A health care community successfully blending collaboration and innovation
Nashville’s health care industry has grown exponentially over the last few years by doing business locally, nationally and globally and establishing a reputation for innovation.
The Nashville area boasts more than 250 health care companies, of which more than 56 are corporate headquarters and 16 are publicly traded. In addition, more than 300 professional service firms lend their expertise to Nashville’s health care industry.
“It starts with the unique culture we have in Nashville,” said Wayne Smith, chairman of the board, president and chief executive officer of Community Health Systems, an operator of general acute care hospitals with 135 affiliated hospitals in 29 states. Smith is also the current chairman of the Nashville Area Chamber of Commerce.
“Companies here have an interest in helping other companies develop,” Smith said. “It’s not that we’re not competitive; we are. But, the companies here are collegial, and we collaborate to improve and grow our industry as a whole. That benefits
“As a community, we must work together to find ways to prevent illness and keep people healthier. We must also find ways to boost efficiency and improve patient outcomes across the board.” BILL CARPENTER Chairman and CEO LifePoint Hospitals®
everyone – our business, our employees, the communities we serve around the country.”
Combining many large and established companies with innovative startups, Nashville has a history of health care management that goes back five decades, said Bill Carpenter, chairman and chief executive officer of LifePoint Hospitals
,a hospital company operating 56 hospital campuses in 18 states.
“We have a legacy and an amazing collection of health care companies in hospital management, health information technology, disease management, life sciences and many other sectors,” Carpenter said. “We have a deep bench of talent and a broad network of advisors that can support companies of all sizes.”
For nearly 20 years, the Nashville Health Care Council has been the catalyst for collaboration and champion of the entrepreneurial spirit that characterizes the Nashville health care community.
“The Council brings us together to consider industry-wide issues and opportunities,” Smith said. “We can talk about the things that matter to all of us and work toward common goals.”
Carpenter said the need for collaboration and innovation will increase in the coming years.
“We are in a period of change and uncertainty in health care,” Carpenter said. “Health reform is leading most of this
change and driving a new focus on improving quality of care and reducing costs. As a community, we must work together to find ways to prevent illness and keep people healthier. We must also find ways to boost efficiency and improve patient outcomes across the board.” “These are exciting times,” Carpenter added. Nashville’s health care industry is one of the most diverse sector clusters in the nation. In addition to traditional provider organizations, such as hospital companies and ambulatory groups, Nashville is home to insurers, technology, care management companies and a variety of support and entrepreneurial ventures.
“In Nashville, and thanks in part to the leadership provided by the Nashville Health Care Council, a unique collaborative spirit exists,” said Richard M. Bracken, chairman and chief executive officer of HCA. “There is a progressive and responsible recognition that a diversity of organizations will be essential for the continued positive growth and efficiency of the health care industry.”
Two highly-respected academic health science centers anchor Nashville’s health care industry: Meharry Medical College and Vanderbilt University Medical Center, known for their tertiary care clinical services and research.
Dr. Wayne J. Riley, president and chief executive officer at Meharry Medical College, believes health care for everyone in the United States is destined to improve.
Founded in 1876, Meharry is well-known for training African American physicians, dentists, biomedical scientists, health care administrators and health policy experts. It is also the nation’s largest private, independent historically black academic health center dedicated to educating minority and other health professionals.
“I envision a health care system that will continue to evolve for the better – first by focusing on ensuring access for everyone who needs health care services and then, by continuing to find better ways to deliver evidenced-based care efficiently and effectively,” Riley said. “We know that prevention is key to good health, so I would envision a future where more and more of us take advantage of practices that we know work toward good health, such as eating a well balanced diet, exercising, minimizing stress, avoiding tobacco use to name a few.”
Innovation often begins with university research, and the Vanderbilt University Center for Technology and Commercialization has found a way to take innovative research from the university and prepare the resulting intellectual property for the marketplace.
Vanderbilt’s Center for Technology also works with local and regional entrepreneurs, investors, executives and other business leaders to advance technologies in sectors such as broad drug delivery, health care management and other information technology systems, said Assistant Vice Chancellor Alan Bentley.
“Health care innovation nationally is probably the single most important element contributing to reducing health care expense and improving patient care,” Bentley said.
Right now, the Center for Technology is working with investors to position some of its medical center information systems for broad commercialization. For one project, the center has engaged a local entrepreneur to create a company to deliver a nanosponge drug delivery system developed in the Vanderbilt Department of Chemistry by Dr. Eva Harth and colleagues.
Bentley said he anticipates similar partnerships between Vanderbilt researchers and the Nashville area health care community will be commonplace in the coming years.
“The Vanderbilt research community is such an innovative bunch, there are numerous opportunities to partner locally to develop high impact health care products,” Bentley said
And, once those innovations become business models, Nashville community groups like the Entrepreneur Center and the Nashville Capital Network are in place to nurture startups into successful ventures.
“Nashville is home to a number of new and longtime entrepreneurs in health care. At the Entrepreneur Center, we connect these innovators with critical resources to accelerate business creation and growth. We are the ‘front door’ of Nashville for all types of entrepreneurs, creating both a physical and virtual place for providing resources, making connections, seeking advice and launching a business,” said Michael Burcham, president and chief executive officer of the The Entrepreneur Center.
“Nashville is home to a number of new and longtime entrepreneurs in health care. At the Entrepreneur Center, we connect these innovators with critical resources to accelerate business creation and growth. We are the ‘front door’ of Nashville for all types of entrepreneurs, creating both a physical and virtual place for providing resources, making connections, seeking advice and launching a business.” Michael Burcham President and CEO The Entrepreneur Center
Tackling community issues
Support from leaders in the Nashville health care industry gives the Council the clout it needs to tackle big issues in the community, exemplified in the Council’s role in an award-winning project by Nashville Public Television.
As Nashville’s business community has thrived, the health of its children has not. The city ranked 48th in the nation for children’s health—from obesity to infant mortality—and the state overall didn’t fare much better. In 2009, Nashville Public Television spearheaded a partnership among Nashville health care organizations and community partners to confront the crippling effects of poor childhood health in the region.
The Council was on board immediately, said Beth Curley, president and chief executive officer of Nashville Public Television. Council member Healthways, the largest independent global provider of well-being improvement solutions, was also an initial key supporter. The Council and its members continued to play a major role, building and participating in a coalition that brought the project to fruition.
Titled “Children’s Health Crisis,” the project’s first phase
consisted of seven documentaries aired over three years. Each episode examined a different issue, from childhood obesity to mental health to adolescent sexuality.
Other elements of the project included 18 health spots for children and parents during daytime children’s television programming, as well as 81 health update spots during prime time. It featured call-in programs, weekly on-air reports and an extensive website.
“We’ve documented great success with innovative initiatives that support the doctor-patient relationship and better align health care resources.” HERB FRITCH President HealthSpring
The project lived off the air, too. Information was distributed to area schools, community centers and health-care providers with translations in four languages other than English. Nashville Public Television held a series of Family Health Nights at Nashville schools. In 2011, more than 550 families attended literacy and nutrition workshops involving games and healthy food.
Throughout the process the Council assisted with the project by providing input on content, identifying health care experts and assisting with staging events, said Daniel Tidwell, vice president of development and marketing for Nashville Public Television.
“They have really been one of our most active and involved partners,” Tidwell said. “They have done a great job in helping us get the word out about it and helping us connect with the health care community.”
The series won the 2011 Midsouth Regional Emmy Award for Community Service. In 2010 it won two Emmy Awards in 2010 for best topical documentary and best public affairs documentary. Other awards include the 2011 American Academy of Pediatrics Friend of Children Award, 2011 and 2012 Tennessee Commission on Children & Youth Making KIDS COUNT Media Award and 2010 National Educational Telecommunications Association awards for best long-lead promo and Science/Nature documentary.
Addressing important local issues with a combination of television programming and other outreach is generating buzz among station managers and producers in the public television community.
“It’s on the radar screen,” Curley said. “People are talking about it at a number of other stations and trying to figure out what they can do.”
But the best news, said Council President Caroline Young, is the impact on children’s health. Tennessee now ranks 39th in child well-being. “All of these efforts are slowly, but steadily moving the needle,” Young said. “More Nashvillians understand the need to create a culture of health and wellness.”
Instilling positive lifelong health habits in kids is the only way to truly change overall health in the United States, said Council member Scott McQuigg, chief executive officer of HealthTeacher, which provides a comprehensive online health education curriculum used in public schools, after-school and home school programs in the United States and internationally.
“Our country desperately needs consumers to take more responsibility for their health,” McQuigg said. “The costs of poor health choices among adults are becoming insurmountable.”
“Successfully teaching young people the intrinsic value of health today will provide a generational shift in health and well-being that will pay dividends for our communities and country tomorrow,” McQuigg added.
Aging population influx
Industry leaders are also focusing on Nashville and the nation’s aging population, which will continue to need a higher level of health care.
“The rising number of seniors is a global trend and not limited to the aging of the baby boomer generation in the United States,” said Herb Fritch, president of HealthSpring, a health plan delivering quality health care, primarily through Medicare Advantage and other Medicare and Medicaid products.
“Advances in science, technology and medicine mean people today are living longer,” Fritch said. “However, as we age we become more susceptible to chronic illnesses like high blood pressure, diabetes, and heart disease.”
HealthSpring works with physicians and patients to develop personalized care plans that combine regular medical care with preventative services and disease management. The approach has resulted in an average 80-90 percent compliance with evidence-based medicine practices compared to a national average of 40-50 percent, Fritch said.
“We’ve documented great success with innovative initiatives that support the doctor-patient relationship and better align health care resources,” Fritch said.
Fritch maintains that pioneering new programs and strengthening existing ones focused on delivering better health outcomes, reduced costs and higher patient satisfaction is vital for keeping seniors healthy in a future with a larger number of older Americans are expected to celebrate their 100th birthday.
When the situation calls for acute care follow up, skilled nursing and home health provide the most cost efficient settings for the majority of cases, said Steve Flatt, president, National HealthCare Corp., one of the nation’s oldest long-term health care companies, operating 130 health care facilities in 11 states.
“As we move to a world of bundled payments and capitated payment for the care of defined populations, we want to be positioned to work with physicians and hospitals to meet the clinical and financial targets for effective, quality care of an aging population,” Flatt said.
An increase in the U.S. elderly population combined with an influx of Medicaid patients due to the passing of the Accountable Care Act means managing the revenue cycle is going to be more important than ever, said Scott Mertie, president of Kraft Healthcare Consulting, an affiliate of Kraft CPAs which is one of the largest independent certified public accounting firms in Middle Tennessee. His practice specializes in all aspects of reimbursement and compliance related to Medicare and Medicaid.
“Providers already struggle with Medicare and Medicaid rates, as well as an increase in compliance,” Mertie said. New health care laws will not likely alleviate that struggle, he added.
“They are going to have to learn to operate their organizations by managing patient care with lower reimbursement rates while caring for more patients.”
Mertie said the best way he can assist his clients is make sure they’re informed about regulations that affect them directly, as well as indirectly over the long term.
Technological advances such as the MISTY™ care management platform for health care providers, payers and caregivers will help patients with chronic conditions, many who are older, said Scotte Hudsmith, president and chief executive officer of Parental Health, which developed and delivers MISTY™.
Established in 2009, Parental Health set out to design a program specifically to support Medicaid and Medicaid Advantage. Being part of the Council was a help in getting his new concept off the ground, Hudsmith said.
“Starting Parental Health in this community has allowed us to tap into a vast knowledge base of how care is provided to patients with chronic conditions,” he said.
Because the same population is responsible for most of Medicare and Medicaid spending, efficiently managing their complex care is paramount. The Centers for Medicare and Medicare Services states that its primary objective is to improve access, outcomes and quality while reducing cost.
“Approximately 5 percent of the members in Medicare and Medicaid consume the majority of the cost,” Hudsmith said. “If a plan can manage those costs proactively, the system overall can save an enormous amount of money, while improve access and quality of care. “
“Physician executives and CMOs should be at the forefront and integrally involved with nonphysician leaders of most organizations that will excel in the future.” LYNN MASSENGALE, MD Executive Chairman TeamHealth
Technology in numbers
Increasing numbers in the aging population is just one of many impending changes related to health care delivery in the United States.
Thanks to health care reform, health systems will also see an increase in the insured population, as well as more participants in indigent care programs nationwide, said George Lazenby, chief executive officer, of Emdeon, the largest health care financial and clinical network in the nation – connecting 1,200 payers, 500,000 providers, 5,000 hospitals, 81,000 dentists and 60,000 pharmacies – and processing more than six billion health care information exchanges per year.
“The one thing that is clear about the future of health care is that we have to improve our efficiency to reduce the costs of our health care system,” Lazenby said.
That is where technological improvements associated with delivering data and exchanging information come into play.
“Any improvements that lead to higher levels of efficiency will be achieved by the increased availability of relevant data for decisions within the workflow,” Lazenby said. “Technology will clearly play a significant role in this going forward.”
Investment in new care models, especially health care information technology will accelerate as health care companies align their processes with the requirements of health care reform, said Claire Miley, a health care regulatory lawyer and member at Bass, Berry & Sims PLC, which represents 16 public health care companies, more than 150 health carerelated businesses and is one of the 10 largest health law firms in the United States.
“Health care technology, especially health information technology, is the underpinning of the new coordinated care models created by health reform,” Miley said.
In addition to the changes brought on by health care reform, hospitals and other health care providers face Medicare reimbursement costs beginning in 2012 if they fail to invest in health care technology that complies with government mandates for “meaningful use,” Miley added.
Centers for Medicare and Medicare Services defines meaningful use as the application of certified electronic health records technology in ways that can be measured significantly in quality and in quantity.
Doing business in the birthplace of for-profit health care and working with some of the world’s most sophisticated health care companies, Miley said she expects to participate on the cutting edge of industry innovation in the area of health care technology.
Executive physicians at forefront
New federal regulations, evolving demographic differences and changes in social populations will contribute to the increasing importance of the chief medical officer and executive physician in the coming years.
As executive chairman at TeamHealth, one of the largest providers of outsourced physician and clinical staffing solutions for hospitals in the United States, Dr. Lynn Massingale said the company is focused on initiatives that improve quality in a measurable way, reduce unnecessary costs and enhance the patient experience in emergency services, hospital programs, anesthesia and urgent care.
Whether it’s a chief medical officer focused on clinical issues or a physician executive with broader executive management duties, physician leaders will need to develop requisite skills beyond their medical credentials to be effective as high-level corporate executives, Massingale said.
Kim Harvey Looney, a health care regulatory practice leader at Waller, a national law firm, shared, “The increased emphasis on quality will require the physician/CMO to be more proactive. While quality standards are not new, the physician/ CMO will be spending more time making sure that new quality metrics are in place before there is a problem. The importance of taking a proactive approach is underscored by developments such as the Hospitals Readmissions Reduction Program which will reduce Medicare payments for hospitals viewed as having excess patient readmissions as well a recent patient care measures endorsed by the National Quality Forum.”
“Physician executives and CMOs should be at the forefront and integrally involved with nonphysician leaders of most organizations that will excel in the future,” Massingale said.
Physician leaders will face increased staffing challenges, said attorney Jay Hardcastle, partner and chair of the Health Care Practice Group at Bradley, Arant, Boult, Cummings LLP.
“There may be a shortage of physicians in the coming