice president of PNC Healthcare for Florida, Alabama and Georgia. “It’ll be important for payers and providers to work together to meet these payment expectations by progressing further along the technology continuum, especially con-sidering that much of the growth in the healthcare payments industry has been driven by a rise in patient responsibility. Those insurers and healthcare providers that thrive will be those that adapt sooner than later to the preferences of this fast-paced, technology-driven generation.”
Growing trends among the millenni-als that are driving change in healthcare include:
Speedy DeliveryWhen it comes to the drive-thru gen-
eration, millennials prefer retail (34 per-cent) and acute care clinics (25 percent) ... double that of boomers (17 and 14 per-cent, respectively) and seniors (15 and 11
percent, respectively). On the flip side, seniors (85 percent) and boomers (80 per-cent) visited their PCP significantly more than millennials at 61 percent.
For example in Florida, Print noted that urgent, specialty and retail clin-ics over the last four years have grown dramatically. “Quick Care” availabil-ity has been recognized as a top priority by many healthcare organizations, and even large retailers and several phar-macy chains. Millennials expressed con-cern about this method of care and the quality of the patient’s care, based on who’s consulting with the patient (level of education), possible lack of patient’s accurate healthcare background, and pressure of being a “quick appointment.”
Word-of-Mouth MarketingNearly 50 percent of millennials and
Gen-Xers use online reviews, such as Yelp and Healthgrades, when shopping for a healthcare provider, compared to 40 per-cent of baby boomers and 28 percent for
Five Ways Millennials Have Shaken Up HealthcareThey Prefer Alternative to Single-Source PCP Favored by Older Generations
Y-90 Radioembolization, continued from page 9
Cancer Among MenNote: The numbers in parentheses are the rates per 100,000 men of all races and Hispanic origins combined in the United States. Hispanic origin is not mutually exclusive from race categories (white, black, Asian/Pacific Islander, American Indian/Alaska Native).
Three Most Common Cancers Among Men• Prostatecancer(128.3)• Lungcancer(73.0)• Colorectalcancer(46.1)
Leading Causes of Cancer Death Among Men• Lungcancer(57.9)First among all men.
• Prostatecancer(20.8)Second among white, black, American Indian/Alaska Native, and Hispanic men. Fourth among Asian/Pacific Islander men.
• Colorectalcancer(18.1)Third among all men.
• LivercancerSecond among Asian/Pacific Islander men.
Source: U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2011 Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2014.
seniors. “The timely management of so-
cial media is critically important to the growth and success of healthcare,” said Print. “Bad patient reviews can come too easy, so making sure positive reviews greatly outnumber the negative ones is a constant challenge for all practices. Get-ting happy patients engaged with sharing their positive experience will continue to be important for a practice’s success.”
Online SourcesHalf of millennials and 52 percent
of Gen X-ers checked online informa-tion about their insurance options during their last enrollment period, compared to 25 percent of seniors, who prefer printed materials (48 percent) or a company rep-resentative (38 percent) before selecting their plan.
Good Faith, Upfront Estimates
One of five people surveyed by PNC listed unexpected/surprise bills as the No. 1 billing-related issue. With out-of-pocket costs on the rise, millennials are more in-clined (41 percent) to request and receive estimates before undergoing treatment. Only 18 percent of seniors and 21 percent of boomers reported asking for or receiv-ing information on costs upfront. Unfortu-nately, 34 percent noted the final bill was higher than the estimate; only 8 percent reported a bill lower than estimate.
“What we’ve found with our clients in the Southeast is that healthcare practices are now more motivated than before to improve the patient’s experience around billing, payment plans, and care and insur-ance coverage education due to the need to comply with healthcare reform require-ments and for the sake of improving the profitability of the practice,” added Print.
Kicking Care Down the RoadAll age groups agreed that medical
care is too expensive (79 percent), and healthcare costs are unpredictable (77 percent). But more than half of millenni-als (54 percent) and Gen-Xers (53 percent) reported delaying or avoiding treatment because of cost, compared to seniors (18 percent) and boomers (37 percent).
“What we’ve found locally,” added Print, “is that with many patients neglect-ing their care due to costs, practices are addressing this issue by offering free/low cost healthcare clinics, healthcare educa-tion, and automated patient payment pro-grams.”
PNC Healthcare is a member of The PNC Financial Services Group Inc. The survey was conducted by Shapiro+Raj in January.
n a s h v i l l e m e d i c a l n e w s . c o m JUNE 2015 > 11
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Let’s Give Them Something to Talk About!
Awards, Honors, AchievementsLast month, the Middle Tennessee
School of Anesthesia (MTSA) celebrat-ed the school’s second annual Mission & Awards Gala. Among the honorees were Mark Spencer, CRNA, APN, chief certified registered nurse anesthetist for Nashville-based Cardiovascular Anesthe-siologists, who won the Clinical Excel-lence Award, and Murfreesboro-based Adam MacDonald, CRNA, MS, APN, who won the Mission & Heritage Award.
Boyden & Youngblutt Advertis-ing and Marketing (B&Y), which has an office in Nashville, has been named a Judge’s Choice winner at the 2015 Aster Awards for their “Parkview GO” cam-paign for Parkview Health. In addition to the prestigious award, B&Y also won three accolades for their work for Biomet Orthopedics and Parkview Health.
Raymond James Investment Banking brought home a trio of awards during the M&A Advisor’s 7th annual awards gala including top honors in two ‘Deal of the Year’ categories.
Wishes GrantedA research team at Vanderbilt Uni-
versity Medical Center has been ap-proved for a $2.7 million funding award by the Patient-Centered Outcomes Research Institute (PCORI) to study id-iopathic subglottic stenosis (iSGS), a rare condition that inexplicably causes middle-aged women to struggle to breathe.
Neighborhood Health has re-ceived $495,000 in Affordable Care Act funding to develop a clinic in Lebanon, Tenn. to serve individuals and families in Wilson County.
Certifications & AccreditationsCenterstone, one of the nation’s
largest not-for-profit providers of com-munity-based mental health and ad-diction services, recently announced its integrated care program, Health Homes for adults, children and adoles-cents, has received accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF) Interna-tional. Currently, there are two accred-ited Health Homes in Nashville as well as a location in Clarksville and Madison.
Lumsdaine to Lead in Healthways Transition
Following last month’s departure of embattled Healthways president and CEO Ben Leedle, com-pany officials announced CFO Alfred Lumsdaine will serve as interim CEO while the board conducts a search for a permanent replacement. Leedle had led the company since the fall of 2003 when he took the reins from company founder Tom Cigarran.
LifePoint Names Young to Oversee Cardiovascular Services
Brentwood-based LifePoint Health recently announced John Young, MD, has joined the company as national medical direc-tor of cardiovascular ser-vices. He will oversee on-going efforts to improve quality, patient safety and clinical functions related to cardiovascular servic-es at LifePoint locations across the nation in this newly created position.
Previously, Young was the division chair for cardiovascular medicine at Ad-ena Health System in Chillicothe, Ohio. He also served as an adjunct professor at The Ohio State University Wexner Medical Center in Columbus and at Ohio University’s Heritage College of Osteopathic Medicine in Athens. Young earned his medical degree from Ohio State, where he also completed a residency in internal medicine, fellow-ships in cardiovascular medicine and critical care medicine, and an advanced fellowship in interventional cardiology. He also holds an MBA from the Fisher College of Business at Ohio State.
Munn Joins InfoWorks to Launch Healthcare Practice
Nashville-based management con-sulting company InfoWorks recently announced the addition of Rebecca Munn as vice president & managing director of Healthcare Services. Munn, a sea-soned professional with 24 years of experience leveraging technology to drive innovation, will lead the healthcare services practice of the company and oversee the firm’s health-care business development efforts.
Previously, she held leadership positions at other healthcare and tech-nology and consulting firms including Healthways and Cisco Systems. Munn received her undergraduate degree from the University of Texas and MBA from the University of Colorado. Active in the community, she serves on the board for Hands on Nashville and is a member of Women Business Leaders of the U.S. Health Care Industry Foun-dation, as well as Leadership Health Care.
Ohringer Joins Tennessee Retina as CAO
Linda Ohringer, MBA, MPH, MS-MOB, has accepted the position of chief administrative officer at Tennessee Reti-na, the largest retina practice in Middle Tennessee. Healthcare veteran Ohringer brings more than 30 years of industry expertise. She will oversee the manage-ment and operations of Tennessee Reti-na’s nine locations across Middle Tennes-see and Southern Kentucky.
Cash InfusionsSeveral area companies have had
recent success in raising capital to fur-ther their corporate missions and ex-pand services and research. NuSirt Bio-pharma, which helps those with chronic metabolic diseases, raised $6 million in Series C financing.
Online healthcare marketplace MDsave, co-founded by industry vet-eran Paul Ketchel, announced its first institutional investment of $12 mil-lion from New York-based MTS Health Investors. The web-based company, which allows consumers to compare the costs of healthcare services and in-cludes Sen. Bill Frist, MD, on its board, raised a total of $14.1 million in this round of financing.
Nashville-based Heritage Group recently secured $100 million in com-mitments to invest in a second fund focused on companies seeking to im-prove the delivery and efficiency of healthcare. The Heritage Group, led by Rock Morphis, David McClellan and Paul Wallace, launched its first Health-care Innovation Fund in 2011.
On the MoveAs has been widely publicized
in the Nashville media, Community Health Systems has announced a $66 million expansion facility in Antioch an-ticipated to bring more than 1,500 new employees to Davidson County. The 240,000-square-foot project is expect-ed to be completed in 2017.
LifePoint RebrandsLast month, officials with Brent-
wood-based LifePoint Hospitals® an-nounced the company is changing its name to LifePoint Health to reflect its evolution from a community hospital operator to a healthcare company ad-dressing comprehensive needs across the continuum of care. This change coincides with the company’s 16th an-niversary.
GrandRounds
Alfred Lumsdaine
Dr. John Young
Rebecca Munn
Rutledge & Partners form American Physician Partners
Last month healthcare veteran John Rutledge announced the for-mation of a new company, American Physician Partners, which will provide a full range of management services for the nation’s hospital EDs and hos-pitalist programs. Joining him in the Brentwood-based venture are Mark Green, president of AlignMD, and Sam Clemmons, president of Elite Emergency Service. Rutledge will serve as the new company’s president.
Pictured (L-R): John Rutledge, Sam Clemmons and Mark Green launch American Physician Partners.
It is an exciting time in the field of oncology, especially blood cancers, because we are discovering more effective treatment options for patients battling multiple myeloma.
Multiple myeloma is the third most common type of blood cancer in the U.S. The disease is more treatable now than ever before thanks to worldwide studies. According to the Multiple Myeloma Research Foundation, treatment options for the disease have increased significantly over the last 10 years. Survival rates have also improved. Multiple myeloma is becoming a chronic disease, and oral medications are playing a significant role in helping patients manage the disease.
The FDA recently approved panobinostat (Farydak—Novartis) in combination with bortezomib and dexamethasone for the treatment of patients with multiple myeloma. It is not a first-line therapy. Panobinostat is a HDAC (histone deacetylase) inhibitor, the first of its kind to be approved for multiple myeloma. The drug disrupts the life cycle of the disease by stopping the enzymes that cause the overgrowth of plasma cells, ultimately leading to cell death.
Panobinostat is taken orally and is a member of a new class of drugs, which is making a substantial impact in the fight against multiple myeloma, especially recurrent disease, when other options are limited and/or non-existent. It is a new weapon in the battle to eradicate multiple myeloma, and it looks promising for patients.
Tennessee Oncology is proud to deliver superior cancer care from our state’s large cities to small towns. Our extensive network and collaborative care approach ensure our patients battling multiple myeloma or any type of cancer have access to clinical expertise and advanced treatments and technologies no matter their location in Tennessee. Caring for cancer patients is a privilege.
PROMISING, NEW DRUG ADDED TO TREATMENT OPTIONS FOR MULTIPLE MYELOMA PATIENTSTENNESSEE ONCOLOGY’S stuart Spigel, M.D.
