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EMHS Vision 2012 - Summary of Progress

How we did it!

Accomplishing our Vision to be the Best Rural Healthcare System by 2012
Since 2007, employees across EMHS have been working to realize a shared vision to become the best rural healthcare system in America by (September 30) 2012. In our quest to be the best, the driving force was prescribed under our pillars of excellence: Quality, People, Finance, Growth, Service, and Community. It is now 2012 – so, how did we do?

How do We Measure “Becoming the Best”
There is no one industry accepted model for objectively assessing health system capabilities, with an ultimate purpose of proclaiming which health system is the best - especially in the context of best rural systems. The only organization that comes close to measuring the wide variety of metrics applicable to a complex, vertically integrated health delivery system is IMS. This company specializes in delivering perspectives and in-depth healthcare analytics. In January of 2012, IMS published its annual list of the top 100 IHNs (Integrated Health Networks) in the nation. For the first time ever, EMHS was included on the list at number 78. And while the list does not distinguish between urban and rural systems, we can say with confidence that EMHS is among the top ten rural health systems in America.
Message from M. Michelle Hood President and CEO, EMHS




A Pillar By Pillar Review of “Becoming the Best”

Click each pillar below to view a bulleted summary of how we accomplished becoming one of the best rural healthcare systems in America.

Quality

  Inpatient Care

Video with Erik Steele, DO discussing inpatient care



EMR (electronic medical records) – EMHS hard wired best practices within EMR, and placed EMHS in the top two to three percent of health systems in the nation.
Zero Defects – Between 2008 and 2011 there was a 35 percent decrease in our original zero defect measures.
Decreasing medication errors – Some kinds of overdoes have been avoided with the use of smart pumps. However, bar coding is expected to make strides in reducing medication errors (success measures to be reported late 2012). Bar Codes remove human memory as the sole barrier from medication administration, generating dramatic improvements in medical safety.
Formulary Committee – The creation of the formulary committee has led to many other medication process improvements by standardizing the drug formulary list across EMHS.
Decrease in VTE (Venous Thromboembolism) screening – A goal was established and hard wired into the EMR to screen every patient for VTE risk. Today, error rate is very low.
Best Practice Bundles – EMHS is now at almost 100 percent compliance with best practice bundles to avoid central line and ventilator associated pneumonia.
Hand Hygiene –Compliance has improved from 70 percent range to the 90 percent range, with at least one hospital averaging above 95 percent.
Culture of Safety –  AHRQ (Agency for Healthcare Research and Quality) survey results indicate that EMHS organizations have been successful in establishing a culture of safety.
Outpatient physician offices

Video of Mike Donahue discussing outpatient physician practices



Quality improvement success largely mirrors inpatient care. In addition, the following was noted.


100% wired! -  EMHS practices have become 100% percent wired with EMR, placing them in the top 20 percent of all systems nationwide.
A Beacon Among Beacons – The Physician Practice Affinity Group is establishing specific quality indicators, which should be in place spring of 2012. The Bangor Beacon Community pilot, when compared recently to the nationally recognized Geisinger system, was significantly better. New quality indicators for around the system will likely emulate Bangor Beacon’s successful design.
Fully certified – All EMHS primary care practices will be certified as Patient Centered Medical Homes by late spring 2012 and will be stretching that certification to level three by the fall of 2012.
Post-Acute Care

Video of Lisa Harvey-McPherson, RN discussing post-acute care



EMHS long term care, including all system nursing homes and assisted living settings, met for a system-wide quality summit in 2011 to evaluate quality outcomes and strategies to eliminate preventable harm for system goal alignment of zero defects and quality service delivery. We found:
Reduction in Pressure Ulcers – A 50 percent reduction in CMS Never Events Stage 3 and Stage 4 Facility Acquired Pressure Ulcers in 2011.
Deficiency free at Stillwater – Stillwater Health Care achieved a deficiency free Federal Quality Improvement Survey. Less than ten percent of the nation’s nursing homes have achieved this quality standard.
Improved patient safety and clinical care – Stillwater Health Care, Dexter Health Care, and Colonial Health Care fully implemented the patient electronic charting system and medication bar coding.
Reduction of medication incidents – Dirigo Pines Inn reduces medication incidents by 29 percent by conducting a gap analysis, developing staff education and engagement strategies, and enhancing medication administration delivery systems to reduce error.
The Northeast Integrated Geriatrics Care (NIGC) project – A Rosscare Nursing Homes Inc, EMMC, and The Acadia Hospital collaboration. Outcomes for nursing home participants includes no emergency department visits for behavioral reasons, as well as improvements in mood and behaviors scores.
Home Health

Video of Lisa Harvey-McPherson discussing home health
Video of Lisa Harvey-McPherson discussing home health



National Recognition – In 2011, Bangor Area Visiting Nurses and Visiting Nurses of Aroostook received national recognition by HomeCare Elite, which identifies agencies that score in the top 25 percent in the nation in quality care, process measure implementation, and financial performance.
Telehealth – Over the past year, Eastern Maine HomeCare (EMHC) has expanded Telehealth services to patients with chronic diseases who do not meet “homebound” criteria, resulting in decreased room visits and unnecessary re-hospitalizations within 30 days of discharge.
Improvement through Bangor Beacon Community– Through Beacon participation, EMHC has improved care coordination and communication in both primary care and homecare settings.
Other
Influenza Vaccine Compliance – EMHS has aggressive policies regarding influenza vaccine screening of employees, which means employees either get a flu shot or sign a declination form formally refusing the vaccine.
Top in Patient Safety – EMHS is the sole recipient of the VHA/Washington Business Group on Health Patient Safety Award in 2009
Leapfrog – SVH (in both 2010 and 2011) and Inland Hospital (in 2010) were recognized by Leapfrog for being high quality rural hospital, two of only a few in the nation.
EMMC and IT Excellence – EMMC won the Davies Award in 2008 for its use of information technology in driving quality and patient safety.
Top in the Nation – EMMC was recognized by JCAHO as being in the top ten percent of all hospitals surveyed.
Magnet Status – Acadia remains the only psychiatric hospital in the world recognized as a magnet hospital.
One of Only 17 Beacons – EMHS is one of only 17 organizations in the nation awarded a Beacon grant in 2010 to improve chronic disease management through information.
EMMC Centers of Excellence – EMMC has nationally recognized Centers of Excellence for stroke, bariatrics and hip/knee surgery, as well as being an ACS level II Trauma center.
Air Medical Program of the Year – Lifeflight of Maine was awarded Air Medical Program of the Year in 2010, the first such program to receive this distinction in its first ten years of existence.  

People

 Employee Health
Decreasing increases in health plan costs – Through a health plan redesign, fostering a culture of wellness, and employee education, EMHS has been able to break its long standing trend of 10 to 12 percent annual increases in health plan costs to both the organization and employees. With strategies in place, it is anticipated that the increase of health plan costs will maintain under a five percent increase during the foreseeable future.
Video of Peter Close discussing health plan costs



Fostering a culture of health – In the first year, health risk levels as measured by the health risk assessment have decreased by two percent. EMHS is also one of the first healthcare organizations to adopt the widely accepted Guiding Stars nutrition program. In addition, EMHS’ “In-System Rewards” health plan option is modeled after national best practice care coordination.
Video of Jaime Laliberte discussing fostering a culture of health



 Well Workplaces – Seven EMHS organizations are considered Well Workplaces, as determined by the Wellness Councils of America. Of these seven, two have achieved “platinum” status, the highest recognition.
Video of Jaime Laliberte discussing well workplaces



Employee Productivity

Video of Phil Johnson discussing employee productivity



Improving Scheduling Practices – A focus on usage of time through improved scheduling, limiting overlap schedules, and flexibility to allow for reductions in hours correlating to reductions in volume - have resulted in reduced overtime.
 Retaining Talent – Opportunities have been discovered to lower overhead (without losing talent) through redeployment and by incentives for early retirement at EMMC and TAMC.
Going LEAN – By introducing LEAN methodologies, EMHS has seen operational improvements, as well as a positive culture change. In the past two years, more than 200 LEAN projects have been completed or are underway.
 Employee Retention
Reducing turnover - EMHS organizations remain under the national benchmark for turnover. The EMHS home office and EMMC both have turnover rations close to our original goal set in 2007 (reduce turnover to 50 percent of the national benchmark).
Video of Phil Johnson discussing employee retention and engagement




Employee Engagement
Monitoring what matters to employees – EMHS has continued to improve its approach to measuring and improving engagement of its employees, including adopting an advanced survey tool offered by the Advisory Board. With the exception of The Acadia Hospital, employee participation rates in the survey were more than 70 percent, which exceed the national average.
Understand our Values – Organizations considered the best consistently demonstrate a strong commitment to its values. EMHS organizations continue to engage employees in its values in creative and lasting ways.
Best Places to Work –Employee scores on “Best Places to Work” surveys have raised both AHS and the EMHS home office to prominence. AHS achieved the distinction once on the state level and EMHS has achieved it five times at the state level and twice nationally.
Employee and Workforce Development

Video of Phil Johnson discussing employee and workforce development



Developing Future Leaders EMHS’ Leadership Academy continues to provide needed leadership skills to new and middle level leaders. In addition, increased development and sharing of local leadership training programs and materials is occurring systemwide.
Standardizing Core Competencies – Work is underway on standardizing core competencies across the system, as well as efforts to improve and formalize succession planning.
Discovering Careers in Healthcare – The promotion of healthcare careers has been enhanced with the expansion of healthcare careers exploration camps, such as Camp Survivor.

Finance

 Traditional Benchmarks
  • The EMHS Board approved a broad set of financial benchmarks several years ago with a goal of emulating a Standard & Poors A+ median rating – with steady improvement since 2006.
  • The EMHS Board also established a system Finance Committee that endorses a methodology for setting operating margin and capital investment targets. Direct connections have been made between this committee and consistent improvement in Days Cash on Hand.
Video of Derrick Hollings discussing traditional benchmarks



Supply Chain

EMHS has made significant progress in reducing cost through supply chain initiatives:

  • product and equipment standardization 
  • Adding hospitals to the collaborative creating the opportunity for increase discounts due to increase purchase volume on products, equipment, and services we purchase. 
  • Achieved savings goal in excess of 6 million dollars for the past three years as a system
  • Standardization across EMHS hospitals exceeds 80 percent for equipment, products and services
  • EMHS Supply Chain Network has been active in creating significant supply chain savings for seven non-corporate hospitals in our geographic area 

Video of George Pelissier discussing supply chain

 


Other Initiatives

  •  CEOs from across the system established the QVAC committee, which has the ability to work with other systems such as MaineHealth and MaineGeneral Health.
  • EMHS participated in the design of the Northeast Purchasing Coalition, a multi-state 120 hospital joint venture.  The NPC  is able to negotiate contracts for 120 hospitals  significantly lowering our cost increasing our savings.
Revenue Cycle
  • Significant progress has also been made in improving productivity, underpayment recovery, and asset management through revenue cycle initiatives. This work began with an extensive engagement with Stockamp consultants in 2006-2007 and progress has continued into 2012.

Growth

 Total Operating Revenue
  • EMHS has seen a 10.6 percent improvement in total operating revenue since 2006.Here are some successes worth noting: When AHS merged with Miller Drug, its APS product line was spun off into a joint venture; At the end of 2011, the joint venture’s total operating revenue was $46,023,871, which added into the consolidated AHS revenue results in a 39 percent increase for AHS since 2006; TAMC strategically eliminated unprofitable service lines, which improved the hospital’s net revenue. This plan contributed to TAMC’s successful FY 2011  - the best financial result in its history; Some members surpassed or came close to achieving a 50 percent increase in revenue - CA Dean at 35 percent, Inland Hospital at 66 percent, SVH at 47 percent.
Supply Chain Partners
  • An additional seven non- affiliated hospitals were added to the original seven EMHS hospitals that make up the internal EMHS purchasers. These 14 hospitals comprise the EMHS Supply Chain Network.
  • More recently, the creation of the Northeast Purchasing Coalition joint venture includes 28 health systems in New England representing$1.5 billion in medical surgical supply spend.
Accountable Care Partners

Video of Richard Freeman, MD discussing accountable care partnerships



  • The Bangor Beacon Community  collaborative, created in 2010 and developed through a $12.75 million grant from the federal Office of the National Coordinator for Health Information Technology, is one of 17 sites nationwide dedicated to advancing the adoption of electronic health records and expanding connections through health information exchange. This collaborative has been so successful that Bangor has become known as the “Beacon among Beacons” nationwide.
  • In 2011, EMHS was selected as one of 32 organizations across the nation to become a Pioneer Accountable Care Organization (ACO) through the Centers for Medicare and Medicaid Services. This five year demonstration project is intended to improve the coordination, efficiency, effectiveness, quality, and cost of healthcare.
  • In January 2012, EMHS partnered with Geisinger Health System to assist with our ACO initiatives. Geisinger was attracted to EMHS’ forward leaning culture.
Member Specific New Services
  • Since 2006, all EMHS members have experienced growth in the development of new services.
Grants/Philanthropy

Video of Michael Crowley discussing Philanthropy


  • Total grant awards in 2010 were $22 million due to the large federal award for the Bangor Beacon Community; philanthropy donations were nearly $10 million, in part due to the successful EMMC CancerCare of Maine capital campaign.

Service

 Patient Experience

Video of Erik Steele, DO discussing patient experience


  • CA Dean received recognition as a national top performer in the 0-99 bed Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) hospital category of “Nurses Always Communicated Well.”
  • The Acadia Hospital’s inpatient ratings from the National Research Institute (NRI) were higher than national averages for April to June 2011.
  • Lakewood Continuing Care Center, CA Dean Memorial Nursing Home, and Katahdin Health Care earned the “Excellence in Action” award from MY InnerView, which monitors overall customer and workforce satisfaction for nursing homes.
  • SVH, TAMC, and Inland Hospital were all recognized for “Exceeding Patient Expectations for 2010” by Avatar International.
  • EMMC is the only tertiary care center in Maine recognized as a preferred provider for providing consistent quality care for the past five years by the Maine State Employee Health Commission.
  • Home health patients from Eastern Maine HomeCare sites rated their overall satisfaction 87 percent higher than both national (85 percent) and state (86 percent) averages for the 12-month period ending July 2011.
 
Patient Access

Video of Erik Steele, DO discussing patient access


  • All EMHS medical/surgical hospitals have worked on expanding access by increasing the number of employed primary care providers at each of the hospitals, and Acadia Hospital established a primary care service for behavioral patients who have no other access available to them.
  • Remote access to specialty care has dramatically expanded since 2007, building on specialty services primarily at EMMC and Acadia.

Community

 Note: EMHS did not have a community pillar prior to 2006. The fact that EMHS has a community pillar is progress in itself!
Community Health Needs Assessment (CHNA)

Video of Jerry Whalen discussing Community Health Needs Assessment



Community Benefits
  • In 2006, EMHS began to develop a more proactive strategy to more accurately reflect the benefit we provide to our community, such as charity care, professional education, community education, free clinics and screenings, and other health-related areas.
  • In 2007, a core community benefits work group, consisting of all EMHS’ nonprofit members, came together to create and test best practices in community benefit reporting. These tools have since been shared with other healthcare entities across the nation as models of community benefit best practice.
  • EMHS shares its community benefit activities in an electronic quarterly report. The “Community Matters” stories highlight each organization’s community benefit activity and focuses on the positive affects it has had in the community.
Bangor Beacon Collaborative
  • The Bangor Beacon Community collaborative, created in 2010 and developed through a $12.75 million grant from the federal Office of the National Coordinator (ONC) for Health Information Technology, is one of 17 sites nationwide dedicated to advancing the adoption of electronic health records and expanding connections through a health information exchange.
  • The Bangor Beacon project has connected 12 different entities to demonstrate the effectiveness of managing chronic disease by using electronic technology as its foundation. The collaborative became the first in the nation to report data back to the ONC (the data demonstrated very positive improvements).
  • Bangor Beacon’s success has made it the cornerstone for improvements in the EMHS employee benefit plan and the new Pioneer ACO initiative, Beacon Health LLC.
Video of Jerry Whalen discussing Bangor Beacon and Pioneer ACO



Pioneer/Beacon Health
  • Work with community collaborators, such as through Bangor Beacon, has set the stage for our emerging role in the Beacon Health LLC accountable care organization. While this is brand new in 2012, the fact is that EMHS was one of only 32 entities selected by CMS to lead the nation in this transformational experience. EMHS will use its experience with patient centered medical homes, chronic disease registries and community based care management to reduce hospitalization and increase the opportunities for individuals to live optimal lifestyles in their communities. As this movement away from hospitalizations occurs, other community based resources will likely be deployed to support EMHS’ mission.

Vision 2020: The Future of Healthcare

Although we have made great strides in transforming how we deliver healthcare, there is still much more work to be done. Today, the healthcare landscape is very different from just a few years ago. A variety of factors, such as unsustainable costs, advancements in science and technology, and a rapidly aging population are driving a change in how healthcare is being delivered. In 2020, we envision a healthcare delivery model that is more effective, efficient, and providers are demonstrating a higher value of care rather than increasing the number of patients they see. Please visit our webpage dedicated to our 2020 vision. Also, be sure to visit our page on EMHS and the Future of Care for more information on how EMHS is leading change so that the people of Maine can live their life to the fullest.

About IMS

IMS uses information from federal, state, and surveyed sources, and includes a breadth of performance measures such as continuum of care and integration of technology. Thomson-Reuters also release a Top 10 Health System Report and Top 100 Hospital Report. However, Thomson-Reuters limit its assessment to public hospital data only, and when EMHS reviewed the results it was found that critical access hospitals were excluded from some of the measures.

About EMHS

EMHS is committed to helping the residents of the communities we serve have access to quality healthcare. By sharing resources and working together with all of our members, EMHS helps ensure that our aligned health providers have access to new technologies and the best medical protocols available, and the support they need to survive. This is why we say, together we’re stronger! A nationally recognized integrated healthcare system, EMHS serves communities from Greenville to Blue Hill and Waterville to Presque Isle. EMHS members include The Acadia Hospital, Affiliated Healthcare Systems, The Aroostook Medical Center, Blue Hill Memorial Hospital, Charles A Dean Memorial Hospital, Eastern Maine HomeCare, Eastern Maine Medical Center, EMHS Foundation, Inland Hospital, Rosscare, and Sebasticook Valley Health.