The BMC Brief

April 12, 2012 Volume 1, Issue 22

• BMC Forms New Partnerships with Blue Cross Blue Shield, Harvard Pilgrim
• New Support Center Enhances Efficiency, Coordination of Care
• Nurse, Long-Time Smoker, Quits
• What Do You Do, Nathan Stanford?
• In Their Words
• News of Note
• Awards and Accolades

BMC Forms New Partnerships with Blue Cross Blue Shield, Harvard Pilgrim

As part of the Be Exceptional Strategic Plan, BMC is working to become the preferred provider in target commercial markets. Work to accomplish this has started, with BMC recently signing a key contract with Blue Cross Blue Shield of Massachusetts (BCBSMA) and being selected to participate in a new Harvard Pilgrim Health Care (HPHC) focused provider network.

Raj Krishnamurthy, MD

Through this strategy, BMC plans to leverage its high quality, low cost position in the Boston market to attract new patients who are becoming increasingly value conscious.

BMC and seven community health centers (Codman Square, Dorchester House, East Boston, Greater Roslindale Medical & Dental Center, South Boston, South End, and Upham's Corner) signed a new five-year contract in March with BCBSMA called the Alternate Quality Contract (AQC). Under this contract, BMC and the health centers will manage the care of approximately 15,000 patients within a set budget. If they stay within budget and meet quality metrics such as low surgical infection rates for inpatients and good diabetes management and cancer screenings for ambulatory patients, the hospital and health centers will receive significant performance incentives from BCBSMA. If they are unable to hit these targets, they must pay BCBSMA for a portion of the additional cost of care.

BMC and the health centers are partners in meeting the full spectrum of patients’ health needs, and the innovative structure of the new contract strengthens their ability to coordinate care and improve patient outcomes.

The AQC contract is an example of how BMC is preparing to move toward becoming an accountable care organization (ACO), a new health-care model focused on lowering costs and improving care. According to Raj Krishnamurthy, MD, Vice Chair, Outpatient Medicine, ACOs are the wave of the future. Krishnamurthy is also the Medical Director of BMC’s management services organization, the administrative unit that oversees all managed care contracting for the organization.

“To be a good ACO, an organization needs to develop skills around management of a population of patients,” says Krishnamurthy. “We need to transform our practice into one that is highly efficient and delivers exceptional quality.”

The first step toward becoming an ACO is building a strong infrastructure to support it, says Krishnamurthy.

“We need to code our services accurately to ensure we are managing the total patient budget efficiently,” she says, noting that Information Technology Services and Finance are currently working to improve the coding and billing process.

Quality and coordination of care also are essential, with BMC keeping patients within the system and providing the right care to them at all times.

“Our quality has to be as good as possible and we need to make sure we keep patients in our system by making sure they get their referral care here,” says Krishnamurthy. “We will do this through timely access to care, including specialty care, and giving patients an outstanding customer service experience.”

BMC’s new Patient Support Center (see story below) supports this work. A team of 31 patient care assistants schedules adult primary care and Women’s Health group patients via phone, working toward the QUEST goal to schedule 80 percent of new primary care patients within 14 days.

“Our primary care services at BMC, health centers and affiliated practices in Boston, Norwood, Taunton and Foxboro are an important foundation for the entire organization to coordinate care delivery,” says Krishnamurthy.

Coordination of care will be achieved by aligning primary care with other areas, such as mental health services and diabetes management where appropriate.

“We need to develop a new proactive approach,” says Krishnamurthy. “Now when patients leave the Emergency Department, we will follow up with a call to see how they are doing and if we need to schedule them for follow-up care. By doing this, we are providing more effective care and giving the patient a true sense that we are a medical home that cares for them. We are truly focusing on the patient experience.”

While there is lots of work ahead, Krishnamurthy says BMC is uniquely positioned to succeed.

“BMC has always had a holistic approach to care delivery,” she says. “Because of the needs of our patient population, we have always been very cost and value conscious about what we do. I think we are positioned to do well at this.”

In addition to the ACQ contract, BMC also recently forged two relationships with HPHC to offer its high quality, low cost care to a new market.

BMC is now part of HPHC’s “focused network.” As a member of this network, BMC has agreed to meet cost and quality standards as determined by HPHC. The benefit of doing so is attracting new Massachusetts employers and their workers as patients to BMC who in turn will receive a 10-percent savings on health insurance for using this network.

HPHC also has designated BMC as 2012 Tier 1 hospital under its ChoiceNet Plan. Members of that plan 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 us,” says Joe Camillis, Senior Director, Business Development. “Over the next year, we expect to see more HPCH patients choosing BMC for both primary and elective specialty care.”

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New Support Center Enhances Efficiency, Coordination of Care

“Welcome to Adult Primary Care and Women’s Health Group. Thank you for choosing us for your care. How may I help you?”

Rosemaine Lamothe, a PCA in the Patient Care Support Center

This is the friendly welcome patients hear when they call BMC’s new Patient Care Support Center. Located on the fifth floor of the Doctors Office Building (DOB), the Center handles scheduling and other care-related issues for 30,000 primary care and Women’s Health patients who are seen by 96 residents, and 35 physicians and nurse practitioners. The Center is staffed by 31 multilingual patient care assistants (PCAs) who schedule and remind patients of upcoming appointments, and triage issues to a team of three dedicated Support Center nurses. Every call is recorded in an online system and PCAs document all patient activity in Logician, BMC’s electronic medical record system, for providers. Since its opening Feb. 28, the Center has averaged 1,300 calls a day.

“Our goal is to answer 80 percent of the calls in 30 seconds or less,” says Jennifer Furlonge, Administrative Director, Adult Primary Care Practice Support Center. “In our first month, we answered more than 28,000 calls in this time frame, giving us a 94 percent answer rate. We are extremely proud of that number.”

Furlonge notes that the center aims to have an abandonment, or un-answered, call rate of less than 5 percent, a metric the Center also met last month.

The numbers are even more impressive considering that a month ago only 12 patient care assistants knew BMC’s systems. The remaining staff was recruited and trained on the systems within a few weeks. The full group then underwent a two-hour customer service training, where PCAs role played to improve their listening skills and refine their tone of voice, a key component of delivering excellent customer service and enhancing the patient care experience, says Furlonge.

“We want our patients to hang up after speaking with us and say, ‘Wow, what a great experience.’ So far we’ve received more than a dozen calls from patients calling us back to say, ‘This person really listened to me and met my needs. She was excellent, thank you.’”

Furlonge says the Center has yet to receive any complaints from patients.

Raj Krishnamurthy, MD, Vice Chair, Outpatient Medicine, says the Center holds great potential for the future.

Jennifer Furlonge oversees the Center

“Our goal is to move to chronic disease management,” she says. “The Center can become a tool to help with the quality of care we deliver and the management of patient cases.” She gives the example of reminding a diabetic patient to bring his medications, blood sugar meter and prescription refills to his next appointment. Or proactive outreach, such as a PCA calling a Women’s Health patient to remind her she is due for a mammography within the next six months and offering to schedule her appointment.

“We can use the Center to help manage the care of a patient population, which is exactly where BMC wants to be,” she says. “It will help us to deliver the right care to patients while becoming a leader in integrative care.”

The Patient Care Support Center is open seven days a week, 7 a.m.- 7 p.m. weekdays and 8 a.m.- 4:30 p.m. Saturday and Sunday.

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Nurse, Long-Time Smoker, Quits

David Gallant, RN, is a nine-year member of the BMC community and a new member of the smoke-free community. An Operating Room (OR) nurse in the Menino Pavilion, Gallant quit his pack-a-day habit Jan. 20, using the nicotine patch to jump start his new life free of cigarettes.

David Gallant, RN

He started smoking in the fourth grade thinking he would be cool and look like a tough guy. He smoked intermittently until he joined the Navy at 17 when he became a heavy smoker. “I haven’t really tried to quit for over 20 years,” says Gallant. “I kept putting it off and putting it off and when I heard BMC is going smoke free it was one of the things that helped me to start thinking about it again. Also, my wife, who quit smoking years ago, and my kids have been pushing me to quit. I also had been thinking that I would quit when I turned 50 which happened in November.”

Gallant swears by the nicotine patch as helping with his physical addiction to cigarettes but feels the psychological and social triggers were not as strong for him. He can still have his cup of coffee in the morning and even has attended a party and was able to stay smoke free. He did a six-week course of the patch gradually reducing his nicotine intake.

“Try what works for you,” he recommends when asked for advice to those wanting to quit smoking. “I know Chantrix [a smoking cessation aid], has worked for some people, but because I am a diabetic and it can raise your sugar level, I chose the patch. I knew I couldn’t go cold turkey the way my wife did.”

Gallant was a hospital corpsman while in the Navy and has been a nurse since 1995. He was working in the OR at Anna Jacques Hospital in Newburyport, but wanted more trauma experience.

“Every trauma that got picked up from the helicopter pad in Newburyport usually came to BMC,” he says. “When my nurse manager came here, I saw it as an opportunity to come to BMC and get that experience.” He currently circulates in the OR and scrubs in on trauma, general surgery and orthopedic cases.

Gallant lives in a smoke-free environment at home and after April 16 will have that same experience at work. “I have come this far and I don’t think I am ever going back.”

BMC and the Boston University Medical Campus go smoke free, inside and out, April 16. Learn more on the intranet and at www.bmc.org/smokefree.

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What Do You Do, Nathan Stanford?

Name: Nathan Stanford
Title: General Services Associate (GSA)
Department: Environmental Services
Years at BMC: 23

Nathan Stanford

What brought you to BMC?
Before coming to BMC I was working in construction/demolition, got injured on the job, and needed to go to the hospital. I didn’t have health insurance at the time and it was then that I knew I needed a job with more security. My aunt worked in housekeeping at BMC and she set me up with an interview. That was 23 years ago. I’ve been here in Environmental Services ever since.

What do you do here?
Every day brings something different. I am never in one place in the hospital. In Environmental Services we do everything from housekeeping, cleaning carpets, stripping floors and removing trash to power machine operating. Like the doctors and nurses we work with, we have to care for the patients first and keep the facilities the safest and in the best possible condition.

How is your department making BMC a healthier environment? Do you have any tips for people who want to be more sustainable?
The chemicals we use for cleaning have improved over time. Now we use milder chemicals in our cleaning products, such as floor wash, so the smell won’t distract or harm anyone. We’ve also adopted more efficient equipment for vacuuming and buffing floors. In addition to what we’re doing in our department, I encourage people to use the many recycling bins around the hospital and on campus to be more environmentally conscious.

What do you like about working here?
When I started here it was like a family and it still is after 23 years. The people I work with are so genuine – we eat together, help each other and we even come into work early just to talk before our shifts begin. I’ve made real friends here, of all different ages and backgrounds, and I still keep in touch with everyone I’ve worked with over the years. I also enjoy the diverse population and all the different people I meet on a daily basis.

How does your job fit into BMC's mission to provide “exceptional care without exception?”
To provide “exceptional care without exception” teamwork is necessary and our team is great. Communication is important with any team, especially when working with doctors and nurses, because everyone’s job boils down to doing what is best for the patients. Without team work and communication we could not function, so I take pride in doing the best I can at my job so others can do theirs.

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

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In Their Words

Patients share their BMC experience

I am a surgeon in private practice in Baltimore. I recently underwent surgery at Boston Medical Center and was admitted to 8W. The surgery that I had is usually associated with severe pain. In fact, Dr. Munarriz told me that the surgery that I had is associated with more pain and discomfort than many other urologic procedures. In the postoperative period, I became very, very sick.

The nurses, lab technician, X-ray technician and residents who worked with me were very nice and professional. There were two individuals in particular who retained my attention.

Bernadine O’Donnell and Michelle Trojano are excellent nurses who went beyond the call of duty to help me in my difficult moments. They are dedicated to the care and sensitive to the suffering of their patients. Those two nurses in my view represent an important asset for Boston Medical Center. They certainly represent a magnet which will draw patients like me from other states to Boston Medical.

I had a great and positive experience at Boston Medical Center.

Baltimore, Maryland

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News of Note

Boston Medical Center HealthNet Plan in final review for New Hampshire Medicaid contract
Boston Medical Center HealthNet Plan (BMCHP) is one of the managed care organizations now under final review for a contract with the New Hampshire Department of Health and Human Services. The contract is conditional upon approval from the Governor and Executive Council and approval from the Centers for Medicare and Medicaid Services.

BMCHP is partnering with Harvard Pilgrim Health Care to bring New Hampshire Medicaid members a robust, statewide network of acute care hospitals, primary care providers and specialists. Like many states, New Hampshire is shifting its Medicaid program from fee for service to a model in which selected managed care organizations will be responsible for handling care and coverage for approximately 115,000 Medicaid members. Among the companies submitting bids, BMCHP was the top scorer on the technical portion of the bid, earning 70 out of 70 possible points. New Hampshire’s Medicaid care management program is targeted to begin July 1.

BMC celebrates Donate Life Month
April is National Donate Life Month. The month was created to raise awareness about the critical need for organ and tissue donation and to inspire people to register to donate life to those in need of a transplant. As a partner in the Donate Life New England Hospital Campaign, BMC held a Donate Life flag raising ceremony April 3 on the Moakley Green. The flag raising was hosted by BMC’s Cancer Care Center and recognized the generosity and commitment of donors and their families, the gratitude of recipients of organs and tissues and the hard work and commitment of BMC’s faculty and staff who support patients every day.

Mohammad Eslami, MD, FAC

Mohammad Eslami joins BMC
Mohammad Eslami, MD, FAC, has joined BMC’s Section of Vascular and Endovascular Surgery. Eslami is also an Associate Professor of Surgery and Radiology at Boston University School of Medicine and Associate Program Director of the Vascular Surgery Fellowship Program. Eslami attended college at SUNY at Stony Brook and Harvard Medical School. He completed his general surgery training at the University of Chicago Hospitals and Brigham and Women’s Hospital. He trained in vascular surgery at Stony Brook University Hospital in New York. In addition, Eslami has completed research fellowships in thoracic and vascular surgery at Brigham and Women’s Hospital.

Eslami is board certified in vascular surgery, is a fellow of the American College of Surgeons, and is a member of the Society for Vascular Surgery, the New England Society of Vascular Surgery, and the American Registry of Diagnostic Medical Sonography (ARDMS).

BMC hosts Cancer Screening and Education Day
BMC held its 17th cancer screening and education event March 31. More than 200 people, including BMC employees, Boston University School of Medicine medical students, Massachusetts College of Pharmacy and Allied Health Services and nursing students from nine colleges and universities, staffed the event that attracted more than 130 people from Boston and the surrounding area. Participants received examinations by BMC's top specialists, including surgeons, medical oncologists, dermatologists, endocrinologist, primary care doctors and nurse practitioners, as well as one-on-one time with oncology nurses and nutritionists. Screenings were conducted for cancers of the head and neck, thyroid, breast and skin, as well as for hypertension. Participants also had the opportunity to learn about the signs and symptoms of women’s cancers and meet with BMC expert physicians. Staff provided education and literature on colon cancer risks, benefits of colonoscopy, BMC’s HealthNet Plan, smoking cessation and more.

NEIDL begins conducting Level 2 research
Boston University researchers are moving into the National Emerging Infectious Diseases Laboratories (NEIDL) on the BU Medical Campus and will begin conducting basic science research (BSL-2 research). They will conduct Tuberculosis (TB) research that has been approved for the BSL-2 laboratories. The funding for these BSL-2 research grants totals more than $4.5 million; 15 researchers have been hired to work on these projects.

“We are pleased that BSL-2 research is starting in the NEIDL. It is noteworthy that these researchers will be conducting important public health research on a disease that affects nearly one-third of the world’s population,” says John Murphy, PhD, NEIDL Interim Director.

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Awards and Accolades

Jane Liebschutz, MD, Primary Care, has been honored as the 2012 Community Clinician of the Year by her physician peers of the Suffolk District Medical Society. The Community Clinician of the Year Award was established in 1998 by the Massachusetts Medical Society to recognize a physician from each of the Society’s 20 districts who has made significant contributions to his or her patients and the community, and who stands out as a leading advocate and caregiver. The Suffolk District comprises nearly 4,000 physicians who live and work in Boston and adjacent communities.

Liebschutz specializes in addiction, chronic pain and post-traumatic stress disorder. In nominating her for the award, her colleagues described her as a physician whose “care for patients goes beyond the walls of the examination room, as she makes home visits to patients with terminal cancer, works with legal services to help patients caught in complicated legal and social scenarios, and advocates for patients dealing with domestic violence. She has unusually close and caring relationships with her patients, many of whom travel to remain with her even after moving far away.”

BMC has received an Outstanding Achievement Award from the Commission on Cancer (CoC) of the American College of Surgeons. BMC is a member of a select group of 106 currently accredited and newly accredited cancer programs across the United States, and one of four hospitals in Massachusetts to receive the award.

The award recognizes cancer programs that strive for excellence in providing quality care to cancer patients. Learn more about the award: http://www.facs.org/cancer/cannews.html.

BMC and Boston University Medical Campus (BUMC) recently were awarded the Excellence in Commuter Options (ECO) award from the Massachusetts Department of Transportation (DOT). DOT awarded TranSComm the Pinnacle Award, the highest level of recognition given, for its efforts to reduce greenhouse gas emissions through decreased drive-alone trips while encouraging employees to travel to work by transit, carpools, vanpools, bicycling or walking.

“We are proud of the efforts of BUMC and BMC employees. We at TranSComm will continue to work on creating and supporting programs that provide our employees with sustainable transportation options,” said Maureen Lacey, TranSComm director.