The BMC Brief

March 9, 2012 Volume 1, Issue 20

• Strategic Plan, QUEST Goals Focus of Town Hall Meeting
• Leadership Corner: Scott O’Gorman, President, Boston Medical Center HealthNet Plan
• How Fast You Walk and Your Grip in Middle Age May Predict Dementia, Stroke Risk
• What Do You Do, Katie Langford?
• In Their Words
• News of Note
• Awards and Accolades

Strategic Plan, QUEST Goals Focus of Town Hall Meeting

On Feb. 29, BMC President and CEO Kate Walsh hosted Town Hall Meetings to update the BMC community on the hospital’s strategic plan and QUEST goals.

President and CEO Kate Walsh

Walsh opened with a refresher of the Be Exceptional Strategic Plan, reminding audiences at the 7:30 a.m., noon and 3:30 p.m. meetings that the bulk of the work for the next two years will focus on the theme, “Provide the Right Care for Every Patient. No Less … No More.”

“Providing the right care is the most important work we do,” Walsh said. “It’s our commitment to provide the care patients need in a way that is consistent with the care that you would want for your own family.”

The destination strategy of the plan is to “Lead in Integrated Health,” said Walsh.

“Our plan starts with the care of patients and ends with our ability to coordinate and manage the care of the entire population of patients that we uniquely serve.”

“Right care” work is underway in the areas of primary care, acute care and elective/specialty care, with a focus on access to that care, and continuous improvement in the quality of care BMC delivers. Many clinical areas are working with quality improvement specialists to achieve this goal, said Walsh. Enabling initiatives to support the work include creating a BMC ambulatory call center to conduct pre-appointment intake via phone before patients arrive and enhancing the patient experience one they get here.

Encouraging discussions are also happening with the state regarding the Medicaid waiver, where BMC stands to gain $103 million in each of the next three years. Unlike previous waivers, BMC now has to earn the funding based on its performance.

“The great news is the state recognizes that we need additional support to do the work that we do,” Walsh said. “Now we have to earn it through a series of projects that are consistent with the goals of our strategic plan. We need to demonstrate capabilities that will help us develop into a full integrated delivery system.” One example is initiatives to improve the quality of care. She noted that BMC’s new Solomont Clinical Simulation and Nursing Education Center, opening later this month, will allow staff to develop and refine skills to deliver the safest, highest quality care.

Walsh then provided an update on the FY12 QUEST goals, which were developed to reflect the priorities of the strategic plan.

1. QU: Quality
   • Improve performance on the University Health Systems Consortium (UHC) mortality observed/expect ratio to the median performance of UHC (0.97).
     BMC has been averaging 1.01. The December ratio was down to .75, which is encouraging, but it is too soon to know if it is a trend, said Walsh. Projects to improve performance include: improving coding, consistency of ICU night coverage, management of sepsis, monitoring post-op pulmonary care for surgical patients, and ongoing work to reduce Central Line and Urinary Catheter related infections.

   • Schedule 80 percent of new primary care patients to be seen within 14 days.

     The rolling three-month average as of January was 63 percent, although the January rate was 74.9 percent, up from 55 percent in the prior month. The shift resulted from adding additional providers and opening up more new appointments.

     Walsh noted that easy access for patients is a critical component of BMC’s volume growth strategy.

   • Improve the number of new patients seen in all other specialties combined within 14 days by an average of 10 percent.

     BMC saw improvements in January compared to the three-month average. There is significant work to do to achieve this goal this fiscal year, said Walsh, and the ambulatory redesign team is meeting with every department to map out an improvement plan. The good news is that outpatient volume is exceeding budgeted levels.

2. E: Efficiency
   
   • Hold spending to the budgeted amount of $810 million for the expense categories of wages, employee benefits, physician services, drugs, supplies and utilities.

     Through January, BMC performed better than budget. Walsh thanked everyone for their work on slowing BMC’s growth in expenses.

3. S: Satisfaction
   
   • Increase the commitment score on BMC’s Employee Engagement survey by 5 percent.

     Based on staff response on the Employee Engagement survey, Walsh said she and other members of the senior leadership team have undertaken weekly rounds, visiting worksites to answer questions and get feedback about BMC from staff. Other work includes:

     Huddle Card: Each week managers and directors share need-to-know hospital information in person with their staff.

     Management Development Program: This professional development program is offered by Human Resources to BMC's 250 managers.

     Town Hall Meetings: Meetings are now held quarterly by Walsh to inform the BMC community of important happenings.

     Employee Recognition Kits: Managers use kits to support and encourage employee performance on-the-spot.

     Digital Signage System: Ten flat screen monitors have been installed in lobbies and cafeterias to share information campus wide.

     Recognition Committee: The Committee plans hospital-wide events, like the Pumpkin Non-Carving Contest in October and the Martin Luther King, Jr. Day celebration in January.

   • Increase the percentage of patients who rate BMC a 9 or 10 on the “Overall Rating of Hospital” to 70 percent for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, as measured by Press Ganey.

     Walsh reported that for January, BMC was at 68 percent. “An area of focus for us going forward will be “Response to Complaints and Concerns,” she said.

     Walsh also noted that making each and every patient encounter a positive one is a top priority for BMC. “Our patients have a choice in where they receive their care and they vote with their feet,” she said.

4. T: Total Revenue
   
   • Achieve patient service revenue of $854 million

     Walsh said BMC is performing better than budget, due primarily to improvements in case mix and to outpatient and emergency visits running ahead of plan.

     “While we are doing better than goal, the results are in spite of a continued decline in inpatient volume, which is a concern,” she said. She noted that inpatient volume is declining citywide, but that BMC is seeing steeper declines than most other hospitals.

     Walsh said BMC is doing everything it can to attract patients, but will have to monitor volume levels carefully.

Visit the BMC intranet to learn more about the Be Exceptional Strategic Plan and QUEST goals.

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Leadership Corner: Scott O’Gorman, President, Boston Medical Center HealthNet Plan

Scott O'Gorman

Boston Medical Center HealthNet Plan (BMCHP) was founded in 1997 to help fulfill and expand the hospital’s mission to the underserved through a managed care organization (MCO). BMCHP serves more than 243,000 members in Massachusetts across three product lines: MassHealth (Medicaid), Commonwealth Care and commercial coverage (Employer Choice/Commonwealth Choice). It is the largest Medicaid plan in the state and earned the No. 3 ranking among Medicaid plans in the nation from the National Committee for Quality Assurance (NCQA) in its Medicaid Health Insurance Plan Rankings for 2011-2012. BMCHP employs a staff of 400 people at its Boston headquarters and regional offices in Springfield and New Bedford.

BMC Brief staff recently spoke with the health plan’s new President, Scott O’Gorman, who joined BMCHP as Chief Financial Officer in 2008 and served as interim Executive Director for several months before being named President in February. Prior to his association with BMCHP, O’Gorman held the position of CFO for Neighborhood Health Plan of Rhode Island, DentaQuest Ventures in Boston and Delta Dental Plan of Massachusetts.

What are some of the strengths of BMCHP?
One of our greatest strengths is the quality of our plan. BMCHP’s Medicaid plan was recently ranked No. 3 in the country by the NCQA, which is considered the gold standard in the industry and is a feather in our cap. Another strength is our people. Our staff has deep experience and dedication to our mission and members. BMCHP members have complex needs and those needs often go beyond the realm of health care. Our staff will do what it takes, for example, to help a disabled man who lives in a third floor apartment move to a first floor unit. We try to make a positive difference in our members’ lives. A third strength is our financial success. We are a robust, healthy plan, and that’s a plus for the BMC system overall.

What are the synergies between the health plan and BMC, i.e. what can BMCHP learn from BMC and vice versa?
I think the Plan can benefit from obtaining clinical data from BMC via electronic medical records. Clinical data will give us a level of detail we haven’t had before and we can merge it with our claims data to work together with BMC clinicians to better manage care for our members, particularly those with chronic or complex medical conditions, and to achieve the best possible outcomes.

In turn, I think the health plan can work with BMC to look at patients across a patient population. BMC has extensive experience caring for Medicaid patients and the health plan provides great coverage to this group, which includes about 190,000 members. We can think strategically with the hospital to approach the care of Medicaid and other low-income patients as a cohesive population.

BMCHP entered the commercial market for the first time in its 15-year history in November. Do you anticipate success in this market?
We entered the commercial market for two reasons. The first was as a strategic measure tied to changes coming in Massachusetts and the whole U.S. health care system. When new components of the federal Affordable Care Act go into effect in 2014, a number of our 40,000 members who are covered and whose premiums are partially or fully subsidized under Commonwealth Care will go to the commercial market under a health insurance exchange mandated by that federal law. Of course, other Commonwealth Care enrollees who are not currently in our health plan will also have access to BMCHP. We want to be the place for these people to land. The second reason was to take advantage of an opportunity for us to diversify. We are a great business, but we have previously only offered government-subsidized products, which is a difficult place to be.

When we entered the market, we expected modest growth, and so far, we have been right. We anticipate adding 1,000 members this year.

What are the strategic goals and objectives of the Plan for FY12?
We have three corporate goals. One goal is to improve a quality metric as defined by NCQA. We have consistently been in the 75 to 90th percentile on these measures, but we always aim to perform better and so we choose one metric to improve every year. This year it is to make sure our diabetic members get their LDL cholesterol screening. A second goal is to remain financially strong. We do not expect to have as strong a year as FY11 due to a 5 percent rate reduction from the state for MassHealth health care reimbursement, but we still expect to do well. Our third goal relates to our membership, and our target is to finish the year with several thousand more members across our entire plan, and several hundred more specifically in Boston, than were originally projected in our FY12 budget.

In addition to those FY12 corporate goals, BMCHP is working hard on other initiatives that tie to our longer term strategic goal of diversifying our product lines and expanding our managed care expertise. I'll give you two examples. One is that we have been pursuing a potential contract to manage care for Medicaid recipients in a neighboring state. We are in negotiations right now, so I can't identify the state. The other example is we are preparing to possibly seek a contract under a state and federal demonstration project for managing care for people ages 21 to 64 who are dually eligible for both Medicaid and Medicare.          

How do these goals and objectives align with BMC’s Be Exceptional Strategic Plan?
BMC aims to be a leader in integrated health care and BMCHP will play a key role in the system’s overall success. Implementation of the BMC strategic plan is just beginning, and while we have work to do together to determine the specifics, we know that the BMCHP and the community health centers are key components in achieving the Be Exceptional plan’s vision.

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How Fast You Walk and Your Grip in Middle Age May Predict Dementia, Stroke Risk

The everyday things you do now, like walking and holding something tightly, may help determine how likely it is you will develop dementia or be at risk for stroke as a middle-age person, according to BMC researchers.

“These are basic office tests which can provide insight into risk of dementia and stroke and can be easily performed by a neurologist or general practitioner,” says Erica Camargo, MD, MSc, PhD.

More than 2,400 men and women with an average age of 62 underwent tests for walking speed, hand grip strength and cognitive function. Brain scans were also performed. During the follow-up period of up to 11 years, 34 people developed dementia and 70 people had a stroke.

The study found people with a slower walking speed in middle age were one-and-a-half times more likely to develop dementia compared to people with faster walking speed. Stronger hand grip strength was associated with a 42 percent lower risk of stroke in people over age 65 compared to those with weaker hand grip strength. This was not the case, however, for people in the study under age 65.

“While frailty and lower physical performance in elderly people have been associated with an increased risk of dementia, we weren’t sure until now how it impacted people of middle age,” Camargo says.

Researchers also found that slower walking speed was associated with lower total cerebral brain volume and poorer performance on memory, language and decision-making tests. Stronger hand grip strength was associated with larger total cerebral brain volume as well as better performance on cognitive tests asking people to identify similarities among objects. Further research is needed to understand why this is happening and whether preclinical disease could cause slow walking and decreased strength.

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What Do You Do, Katie Langford?

Name: Katie Langford, CCLS
Title: Child Life Specialist
Department: Pediatrics
Years at BMC: 6

What brought you to BMC?
After graduating from Wheelock College in 2006, I began an internship on the BMC pediatric inpatient unit. That experience allowed me to further develop my newly acquired skills as a Child Life Specialist while getting to know the hospital environment and our patient population. I also trained with the Good Grief Program, where I learned about the best ways to increase the coping skills of children who have suffered from illness, experienced trauma or the death of a family member. Upon completion of my internship, I was offered a full-time position and have been here ever since.

What do you do?
My role is to normalize the hospital experience for children and their families. I help prepare patients emotionally for procedures and in some cases, stay with them throughout the procedures. Another important part of my job is to facilitate play with books and toys. This enables them to be kids for a minute, not just our patients.

What is unique about being a Child Life Specialist?
The diverse population at BMC makes being a Child Life Specialist very unique. I’ve had many opportunities to meet children and families from all around the world, many of them new to our country and here specifically for BMC’s medical care. I enjoy creating an environment for these families that’s not only developmentally appropriate but culturally sensitive too. The diversity at BMC also allows us to see and learn about illnesses that perhaps aren’t as common here in the US, making it an even more interesting place to be!

What is the most rewarding experience you’ve had here?
Developing relationships with our patients with chronic illness. Many of these children and teens spend a great deal of time in our hospital and I think being a familiar face and advocate for them makes the hospitalization experience a little less scary. I enjoy interacting with them and their families and having the opportunity to empower patients to take good care of themselves.

What’s your favorite BMC memory?
My favorite time of year to work here is during the holidays. For the month of December, Child Life organizes a toy drive donation in the pediatric outpatient clinic. Physicians give “holiday toy referrals” for the patients and families in need and each child referred receives three developmentally appropriate gifts. All of the gifts are donated and this past year we provided gifts to more than 170 families!

Do you know a staff member or department that should be profiled? Send your suggestions to communications@bmc.org.

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In Their Words

Patients share their BMC experience

Dear Dr. Grundfast,

I am writing to tell you about a pleasant experience I had with your staff during a recent appointment. I am a long-time patient of Dr. Thomas Barber and BMC. Recently Dr. Barber recommended that I speak with Dr. Scharukh Jalisi in regards to an issue I was having.

From the moment I arrived in the Otolaryngology Department I was treated with great care and consideration. The support staff went above and beyond in seeing that my needs were met. Then I was seen by Dr. Jalisi and his associate, Dr. Mike Cohen. Dr. Cohen is to be commended on his thoughtfulness and patience throughout my appointment. He addressed each and every one of my concerns. He did not rush the appointment, but rather really took the time that was needed for me to feel comfortable with the exam and the directions that he was giving me.

Dr. Cohen is an asset to Boston Medical Center and I will be happy to recommend him at any time to anyone who is in need of his expertise.

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News of Note

BMC/BUMC opens electric vehicle charging stations
BMC and Boston University Medical Campus (BUMC) opened two electric vehicle charging stations in February. BMC/BUMC is the first medical campus in Boston to launch charging stations, which are overseen by TranSComm. The fueling stations offer electricity for plug-in hybrid and electric vehicles, and can service two vehicles at a time for four-hour periods. The stations are located on the first level of the 710 Albany St. parking garage and are open to the public. Because of a grant secured by TranSComm, the electricity will be free for all registered employee parkers for two years.

“This is another great step forward in BMC’s commitment to sustainability,” says Maureen Lacey, Director, TranSComm.
Learn more about the electric vehicle charging stations.

Kelly named Director of Facilities Operations
Mike Kelly has joined BMC as Director of Facilities Operations. Kelly has a strong track record in hospital facilities and energy management and in this role will oversee the Maintenance department, Facilities trade staff, and the Room-a-Day program. Kelly previously served as Director of Facilities at UMass Memorial Health Care.

Findlay named Director of Design and Construction
Denise Findlay has accepted a new role as Director of Design and Construction. Findlay will focus on the planning and implementation of BMC’s real estate strategy in support of the Be Exceptional Strategic Plan.

O’Gorman named president of BMC HealthNet Plan
Scott O’Gorman has been named President of BMC HealthNet Plan (BMCHP) following a four- month nationwide search. O’Gorman joined BMCHP as Chief Financial Officer in 2008, and since last fall has served as the organization’s Interim Executive Director. Prior to joining BMCHP, O’Gorman held the position of CFO for Neighborhood Health Plan of Rhode Island, DentaQuest Ventures in Boston and Delta Dental Plan of Massachusetts. A graduate of Amherst College, he received an MBA from Boston College.

“Scott has demonstrated a strong financial acumen, clear strategic thinking and decisiveness. These qualities made him the consummate choice to lead BMCHP as an integral partner in Boston Medical Center’s strategic efforts,” says BMC President and CEO Kate Walsh. “This is especially crucial as our health care system moves deeper into an integrated delivery model where providers and health plans need to work closely together to achieve the best outcomes for patients.”

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Awards and Accolades

BMC was recognized recently by the New England Regional Black Nurses Association (NERBNA) for its support of the organization. BMC was presented with a plaque by the NERBNA at its 24th Excellence in Nursing Awards dinner at the Boston Marriott Copley Place. The plaque reads, “In appreciation to BMC for 20 years of support and dedication to NERBNA and the community.” The NERBNA celebrates its 40th anniversary this year.
Nurses pictured are: Jeanine Midy, RN; Jocelyn Lundi, RN; Jonell Johnson, RN; Kimberly Claude, RN; Cheryl Tull, RN; Jane Jansen, RN; and Sebra Barcuis, RN.

BMC has been designated a 2012 Tier 1 hospital by Harvard Pilgrim Health Care (HPHC). Under its ChoiceNet Plan, HPHC members pay different cost sharing amounts based on a provider’s assigned benefit tier. Tier 1 providers are rated the highest quality, lowest cost providers. BMC is the only Boston academic medical center in Tier 1.

“Patients are searching for more value for their dollar and BMC’s Tier 1 distinction means more patients will be made aware of the quality of care we deliver and be attracted to our facility,” says Joe Camillus, Senior Director, Business Development. “Over the next year, we expect to see more HPHC patients choosing us for both primary and elective specialty care.”

Thea James, MD, Director, Violence Intervention Advocacy Program, served as an honorary captain at the Basketball for Peace Tournament Feb. 23. The tournament attracts kids, teens and families from across the city for a day of healthy fun with prosecutors, victim advocates, civilian investigators and others from Suffolk County District Attorney Daniel Conley’s office. More than 100 youth, staff, community partners, neighbors and friends participated in the event. James, along with five other captains, received an award recognizing her as a role model for youth.