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State of Medical Center 2018: VUMC ahead of key healthcare trends

by Feb. 20, 2018, 11:40 AM

Jeff Baler, MD, PhD, discusses VUMC’s response to emerging healthcare trends during last week’s State of the Medical Center Address. (photo by Anne Rayner)

Vanderbilt University Medical Center (VUMC) is out in front on the key trends in healthcare, said Jeff Balser, MD, PhD, President and CEO of VUMC and Dean of Vanderbilt University School of Medicine, when speaking last Wednesday at his annual State of the Medical Center Address, a presentation paired with the year’s first Leadership Assembly.

VUMC’s Strategic Directions are already aligned with fostering capability-driven change, having a consumer-focused brand, concentrating on social determinants of health and planning for smart, strategic growth — four key trends identified as the most important to future success for U.S. health systems at the 36th Annual J.P. Morgan Healthcare Conference, the world’s largest investor conference for the healthcare industry, he said.

“When I look at this list, these priorities play to our strengths,” Balser said.

The event fell on Valentine’s Day and during a period when VUMC is continuing to stabilize eStar, the new Epic-based clinical software platform in use throughout all hospitals and clinics. The presentation’s theme was, “Post EpicLeap: Where are We Headed?”

In light of the Valentine’s holiday, Balser commented, “I wouldn’t call this relationship a romance — yet,” as a slide titled “eStar Key Points of Pain” flashed onto a large screen.

Balser and C. Wright Pinson, MBA, MD, Deputy Chief Executive Officer and Chief Health System Officer for VUMC, both spoke about steps underway to further stabilize the new clinical platform that was launched on Nov. 2, 2017.

Work groups have been created to prioritize critical issues raised by users of the clinical system. Topping the list are “in-basket” issues impacting communications with patients that have been troublesome for clinicians, particularly in outpatient clinics, followed by work queues for scheduling, and then the issue of not all information porting over into the new system during the eStar transition.

“I want you to know that we are focused on this like a laser beam,” Balser said. “The Health IT team is so dedicated and completely focused on getting these issues resolved. We are not starting anything else new until these problems are resolved. They are absolutely top priority.”

Balser and Pinson each thanked the VUMC community for their patience and leadership during the clinical systems transition, a massive undertaking that typically takes most medical centers a year to fully stabilize. Pinson reminded employees of the importance of continuing to exude confidence during this process and, if necessary, to communicate frustrations to colleagues rather than to patients.

Referring to the four key trends identified at the J.P. Morgan conference, Balser detailed how VUMC’s Strategic Directions, mapped out in 2016, align with key trends followed by the most successful healthcare organizations. VUMC’s commitment to “design for patients and families” is about being a consumer-focused brand. Its quest to “discover, learn and share” parallels with capability-driving change. Its pledge to “make diversity and inclusion intentional” addresses the social determinants of health. And its actions to “amplify innovation” bolster smart, strategic growth.

One example of smart, strategic growth is the Vanderbilt Health Affiliated Network. Founded in 2012, the network is now a multi-state affiliation of like-minded health systems, hospitals and clinicians focused on regional collaborations that are improving patient care and advancing population health. The Network now includes 13 health systems, more than 60 hospitals and more than 5,000 clinicians.

“This year, we are going to have more than 300,000 covered lives in the network,” Balser said. “When I gave the State of the Medical Center address a little over a year ago, it was half that. We are working hard to grow to a million covered lives, and most importantly, to provide value to patients and employers through seamless clinical integration across the network.”

With demand for beds rising because of relationships within the network, and as a result of Nashville’s booming population, VUMC is adding 200 new beds by 2020 to the Adult Hospital and Monroe Carell Jr. Children’s Hospital at Vanderbilt.

Balser cited several examples of capability-driving change. Predictive analytics are being developed and used to improve patient safety, control length-of-stay, and make supply chain management more efficient.

My Health at Vanderbilt, the Medical Center’s patient web portal, and Vanderbilt Health OnCall, an app that allows patients to schedule clinician house calls, also are driving change. Balser expressed appreciation for everyone’s help to meet a request he made at the last Leadership Assembly to get more patients signed up on MyHealth.

“Getting more patients enrolled in My Health is key to scheduling return appointments online, and eliminating the need for paper forms in clinics. In a normal year, we will have 150,000 new people sign up for My Health,” he said. “In the last 10 weeks, we have had 100,000 people sign up, just extraordinary progress.”

VUMC is also launching wholly owned subsidiaries to provide unique services to the region, while diversifying its revenue stream. Vanderbilt Health Rx Solutions offers specialized pharmaceutical knowledge to clinical facilities across the country. Vanderbilt Health Supply Chain Solutions will soon offer expertise to other hospitals and health systems about purchasing, moving supplies and equipment to points of care in an efficient and cost-effective manner.

Social determinants of health are being addressed at VUMC in a variety of ways, Balser said. The Vanderbilt-Ingram Cancer Center is participating in a Medicare pilot program, the Oncology Care Model, which identifies the psychological needs of patients on the front end of the care pathway — “as a forethought and not as an afterthought.”

VUMC continues to confront the opioid epidemic in a variety of ways, ranging from using the VUMC QuizTime app to educate clinicians about the effectiveness of non-opioid pain medicines to improving the care pathways for mothers and babies afflicted with neonatal abstinence syndrome.

Addressing workplace satisfaction, Balser said initiatives are underway to identify ways to offload the volume of clerical work clinicians have to deal with for billing purposes, and to provide more childcare options, including extended hours of operation. Balser also made comments about the importance of diversity and inclusion to VUMC, and in particular spoke about the #MeToo movement. “This is not just an issue for the entertainment and media worlds — it is an issue in medical centers like ours.” Balser indicated that he is working with senior VUMC women to identify practical steps that the Medical Center can implement to reduce sexual harassment in the workplace, stating “this is our home — it must be safe and supportive for everyone.”

VUMC continues to build a consumer-focused brand by making care personal, Balser said. One challenge is that consumers think of VUMC as the place they want when facing life-threatening illnesses, but not necessarily for routine medical needs. A new marketing campaign focusing on “redefining personalized care” is designed to show consumers that VUMC is not only highly accessible, but is extraordinarily personable, warm and caring to patients and families.

There are already 53 locations where Vanderbilt Health’s services can be accessed in the greater Nashville area, with the Medical Center’s nurse practitioners and physicians now staffing a large number of after-hours and walk-in clinics in prime locations, school and employer-based clinics and since Nov. 14, new Vanderbilt Health at Walgreens Clinics. In the next few years, VUMC plans to increase that number to at least 90. In addition, the Medical Center will be opening a number of “big box” ambulatory care facilities that will support outpatient surgery, imaging and other kinds of specialty care for adults and children throughout the metropolitan area.

C. Wright Pinson, MBA, MD, gives the Pillar update during last week’s meeting. (photo by Anne Rayner)

“We identified locations in the fastest-growing areas of Middle Tennessee to construct six facilities that offer multiple services on a smaller scale than here on campus,” Pinson said.

In his quarterly Pillar update Pinson praised employees for the compassion and personal connections they make with patients.

“So much of what we do and why we are called to healthcare is about having the heart to serve others,” Pinson said. “At any given time, there are countless acts of compassion occurring throughout our health system.”

Pinson reminded employees that the triennial visit of the Joint Commission will likely occur in April or May. He stressed the new “see it, cite it” scoring matrix the Joint Commission is using will likely result in a higher number of citations. Employees can attend readiness forums to prepare for the visit, obtain copies of the Joint Commission Resource Handbook and watch for the “Survey Sparks” newsletter distributed through MyVUMC.

Pinson said that VUMC’s second quarter Pillar results are at threshold for nine of 19 Pillar Goals that can be measured now. The Medical Center’s service performance has been consistent with that of 26 of VUMC’s peer institutions during their Epic clinical systems implementation. “We need to focus on areas where we are not meeting our threshold, so that we can rebound and finish the year strong,” he said. He emphasized the need to focus on access and controlling length-of-stay for the remainder of the fiscal year.

“Based on fiscal year second quarter results, we are on track to meet all of our organizational goals for staff — retention, patient experience and academic performance,” he said.

VUMC’s commitment to the social determinants of health was underscored by a post-assembly workshop led by André Churchwell, MD, the Levi Watkins Jr., MD, Chair and the Medical Center’s Chief Diversity Officer. The workshop’s theme was making diversity and inclusion intentional.

“This workshop reflects the continuing importance of diversity and inclusion to the growth and development of the Medical Center,” said Churchwell.

“In the workshop we addressed the “why” for unconscious bias training; the issues around the care of underrepresented groups in the Medical Center; the roll out of our new gender clinic and a host of other issues and programs that make up our push for making diversity and inclusion intentional. The breadth of leaders who spoke this morning speaks to the team effort and partnerships that are required and central to continual success of our diversity and inclusion programs.”

To view Balser’s State of the Medical Center Address please go here: https://mediasite.vanderbilt.edu/Mediasite/Play/cdb4192d2fc14483a1828420dab4a9301d.

To view both Balser’s State of the Medical Center Address and the Leadership Assembly presentation, including Pinson’s Pillar update, please go here: https://mediasite.vanderbilt.edu/Mediasite/Play/a07c4d5253c2445fa88ecf0f9070341b1d.

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