ACMCA
SESSION ABSTRACTS

To thrive in a capitated managed care environment, health systems must enroll more lives to increase revenue, yet they must also control costs to remain viable. This presentation will describe how a team of junior managers and frontline providers solved this conflict for their government-owned health system. The team used a simple, elegant combination of a basic continuous improvement model and the Theory of Constraints. Using these tools, the team:
• • Exposed a fundamental assumption that was limiting daily throughput;
  • Shifted resources to key processes, improving overall system performance;
  • Significantly increased primary care access with no increase in cost;
  • Devised a plan to increase capacity with a resource investment that has a two month payback period.

Exit Strategies: When Survival as an Independent is No Longer Possible
Friday, November 10, 2000 3:40 – 4:40 p.m.
Speaker: Michael D. Treacy, JD.

Financial and competitive pressures are making it increasingly difficult for some local health systems to operate in the black. Local health system leaders struggle with how to strengthen the system without selling out to an outside organization whose interests may not be the same as that of the local community. Large regional systems have their own financial and competitive pressures and they encounter suspicion and resistance from the local community. How can they gain trust and support? This presentation discusses a case history from two perspectives: how a local community health system worked with the community; how a large regional system successfully out maneuvered competitors to become a welcome ally for the local health system. The result – a partnership supported by the community, with no adverse political fallout.

New Directions for Change in Health Care Organizations
Friday, November 10, 2000 4:45 – 5:45 p.m.
Speaker: Leonard H. Friedman, PhD, MPH

Organizational and environmental change are constantly present in all health care settings and attempting to manage the change process is a fundamental part of every health care executives job description. A new method of classifying and categorizing change will be proposed that examines change along three dimensions. More than just a classification scheme, the model provides a number of recommendations on how to facilitate change that takes advantage of the unique capabilities inherent in every organization.

Quality Reduction Improvements and Cost Reduction Through Provider Profiling — Provider Profiling in High Preference Areas — An Example in Interventional Cardiology Services
Saturday November 11, 2000 8:00 – 9:00 a.m. (part 1)
                                           9:10 – 10:10 a.m. (part 2)
Speaker: Joseph C. DeLeon
              Maj. Barry W. Evans, PhD,USAF,MSC

High quality health care at a low cost is achievable in today’s technologically advanced marketplace. H. David Sherman of Northeastern University defines “high-value physicians” as those who provide high quality care at a low cost. Healthcare providers across the nation are on their toes attempting to get a firm grasp of cost reduction initiatives in order to survive the onslaught of revenue decreases of recent years. Careful measurement and analyses of cost and quality of physician services can lead to the development of a provider profiling tool that can position an organization to achieve sizeable decreases in the cost of health services, together with physicians.

• Several forms of physician profiling have beem employed in the past by managed care organizations and other healthcare delivery systems. The majority of them are limited solely to information pertaining to the cost of providing health services. This presentation will describe the essentials of a physician profiling methodology that integrates both cost and quality measurements to affect the entire provision of health services, and will present an example of a provider profiling system used to enhance quality and reduce direct cost per case by 20% in interventional cardiology.

Update on TRICARE Senior Prime — The Department of Defense Medicare HMO
Saturday, November 11, 2000 11:00 a.m. – 12:10 p.m.
Speaker: Michael K. Petty, MBA,FAAMA

TRICARE Senior Prime has been a resounding success – as seen in the eyes of the 30,000 plus enrollees. An extremely rich benefit, low co-pays and outstanding care make TRICARE Senior Prime one of the most sought after Medicare HMOs in the nation and on the top of all of the satisfaction lists. This presentation will present the most current information on the future of this program as well as results from local health status outcome studies.

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